Myofascial pelvic floor dysfunction as a hidden contributor to urinary symptoms

Lower urinary tract symptoms (LUTS) such as frequency, urgency, and sensation of incomplete emptying are frequently attributed to bladder or urothelial disorders, but pelvic floor myofascial dysfunction is underrecognized as an etiologic factor. To present a conceptual framework for myofascial pelvic floor dysfunction (MPFD) as a contributor to urinary symptoms, review its urologic manifestations, discuss, and explore occult contributing factors, and propose integrated diagnostic and interventional therapeutic strategies. This is a narrative review and conceptual synthesis anchored on recent observational studies and existing literature on myofascial pelvic floor dysfunction. MPFD involves failure of appropriate muscle relaxation (or paradoxical contraction), often resistant to standard rehabilitation if underlying drivers remain untreated. The pelvic floor should be conceptualized as a biomechanical "cuboid" interacting with the diaphragm, spine, and abdominal wall. Patients may present with a spectrum of urinary, bowel, sexual, neurogenic, and pain symptoms. Success in rehabilitation demands identification and targeting occult contributors (anatomic, biomechanical, inflammatory, neurologic, behavioral, and central nervous system). Recognizing and addressing myofascial dysfunction as part of the multidimensional pathophysiology of LUTS may improve outcomes in patients' refractory to bladder-centric therapies. Prospective trials are needed to validate integrative treatment strategies.