Many women in the United States have one or more PFDs.1,2 PFDs can significantly reduce a woman’s quality of life.2 The number of women who undergo surgery to correct a bladder control problem or pelvic organ prolapse is projected to rise sharply over the next several decades.2 NICHD-supported researchers have predicted that the number of surgical patients for PFDs will increase by 47%—from about 210,000 in 2010 to 310,000 by 2050.3
NICHD has invested substantially in PFD research. Specifically, NICHD-supported scientists seek to better understand the basic mechanisms of PFDs and the factors, including pregnancy and childbirth-related injuries, that might affect a woman’s risk of developing PFDs. Researchers are also working to develop and evaluate minimally invasive treatments for PFDs. Finally, NICHD is striving to better define what outcomes women value most.
PFD research is important to NICHD. Current research efforts seek to better understand PFDs, with the goal of decreasing the disease burden and improving treatment outcomes. Specifically, NICHD aims to:
- Better understand the etiology of PFDs. Many factors are associated with the development of a PFD. NICHD is investigating the genetic and biologic mechanisms of PFDs, as well as environmental and lifestyle factors that may either contribute to or protect against PFDs. This new knowledge will inform further research on prevention and treatment.
- Identify interventions that prevent or lower the risk of PFDs. NICHD is pursuing research on prevention in a variety of directions. For example, scientists are using an animal model to find out if directing adult stem cells to damaged areas could facilitate the repair of childbirth-related injury and prevent PFDs.
- Develop and evaluate improved treatments. NICHD research priorities include the development of nonsurgical and less invasive therapies, improved surgical approaches, and pharmacologic interventions. Related to these goals are NICHD efforts to understand the functional and quality-of-life effects of PFDs, define treatment outcomes that women value, and describe factors that contribute to good decision making about treatments.
- Clarify the roles of pregnancy, childbirth, and obstetrical practices as risk factors for PFDs. Going through childbirth at least once is reportedly a factor in developing PFDs. Even so, the biologic mechanisms of pregnancy- and childbirth-related pelvic injury are not clear and remain active areas of research. Furthermore, the relative effects of pregnancy and of delivery on the risk of PFDs have yet to be determined. It is also not clear whether cesarean birth can reduce the long-term risk of pelvic floor problems. Researchers aim to clarify these and other issues related to pregnancy, childbirth, and PFDs.
Institute Activities and Advances
Among NICHD projects related to PFD research is the Pelvic Floor Disorders Network (PFDN), which 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. Visit the PFDN website to see the latest findings. For example:
- The Extended Operations and Pelvic Muscle Training in the Management of Apical Support Loss (E-OPTIMAL) study found no significant difference in the rates of surgical failure for uterosacral ligament suspension and sacrospinous ligament fixation with or without perioperative behavioral therapy and pelvic floor muscle training. (PMID: 29677302)
- The Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) study found that midurethral sling surgery may benefit women who have both stress and urge incontinence, contrary to previous studies’ findings that the procedure may worsen urge incontinence. (PMID: 31529007)
- The Study of Uterine Prolapse Procedures - Randomized Trial (SUPeR) investigated the effectiveness of vaginal mesh hysteropexy and vaginal hysterectomy with suture apical suspension for treating vaginal prolapse and found that the two procedures had comparable outcomes after three years. (PMID: 31529008)
- The Refractory Overactive Bladder: Sacral NEuromodulation v. BoTulinum Toxin Assessment (ROSETTA) study compared the effectiveness of botulinum toxin A versus sacral neuromodulation for the treatment of urge urinary incontinence. The study found that both treatments were effective for women in both older and younger age groups. (PMID: 29031894)
Current network studies are comparing different surgeries for prolapse, looking at a device to treat fecal incontinence, and following up the SUPeR study.
Current GHDB-supported research also 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
- How physical activity affects 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 vaginal prolapse
- Patient-reported outcome measures
Other Activities and Advances
- The NICHD-funded Women’s Reproductive Health Research (WRHR) Career Development Program provides an opportunity for obstetrician/gynecologists (OB/GYNs) who recently completed postgraduate clinical training to further their education and experience in basic, translational, and clinical research. WRHR scholars represent a diverse group of physician-scientists from several subspecialties and emerging areas in OB/GYN; they pursue a broad range of basic science, translational, and clinical research topics and are often appointed to faculty positions. The program emphasizes research relevant to OB/GYN and its subspecialties and related fields, including maternal-fetal medicine, gynecologic oncology, reproductive endocrinology, infertility, and adolescent gynecology and urogynecology.
- The GHDB report Gynecologic Health and Disease Research at NICHD: A Scientific Vision (PDF 1.55 MB) outlines the branch’s portfolio and future research directions.
- NICHD is part of the NIH Pain Consortium, which promotes collaboration across NIH institutes and centers with programs addressing pain, including pelvic pain.
- The Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) program supports physician-scientists as they move between completion of clinical or postdoctoral training and an independent research career. BIRCWH research projects span the spectrum of women’s health topics, and the program is open to all types of clinicians and nonclinicians.
- Lawrence, J. M., Lukacz, E. S., Nager, C. W., Hsu, J. W., & Luber, K. M. (2008). Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstetrics & Gynecology, 111(3), 678–685.
- Nygaard, I., Barber, M. D., Burgio, K. L., Kenton, K., Meikle, S., Schaffer, J., et al. (2008). Prevalence of symptomatic pelvic floor disorders in U.S. women. JAMA, 300, 1311–1316.
- Wu, J. M., Kawasaki, A., Hundley, A. F., Dieter, A. A., Myers, E. R., & Sung, V. W. (2011). Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. American Journal of Obstetrics and Gynecology, 205(3), 230.e1–230.e5. Retrieved October 10, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/21600549