The diagnosis of dysautonomia is on the rise, with patients experiencing a variety of symptoms. In females diagnosed with dysautonomia, the most common complaints are overactive bladder and pelvic pain. Patients with dysautonomia are generally referred to neurologic rehabilitation for treatment of physical disability, but there can be a disconnect with screening appropriately for bowel and bladder dysfunction in this setting and population. This case series was a retrospective review of three patients referred to outpatient physical and occupational therapy for dysautonomia diagnoses. Each of the patients was screened for bowel and bladder dysfunction and subsequently referred to a pelvic floor physical therapist with special training in neurologic dysfunction. The case series will review common pelvic floor dysfunction observed in this patient population as well as standard treatment techniques used in conjunction with traditional neurologic rehabilitation.

This was a retrospective case series. Patients were seen over a three-year period at an outpatient rehabilitation facility connected to a large hospital. Cases were reviewed after patients had finished both neurologic and pelvic floor physiotherapy treatment.

Patients were most often referred for urinary urgency concerns and pelvic pain. All three patients had a history of trauma that further complicated their pelvic floor disorders. It was not uncommon for patients to have other chronic diseases, such as POTS and hypermobile Ehlers-Danlos syndrome. All patients were undergoing neurologic physiotherapy and occupational therapy. None had been previously referred to urology, but some were seeing gynecology for their pelvic pain symptoms. Common treatment techniques employed included internal manual therapy, generalized down training, modalities, and vagal nerve techniques. Patients were seen for an average of 10-15 visits for pelvic floor physiotherapy and were also referred to urology. While outcomes were not full relief of symptoms, it was more common for bladder symptoms to improve than pelvic pain.

This population of patients should be screened for pelvic floor disorders, including bowel, bladder, and sexual function. While this is a chronic condition, patients can be given coping strategies for improving symptoms and quality of life if they are seen by pelvic floor physiotherapy. Preventative strategies and education are also important for this population to improve health literacy and decrease time to treatment. Expectations must be discussed that these pelvic floor disorders may be chronic and treatment isn't always curative.

Screening for pelvic floor disorders in this population may also decrease the time to referral to urology and allow for a reduction in bladder symptoms in patients with dysautonomia. Decreasing pelvic floor symptoms may also help patients to concentrate on their other issues stemming from dysautonomia.

Aubin, M. S., Shridharani, A., Barboi, A. C., Guralnick, M. L., Jaradeh, S. S., Prieto, T. E., & O'Connor, R. C. (2015). Lower urinary tract dysfunction in patients with dysautonomia. Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 25(6), 407–410. https://doi.org/10.1007/s10286-015-0320-z