Post-polio syndrome (PPS) is a progressive neuromuscular disorder that manifests decades
after the initial poliomyelitis infection, characterized by muscle weakness, fatigue, and
autonomic dysfunction. Although the musculoskeletal sequelae of PPS are well-documented,
its impact on pelvic floor dysfunction, including neurogenic bladder and bowel disorders,
remains underrecognized [1]. These impairments can significantly affect quality of life, yet they
are often underdiagnosed and mismanaged. We present a complex case of post-polio
syndrome in a 53-year-old woman with overflow urinary incontinence, stress urinary
incontinence, severe pelvic organ prolapse, and fecal incontinence, necessitating a
multidisciplinary diagnostic and therapeutic approach.

A 53-year-old woman with a history of childhood poliomyelitis, complicated by left foot drop
and severe lower limb muscle weakness.She exhibited a limping gait and had undergone left
foot and ankle surgery in childhood. She presented with progressive lower urinary tract
symptoms (LUTS) and bowel dysfunction over the past year. She reported predominantly
overflow urinary incontinence with intermittent stress incontinence, characterized by large-
volume leakage episodes occurring twice weekly, necessitating frequent panty liner use.
Additional urinary symptoms included voiding dysfunction with an interrupted stream,
prolonged micturition, and post-void fullness, though she denied hematuria, recurrent urinary
tract infections, polyuria, nocturia, or nocturnal enuresis. Her bowel dysfunction included
chronic constipation with associated fecal and flatus incontinence, with bowel movements
occurring 1–2 times per week, improved by laxatives and dietary fiber supplementation. She
also described symptomatic pelvic organ prolapse, with worsening vaginal pressure upon
prolonged standing.

Pelvic examination revealed grade 1 cystocele, grade 4 rectocele, enterocele, hypermobile
urethra, and a deficient perineum. Pelvic floor muscle tone was markedly reduced (Oxford
scale 1–2), and digital rectal examination revealed weak anterior anal sphincter tone. Urine
culture was negative for infection, and pelvic and renal ultrasounds showed no abnormalities.
Colonoscopy revealed a moderately tortuous colon but was otherwise normal. Anorectal
manometry demonstrated significant anorectal dysfunction, including low anal resting pressure
(52 mmHg), reduced squeeze pressure (96 mmHg), weak cough reflex, and impaired simulated
defecation due to inadequate propulsive force. Rectal hypersensitivity was evident, with
reduced sensory thresholds for first sensation (60 mL) and urge to defecate (100 mL),
indicating impaired rectoanal coordination and external anal sphincter weakness .
Given the complexity of her condition, a multidisciplinary management plan was implemented.
Conservative measures included pelvic floor rehabilitation with biofeedback therapy,
neuromuscular re-education, and a structured bladder and bowel management program
comprising timed voiding, dietary modifications, fiber supplementation, and osmotic laxatives.
Due to the severity of her symptoms, surgical intervention was planned, including tension-free
vaginal tape obturator (TVTO) placement for stress urinary incontinence, anterior and posterior
vaginal repair for cystocele and rectocele, and sphincteroplasty for anal incontinence, along
with cystoscopy. She was scheduled for urodynamic before surgery.

Bladder dysfunction is common among polio survivors, with studies reporting that 87.5%
experience at least one bladder symptom within two weeks, and 76.5% find these symptoms
bothersome. Incontinence is significantly more prevalent among women (73.3%) than men
(40.9%), highlighting the need for targeted rehabilitation programs [2]. Additionally, a case
report described a 69-year-old woman with PPS who developed cauda equina syndrome after
neuraxial anesthesia, emphasizing the potential for severe neurological complications in these
patients [3].

This case highlights the underappreciated intersection between neuromuscular disorders and
pelvic floor dysfunction in post-polio syndrome. The presence of neurogenic bladder and bowel
dysfunction, compounded by severe pelvic organ prolapse, necessitates early recognition and
a comprehensive, interdisciplinary management strategy. Given the progressive nature of PPS,
timely intervention integrating conservative modalities with surgical reconstruction is essential
to optimize function and enhance quality of life. Further research is needed to develop
standardized guidelines for managing neurogenic pelvic floor dysfunction in PPS patients.

Halstead LS. Post-polio syndrome and neuromuscular function. Journal of Rehabilitation Research and Development. 1995;32(3):317-323.
2. Vercelli R, Bosia L, Zuffardi A, et al. Bladder dysfunction in post-polio syndrome. Acta Neurologica Belgica. 2014;114(3):161-165.
3. Jha A, Thacker D, Mukherjee A, et al. Cauda equina syndrome in post-polio syndrome: A case report. Spinal Cord. 2017;55(4):335-337