Patients undergoing rehabilitation for neurologic conditions often experience multiple comorbidities that significantly impact their overall quality of life. While considerable emphasis is placed on physical rehabilitation, bowel and bladder dysfunction frequently remains underrecognized despite its potential to impede recovery and functional outcomes. Notably, many physiotherapists practicing in neurologic settings report discomfort with screening for bowel and bladder dysfunction. Conversely, pelvic health physiotherapists often feel inadequately prepared to manage patients with neurologic disorders, as their training is typically oriented toward orthopedic-related pelvic health conditions. Consequently, despite the clear benefits of pelvic health physiotherapy for individuals with neurologic impairments, a substantial gap in care persists.

To address this gap, a neurologic pelvic health physiotherapy program and residency were developed within a large hospital system in Columbus, Ohio, United States. As part of this initiative, neurologic physiotherapists received targeted training to screen for pelvic health disorders, resulting in improved screening for bowel and bladder dysfunction. In addition, a pelvic health physiotherapist with expertise in neurologic care established both educational and treatment pathways for patients who screened positive.

This study involved a retrospective review of screening practices, referral patterns, and diagnostic outcomes across multiple neurologic rehabilitation facilities within a large hospital-based outpatient system. The study outlines the development and implementation of a screening tool tailored to patients receiving neurologic care, including its iterative refinement over time. Additionally, the analysis examines the rate of successful implementation, the most common conditions prompting referral to pelvic health physiotherapy, and the distribution of patients requiring comprehensive physiotherapy intervention versus those benefiting from education and referral alone.

Screening: The pelvic health physiotherapy screening tool underwent multiple iterations over the five-year review period. The final version of the tool is presented alongside a rationale for each item and corresponding response patterns.

Diagnoses: The highest referral rates were observed among patients with multiple sclerosis, with common symptoms including urinary incontinence, urinary urgency, and constipation. The second-highest referral rates occurred in patients with spinal cord injury, many of whom lacked appropriate education regarding the need for ongoing urologic care following discharge from inpatient rehabilitation. Physiotherapy interventions facilitated appropriate referrals for urologic care, access to catheter-related resources, and the development of comprehensive bowel management programs. 

Type of Appointments: Not all patients with positive screening results required comprehensive physiotherapy intervention; some benefited from targeted education alone, which contributed to improvements in both quality of life and neurologic rehabilitation outcomes.

This retrospective review demonstrates the successful implementation of a neurologic pelvic health physiotherapy program within a large hospital system. The program was positively received by both patients and clinicians. Neurologic physiotherapists reported increased confidence in screening for bowel and bladder dysfunction, while patients expressed greater comfort in reporting these concerns and accessing appropriate referral pathways. The model proved effective and demonstrates strong potential for replication across diverse healthcare systems.

Bowel and bladder dysfunction is highly prevalent among patients with neurologic conditions but is frequently underreported and undertreated. Patients may be uncertain about whether to discuss these concerns with their neurologist or primary care provider, contributing to gaps in care. The development of a neurologic pelvic health physiotherapy program provides a structured approach to addressing neurogenic bowel and bladder dysfunction, leading to improved patient satisfaction, enhanced quality of life, and better overall 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.