Neurological Conditions and Pelvic Floor Health – An Often-Overlooked Connection

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Neurological conditions such as Parkinson’s disease and Cerebral Palsy can disrupt the brain-muscle signaling that controls the pelvic floor. Because pelvic floor muscles rely on precise nerve input, impaired motor control in these conditions often results in weakened or poorly coordinated pelvic floor activity.

What is Parkinson’s Disease?

Parkinson’s disease (PD) is a progressive neurological condition that affects movement and muscle control and coordination. Parkinson’s occurs when there is reduction in dopamine generation in the brain leading to decreased coordination of smooth, controlled movements. This decrease in dopamine can lead to common motor symptoms such as:

• abnormal walking patterns,
• balance deficits,
• difficulty initiating movement or slow muscle activation,
• muscle rigidity,
• poor posture – forward flexed posture decreases core stability and pressure management in the abdomen,
• slow movements (Bradykinesia),
• tremors.

When people think of PD they think of these symptoms, While they are the most common presentation, PD can affect the pelvic floor. Research has found that pelvic floor dysfunction in women with PD is underreported and untreated, despite the fact that it often limits daily activities. The good news is pelvic floor therapy can aid in managing these challenges and improving overall quality of life.

Common PD pelvic floor dysfunction symptoms are:

• constipation- the most common digestive symptom in Parkinson’s due to slow movement in digestive tract, decreased ability to relax pelvic floor muscles, and poor pelvic floor muscle coordination,
• erectile dysfunction,
• over-active pelvic floor muscles,
• urinary urgency and frequency,
• incontinence – urge, stress, and functional.

Let’s Look at Cerebral Palsy

Cerebral Palsy (CP) is a group of non-progressive neurological conditions that can affect coordination, muscle tone and overall body movement. CP occurs when a developing brain experiences injury or abnormal development. This leads to a wide range of physical challenges depending on the area of the brain that is affected.

Cerebral palsy primarily affects movement and muscle control. Symptoms include:

• abnormal movement patterns or posture,
• muscle weakness,
• poor coordination,
• poor balance,
• spasticity/ muscle stiffness.

The most common symptom of CP is spasticity/muscle tightness, which can make it really difficult for muscles to relax when needed. Pelvic floor muscles affected by spasticity remain tight which can lead to bowel and bladder symptoms such as:

• bowel straining,
• constipation,
• difficulty emptying the bladder,
• urinary incontinence- stress, urge,
• urinary urgency/ frequency,
• pain during intercourse,
• pelvic floor pain/ discomfort.

Poor postural alignment can lead to abnormal pelvic alignment, asymmetrical sitting posture, tailbone pain, and poor abdominal expansion.

How Pelvic Floor Therapy Can Help

Pelvic floor therapy can help in managing these symptoms. With a comprehensive evaluation of the pelvic floor muscles, abdominal breathing patterns and movement strategies, our therapist will create an individualized treatment plan to include:

• bladder/ bowel retraining strategies,
• core and hip strengthening,
• functional movement strategies,
• pelvic floor coordination training,
• postural exercises.

Research shows that regular movement and exercise are beneficial for managing Parkinson’s symptoms. An individualized home exercise program created by your physical therapist can aid in improved muscle flexibility, balance, mood/ energy levels and overall functional mobility. Specifically, pelvic floor therapy can provide:

• breathing and relaxation strategies,
• bowel and bladder habit education,
• gentle stretching and mobility instruction,
• pelvic floor muscle coordination training,
• postural exercises.

Your individualized plan can result in:

• decreased pelvic floor muscle tension,
• decreased urinary frequency/ urgency,
• improved bladder control,
• improved bowel frequency,
• improved coordination of pelvic floor and abdominal muscles.