A Case Series on the Utilization of Pelvic Floor Physical Therapy (PFPT) in Two Women with Functional Neurological Disorder (FND) and Pelvic Floor Dysfunction (PFD)

Case Diagnosis: Two women, ages 45 and 66, with Functional Neurological Disorder (FND) presenting separately to physical therapy (PT) with pelvic floor dysfunction (PFD).

Case Description or Program Description: Both patients experienced traditional FND symptoms (gait changes, limb weakness, tremors, and jerking) that was improved with typical FND-focused care (multidisciplinary PT and occupational therapy, cognitive behavioral therapy, etc.). However, both women were also survivors of sexual assault and endorsed PFD symptoms of dyspareunia, low libido, anorgasmia, urinary incontinence, and strain with bowel movements. Therefore, they additionally completed 12-weekly sessions of pelvic floor PT (PFPT) to complement their FND care.

Setting: Academic Medical Center

Assessment/Results: PFPT goals for both women focused on diaphragmatic breathing, voluntary relaxation/contraction of pelvic floor muscles, reduction of resting tone, normalization of bowel and bladder habits, improvement of orgasmic ability, and completion of a home exercise program.

Per their physical therapists, both patients achieved or progressed towards all their PFPT goals by 12 weeks. Notable positive PFPT outcomes included relaxation of pelvic floor muscles, reduction in pelvic tone, and progression towards bladder function and sexual goals.

Additionally, PFPT was well tolerated alongside typical FND focused care, with overall good FND outcomes and FND stability. Both women experienced overall improved FND and PFD symptoms with this joint rehabilitation model.

Discussion (relevance): This is the first case series, to our knowledge, that highlights the tolerability and utility of PFPT in women with FND alongside traditional FND rehabilitation interventions. Given PFD is regarded along the functional symptom spectrum (brain-body muscle coordination dysfunction), holistic targeting may have synergistic effects with traditional FND rehabilitation models.

Conclusions: PFD and PFPT should be considered in patients with FND given higher prevalence of both PFD and FND in women with a history of sexual abuse. Early recognition and treatment of PFD in patients with FND is well tolerated and may improve function and quality of life.