Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called “pelvic organ” dysfunctions) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and “prokinetic” drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. 1. Introduction Parkinson's disease (PD) is a common movement disorder associated with the degeneration of dopaminergic neurons in the substantia nigra. In addition to the movement disorder, patients with PD often show nonmotor disorders. The nonmotor problems of PD include neuropsychiatric disorders, sleep disorders, sensory symptoms, and autonomic disorders [1]. Bladder, bowel, and sexual dysfunction (also called “pelvic organ” dysfunctions) is one of the most common autonomic disorders [2, 3]. Studies have shown that the pelvic organ dysfunctions have great significance in relation to quality-of-life measures, early institutionalization, and health economics [4, 5]. It is particularly important to note that, unlike motor disorder, pelvic organ dysfunctions are often nonresponsive to levodopa, suggesting that they occur through a complex pathomechanism [6]. This is because pathology of PD is not confined to the degeneration of dopaminergic neurons in the
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