Abstract
Pelvic floor dysfunction is a prevalent multifactorial condition that significantly impairs quality of life. Traditionally managed from a compartmentalized perspective, recent evidence highlights the connection between the pelvic floor and the gut-brain axis. This review analyzes the pathophysiological association between both and proposes an integrated diagnostic and therapeutic approach involving gynecology, gastroenterology, and general surgery. A narrative review of the literature was conducted. Bidirectional communication between the central nervous system, enteric nervous system, and gut microbiota influences pelvic tone, visceral sensitivity, and symptom perception. Chronic constipation, intestinal dysbiosis, and psychological stress can exacerbate or trigger pelvic floor dysfunction, which in turn alters bowel habits and contributes to anxiety and depression. An interdisciplinary model enables comprehensive management including dietary interventions, pelvic floor physical therapy, psychological support, and coordinated surgery, thereby improving diagnostic accuracy and expanding therapeutic options.
References
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[2] R. Cobo, M. Rodríguez, and J. Ortiz, "Prevalencia y factores de riesgo asociados a incontinencia urinaria en mujeres ecuatorianas," Revista Ecuatoriana de Ginecología y Obstetricia, vol. 25, no. 2, pp. 45–52, 2019.
[3] G. W. Cundiff, A. C. Weidner, A. G. Visco, R. C. Bump, and W. A. Addison, "An anatomic and functional assessment of the discrete defect rectocele repair," American Journal of Obstetrics and Gynecology, vol. 179, no. 6 Pt 1, pp. 1451–1457, 1998. doi: 10.1016/s0002-9378(98)70017-1.
[4] J. F. Cryan, K. J. O'Riordan, C. S. M. Cowan, K. V. Sandhu, T. F. S. Bastiaanssen, M. Boehme, M. G. Codagnone, S. Cussotto, C. Fulling, A. V. Golubeva, K. E. Guzzetta, M. Jaggar, C. M. Long-Smith, J. M. Lyte, J. A. Martin, A. Molinero-Perez, G. Moloney, E. Morelli, E. Morillas, and T. G. Dinan, "The microbiota-gut-brain axis," Physiological Reviews, vol. 99, no. 4, pp. 1877–2013, 2019. doi: 10.1152/physrev.00018.2018.
[5] S. S. C. Rao and T. Patcharatrakul, “Diagnosis and treatment of dyssynergic defecation,” Journal of Neurogastroenterology and Motility, vol. 22, no. 3, pp. 423–435, Jul. 2016, doi: 10.5056/jnm16060.
[6] J. F. Cryan and T. G. Dinan, "Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour," Nature Reviews Neuroscience, vol. 13, no. 10, pp. 701–712, 2012. doi: 10.1038/nrn3346.
[7] E. A. Mayer, K. Tillisch, and A. Gupta, "Gut/brain axis and the microbiota," Journal of Clinical Investigation, vol. 125, no. 3, pp. 926–938, 2015. doi: 10.1172/JCI76304.
[8] S. R. Till, H. A. Wahl, and S. As-Sanie, "The relationship between pelvic floor disorders and irritable bowel syndrome: A systematic review," International Urogynecology Journal, vol. 30, no. 7, pp. 1079–1088, 2019. doi: 10.1007/s00192-018-3836-7.
[9] C. Leue, J. Kruimel, D. Vrijens, A. Masclee, J. van Os, and G. van Koeveringe, "Functional urological disorders: A sensitized defence response in the bladder-gut-brain axis," Nat. Rev. Urol., vol. 14, no. 3, pp. 153–163, Mar. 2017. doi: 10.1038/nrurol.2016.227.
[10] Z. A. Khan, C. Whittal, S. Mansol, L. Osborne, P. Reed, and S. Emery, "Effect of depression and anxiety on the success of pelvic floor muscle training," J. Obstet. Gynaecol., vol. 33, no. 7, pp. 710–714, Oct. 2013. doi: 10.3109/01443615.2013.810198. [
11] A. E. Bharucha, P. F. Pemberton, and G. E. Locke III, "American Gastroenterological Association technical review on constipation," Gastroenterology, vol. 144, no. 1, pp. 218–238, Jan. 2013. doi: 10.1053/j.gastro.2012.10.028.
[12] C. Li, Y. Gong, and B. Wang, "The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis," Int. Urogynecol. J., vol. 27, no. 7, pp. 981–992, Jul. 2016. doi: 10.1007/s00192-015-2846-y.
[13] B. J. Shea, B. C. Reeves, G. Wells, M. Thuku, C. Hamel, J. Moran, D. Moher, P. Tugwell, V. Welch, E. Kristjansson, and D. A. Henry, "AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both," BMJ, vol. 358, p. j4008, Sep. 2017. doi: 10.1136/bmj.j4008.
[14] F. F. Fitz, M. A. T. Bortolini, G. M. V. Pereira, G. R. F. Salerno, and R. A. Castro, "Lifestyle and comorbidities as risk factors for pelvic organ prolapse—A systematic review and meta-analysis," Int. Urogynecol. J., vol. 34, no. 9, pp. 2007–2032, Sep. 2023. doi: 10.1007/s00192-023-05569-3.
[15] AGREE Next Steps Consortium, "The AGREE II instrument," 2017. [Online]. Available: https://www.agreetrust.org.
[16] M. J. Page, J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, L. Shamseer, J. M. Tetzlaff, E. A. Akl, S. E. Brennan, R. Chou, J. Glanville, J. M. Grimshaw, A. Hróbjartsson, M. M. Lalu, T. Li, E. W. Loder, E. Mayo-Wilson, S. McDonald, and D. Moher, "The PRISMA 2020 statement: An updated guideline for reporting systematic reviews," BMJ, vol. 372, p. n71, Mar. 2021. doi: 10.1136/bmj.n71.
[17] M. V. Nishtala, U. J. Patel, J. Sous, C. Heisler, and R. King, "Development of a Pelvic Floor Disorders Multidisciplinary Curriculum for Urogynecology and Reconstructive Pelvic Surgery and Colon and Rectal Surgery Fellows," J. Surg. Educ., vol. 82, no. 9, p. 103597, Sep. 2025. doi: 10.1016/j.jsurg.2025.103597.
[18] D. Kapoor, A. Sultan, R. Thakar, M. Abulafi, R. Swift, and W. Ness, "Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic," Colorectal Dis., vol. 10, no. 2, pp. 118–123, Feb. 2008. doi: 10.1111/j.1463-1318.2007.01264.x.
[19] C. M. Panman, M. Wiegersma, B. J. Kollen, M. Y. Berger, Y. Lisman-Van Leeuwen, K. Vermeulen, and J. H. Dekker, "Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care," BJOG, vol. 124, no. 3, pp. 511–520, Feb. 2017. doi: 10.1111/1471-0528.13992.
[20] B. N. Green, C. D. Johnson, and A. Adams, "Writing narrative literature reviews for peer-reviewed journals: Secrets of the trade," J. Chiropr. Med., vol. 5, no. 3, pp. 101–117, Sep. 2006. doi: 10.1016/S0899-3467(07)60142-6.
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