The NICHD supports a broad portfolio of research related to the etiology, treatment, and prevention of Pelvic Floor Disorders (PFDs). Brief descriptions of this research are included below.
Institute Activities and Advances
The NICHD has expanded its funding of research on PFDs, including pelvic organ prolapse and urinary and fecal incontinence. Most of this research is supported through the Pelvic Floor Disorders Network (PFDN), which the NICHD established in 2001 to encourage collaborative research on PFDs and to improve patient care. The PFDN is currently supported through the Gynecological Health and Disease Branch (GHDB).
PFDN research has advanced understanding of the prevalence, epidemiology, and risk factors for PFDs and has informed clinicians regarding diagnosis and treatment modalities. For example:
- Using National Health and Nutrition Examination Survey data, the PFDN provided, for the first time, national prevalence estimates of symptomatic PFDs in women in the United States.
- The Childbirth and Pelvic Symptoms (CAPS) study, a prospective cohort study, found that women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence as are women without these sphincter tears. It also found that cesarean delivery before labor is not entirely protective against PFDs.
- The Ambulatory Treatments for Leakage Associated with Stress (ATLAS) study, a randomized controlled trial of nonsurgical treatment for stress urinary incontinence, provided information on the relative efficacy of (and satisfaction with) pessaries, training and exercise of the pelvic floor muscles, and the two treatments combined.
- Results from the Colpopexy and Urinary Reduction Efforts (CARE) and Outcomes Following Vaginal Prolapse Repair and Mid-Urethral Sling (OPUS) studies showed that adding a procedure used to treat stress incontinence at the time of surgery for pelvic organ prolapse in women without symptoms of stress incontinence can help to prevent stress incontinence after surgery, without increasing risk.
Current network studies are examining the effectiveness of both surgical and nonsurgical interventions for PFDs, including pharmacological agents, the short- and long-term anatomical or functional outcomes of interventions, and preventive strategies.
Other GHDB -supported researchers recently estimated the number of women who will undergo surgery for PFDs in the future, based on 2006‐2007 hospitalization data and overall population data from the U.S. Census. They predicted that the number of surgical patients for PFDs can be expected to increase by 47% by 2050. These data demonstrate an urgent need to develop effective, low-cost interventions for PFDs to minimize the public health burden (PMID: 21600549).
Current GHDB -supported research includes studies of:
- The basic mechanisms of pelvic floor support and of pregnancy- and childbirth-related pelvic floor injury
- Genetic determinants affecting predisposition to pelvic organ prolapse
- The natural history of pelvic floor changes during pregnancy and following childbirth
- How physical activity affects PFDs
- Whether obstetrical care can be modified to prevent PFDs
- Factors associated with making decisions about PFD treatment
- Animal models of stem-cell homing for treatment of PFDs
- Minimally invasive techniques for surgical repair of PFDs
- Patient-reported outcome measures
Reducing and eliminating obstetric fistula in women who live in developing countries is also an active area of NICHD research. The Institute issued the following program announcements to invite research projects on this topic:
Other Activities and Advances
NICHD investigators have designed an adjunct study to the National Children's Study, a longitudinal cohort study that began in 2005 and monitors mothers and their children from before the child's birth to when they reach age 21. This adjunct study aims to describe the natural history of PFDs over time and estimate the attributable risk of pregnancy and delivery for the development of PFDs.