A faculty spotlight on Erica Vitek and her upcoming remote course at Herman & Wallace.

Pelvic rehab and neurorehab have traditionally lived in separate clinical silos. Pelvic clinicians manage incontinence, prolapse, and pelvic pain from a primarily musculoskeletal frame. Neuro clinicians work on gait, ADL, and cognition. The patient sitting across from you with multiple sclerosis, spinal cord injury, or Parkinson disease lives at the intersection, and their pelvic floor symptoms are often the ones quietly eroding their quality of life.

Erica Vitek, MOT, OTR, BCB-PMD, PRPC, has spent her career at that intersection. Her two-day remote course at Herman & Wallace, Neurologic Conditions and Pelvic Floor Rehabilitation, returns on June 27 and 28, 2026, and it is the rare course that gives pelvic rehab clinicians a neuroanatomy-forward framework for these patients.

How common is pelvic floor dysfunction in neurologic disease?

Far more common than referral patterns would suggest. In the North American Research Committee on Multiple Sclerosis (NARCOMS) survey of 9,397 patients, moderate-to-severe pelvic floor symptoms were reported by roughly one in three respondents, including 41% with bladder symptoms, 30% with bowel symptoms, and 42% with sexual dysfunction (Browne et al., 2015). Lower urinary tract symptoms in Parkinson disease run between 27 and 80% across studies, driven by dopaminergic degeneration in pathways that govern autonomic and pelvic floor function (Cheng et al., 2023). Spinal cord injury reliably produces neurogenic bladder and bowel patterns that depend on the level and completeness of the lesion.

The clinical gap is wider than the prevalence gap. Most patients with these conditions have never been offered pelvic rehabilitation, and many of the clinicians treating their gait and balance issues have never been trained to evaluate the pelvic floor in a neurologic context.

One in three people with MS reports moderate-to-severe pelvic floor symptoms. Most have never been offered pelvic rehabilitation.

What changes in the nervous system affect the pelvic floor?

The pelvic floor is governed by an unusually long and vulnerable neural chain that runs from cortical micturition centers down through the pontine micturition center, spinal cord, sacral plexus, and pudendal and pelvic nerves. Damage anywhere along that chain produces a different clinical picture. Cortical and subcortical lesions, demyelinating disease, and dopaminergic degeneration each disrupt different aspects of storage, voiding, and pelvic floor coordination.

That is why an orthopedic-style pelvic assessment, on its own, will miss the diagnosis in these populations. A neurogenic bladder is not a tight pelvic floor. A sphincter dyssynergia is not a coordination problem in the conventional sense. The course gives clinicians the neuroanatomy and pathophysiology they need to read the picture correctly before deciding on intervention.

What conditions does this course cover?

The course goes in depth on three conditions and offers a generalizable framework for others:

• Multiple sclerosis. Demyelination across the central nervous system produces a wide range of bladder, bowel, and sexual health patterns. Up to 80% of women with MS experience bladder and sexual dysfunction within ten years of diagnosis.
• Spinal cord injury. Lesion level and completeness determine whether the clinical picture skews toward upper motor neuron, lower motor neuron, or mixed bladder and bowel patterns. The course covers assessment and management for each.
• Parkinson disease. Dopaminergic degeneration drives lower urinary tract symptoms in 27 to 80% of patients, with orthostatic hypotension and constipation often appearing years before the motor diagnosis is made.
• General neurologic considerations. A foundation participants can extend to stroke, traumatic brain injury, and other neurologic populations they may encounter.

What will you learn in this course?

The course runs over two days on Zoom and is built for clinicians with prior pelvic floor coursework or treatment experience. Participants leave with:

• A working knowledge of neuroanatomy and pathophysiology of the central and peripheral nervous system as it relates to pelvic structures
• Assessment frameworks for neurogenic bladder, neurogenic bowel, and neurogenic sexual health considerations
• Pelvic floor external evaluation considerations adapted to neurologic populations
• Treatment planning and intervention strategies for MS, SCI, and Parkinson disease
• Applications of biofeedback and TENS in the neurologic population
• An Ask the Experts Q&A session for problem-solving complex neurologic patient cases

References

Browne, C., Salmon, N., & Kehoe, M. (2015). Pelvic floor disorders and multiple sclerosis: Are patients satisfied with their care? International Journal of MS Care, 17(1), 6 to 12.

Cheng, B., Chen, Z., Yang, K., & colleagues. (2023). Lower urinary tract symptoms in Parkinson disease: Prevalence, mechanisms, and management. Frontiers in Aging Neuroscience.

Tornic, J., & Panicker, J. N. (2018). The management of lower urinary tract dysfunction in multiple sclerosis. Current Neurology and Neuroscience Reports, 18(8), 54.

Parkinson's Foundation. (n.d.). Autonomic dysfunction and orthostatic hypotension in Parkinson disease. Parkinson's Foundation Clinical Resources.