Patients undergoing rehabilitation for neurologic issues have multiple disease processes impacting their quality of life. While attention is focused on their physical rehabilitation, bowel and bladder problems can hinder progress. Most physiotherapists in the neurologic setting do not feel comfortable screening for bowel and bladder issues. Concurrently, most pelvic health physiotherapists do not feel equipped to treat those with neurologic disorders because they are typically only trained to treat those with orthopedic-based pelvic health issues. While patients with neurologic disorders would benefit from pelvic health physiotherapy, this has become a large gap in care. A neurologic pelvic health physiotherapy program and residency were started at a large hospital system in Columbus, Ohio in the United States. Training was put in place for the neurologic physiotherapists to screen for pelvic health disorders, and over 50% of patients were screened for various bowel and bladder issues. A pelvic health physiotherapist with a background in neurologic care was able to create both an educational and treatment pathway for these patients if they had a positive bowel and bladder screen. Patients were able to receive both education on healthy bowel and bladder habits and pelvic exercise, and had more proactive referrals to urology, gynecology, and gastroenterology. This program increased quality of life and patient satisfaction and resulted in a 3-fold increase in early referral to urology.

This was a retrospective review of screening methods, referrals, and diagnoses that occurred in several neurologic rehabilitation facilities at a large hospital-based outpatient system. The study outlined the process of creating an appropriate screening tool for patients undergoing neurologic care, and the success rate with implimentation. The researcher also looked at rates of referral for full physiotherapy treatment versus bowel and bladder education and referral to a physician.

Screening - The pelvic floor physiotherapy screening tool has undergone several iterations throughout this five-year retrospective review. A final screening tool will be presented along with a rationale for each of the questions and the number of positive responses that are generally given to each question. 
Diagnoses - The highest number of referrals were seen for patients diagnosed with multiple sclerosis. Common complaints included urinary incontinence, urinary urgency, and constipation. The second highest number of referrals was seen for those with spinal cord injury. These patients were not provided with appropriate education on the need for urologic care following discharge from inpatient rehabilitation. Physiotherapy was able to procure patient referrals for urologic care, connections for catheter providers, and a comprehensive bowel program. A treatment pathway for this population will be provided in the abstract for physiotherapy providers to follow. Patients undergoing care for CVA, Parkinson's disease, and polyneuropathy will also be discussed. 
Type of Appointments - Not all patients who had positive screens required full physiotherapy treatment plans. Approximately 50% only required education to improve both quality of life and neurologic physiotherapy outcomes.

This was a retrospective review of the implementation of a neurologic pelvic health physiotherapy program in a large hospital system. The program was met with positive reviews from both patients and practitioners alike. Neurologic physiotherapists felt more confident in screening for bowel and bladder issues in their clients, and patients felt like they had an avenue for treatment of these issues.

Patients undergoing treatment for neurologic dysfunction often have bowel and bladder issues. These issues often go unreported because patients are unsure if they should report them to their neurologist or primary care physician. By creating a pelvic health physiotherapy program that is centered around neurogenic bowel and bladder, patient satisfaction and quality of life can be increased as well as neurologic rehabilitation outcomes.

Ginsberg DA, Boone TB, Cameron AP et al: The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. J Urol 2021; 206: 1097.