Abstract / Summary
Background and Objectives: Lower urinary tract symptoms (LUTS), such as urgency, frequency, and pelvic discomfort, are often attributed to bladder-centered mechanisms; nonetheless, several patients exhibit overlapping pelvic floor dysfunctions that existing urologic models do not fully explain. Evidence from the musculoskeletal and pain literature demonstrates that myofascial trigger points within the pelvic floor are prevalent in patients with pelvic pain and urinary symptoms, potentially contributing to symptom generation. In this narrative review, we synthesized the literature on pelvic floor myofascial dysfunction, referred pain patterns, and autonomic regulation of bladder function to develop an integrated neuromusculoskeletal framework. Materials and Methods: PubMed and the TRIP Database were searched, with Elicit used for multi-database querying, abstract screening, and assisted data extraction; the final search was performed on 7 April 2026. Eligible publications addressed myofascial trigger point physiology, pelvic floor dysfunction, lower urinary tract function, or mechanisms of central or cross-sensitization and were required to describe or propose a physiological mechanism. Case reports were excluded. Seventeen publications were included in the synthesis. Results: The reviewed evidence supports a pathway in which active myofascial trigger points generate sustained nociceptive afferent inputs that converge with bladder afferents in the sacral spinal cord, potentially facilitating cross- and central sensitization, lowering the threshold for bladder sensation, and altering micturition reflex processing. The resulting amplification of afferent signaling provides a mechanistic basis for urgency, frequency, and pelvic pain in the absence of primary bladder pathology. Conclusions: This model integrates musculoskeletal and urological perspectives and suggests that, in a subset of patients, LUTS may reflect the central processing of peripheral musculoskeletal input. Incorporating pelvic floor assessment into clinical evaluations may improve diagnostic accuracy and provide more targeted management. Further prospective studies are warranted to validate this integrated pathway and its therapeutic implications.