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Here, \u201caxis\u201d denotes a control-architecture mapping and phenotyping heuristic for LUT control and pelvic-floor outlet coordination, rather than a claim of new anatomy or shared etiology. Accordingly, we use a hypothesis-generating control-loop framing that links descending executive control with ascending interoceptive signaling to account for this clinicobiological mismatch. Within this framework, two provisional working failure-mode categories: top-down disintegration, in which impaired supraspinal control weakens volitional inhibition and shifts continence toward reflex-dominant regulation; and bottom-up disturbance, in which persistent peripheral salience-like signals may up-weight interoceptive processing and contribute to maladaptive central network adaptations. These categories are LUT-focused working categories and are not intended as a comprehensive taxonomy of all LUT phenotypes. We further introduce Coordinated Axis Neuromodulation (CAN) as a hypothesis-driven intervention concept that temporally couples cortical, spinal, and peripheral stimulation and may facilitate control-loop\u2013level rebalancing compared with single-node modulation; this proposal requires direct empirical validation. This framework yields testable predictions, including directionally specific coupling between cortical biomarkers (e.g., executive\/salience network metrics) and peripheral readouts (e.g., pelvic-floor EMG timing indices and\/or diary-defined urgency\/UUI burden; urodynamics as supportive phenotyping\/secondary mechanistic data when included), and differential response profiles of CAN protocols across failure-mode\u2013stratified cohorts. We outline a validation route spanning synchronized neurophysiology\u2013pelvic physiology paradigms (e.g., EMG timing and diary endpoints; urodynamics as supportive phenotyping\/secondary mechanistic data when included), proof-of-mechanism studies, and safety-monitored, mechanism-oriented RCTs designed to falsify or refine the CPA\/CAN hypothesis.<\/jats:p>","DOI":"10.3389\/fnins.2026.1773086","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T06:43:45Z","timestamp":1774248225000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The cerebro-pelvic axis: a unified framework linking higher brain function, pelvic floor control, and lower urinary tract dysfunction"],"prefix":"10.3389","volume":"20","author":[{"given":"Zhong","family":"Li","sequence":"first","affiliation":[{"name":"Second Clinical Medical College, Yunnan University of Chinese Medicine","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Fu","sequence":"additional","affiliation":[{"name":"Second Clinical Medical College, Yunnan University of Chinese Medicine","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianlin","family":"Pu","sequence":"additional","affiliation":[{"name":"School of Traditional Dai Medicine, West Yunnan University of Applied Sciences","place":["Xishuangbanna, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Qian","sequence":"additional","affiliation":[{"name":"School of Medicine, Kunming University of Science and Technology","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Gai","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology)","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Emergency Trauma Surgery, The First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology)","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e21200005","DOI":"10.14440\/bladder.2024.0012","article-title":"Bladder dysfunction following stroke: an updated review on diagnosis and management","volume":"11","author":"Agapiou","year":"2024","journal-title":"Bladder"},{"key":"B2","doi-asserted-by":"publisher","first-page":"8646","DOI":"10.1038\/s41598-019-45234-8","article-title":"Traumatic brain injury-related voiding dysfunction in mice is caused by damage to rostral pathways, altering inputs to the reflex pathways","volume":"9","author":"Albayram","year":"2019","journal-title":"Sci. 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