Urologic Manifestations of Nonrelaxing Pelvic Floor Dysfunction: Insights on Clinical Workup and Management.

Abstract

Purpose of review: Non-relaxing pelvic floor dysfunction (NR-PFD) is a poorly understood and underdiagnosed cause of voiding dysfunction in patients without clear anatomic or neurologic obstruction. Symptoms may include pelvic pain, urinary complaints, defecatory dysfunction, and sexual issues, but their variability makes NR-PFD challenging to recognize and manage. This review focuses on the urologic manifestations of NR-PFD and outlines current diagnostic and treatment strategies.

Recent findings: Video urodynamics and surface EMG, alongside focused physical examination, are key tools for diagnosing NR-PFD. Pelvic floor physical therapy remains the first-line treatment, with strong evidence supporting its efficacy across sexes. Adjunctive options, including biofeedback, trigger point injections, botulinum toxin, and sacral neuromodulation, can benefit patients with refractory symptoms. Cognitive behavioral therapy and integrative modalities are also increasingly utilized. NR-PFD is an underrecognized cause of functional bladder outlet obstruction and complex LUTS. Management should be individualized and multidisciplinary. Future studies are needed to standardize diagnostic criteria and refine treatment algorithms.