Pelvic floor disorder is a hidden epidemic. Many women have never heard of it until they develop it.
Medical professionals, on the other hand, historically considered pelvic organ prolapse or incontinence inevitable as women age. Statistics show that nearly half of women in the U.S. older than 50 experience pelvic floor disorders. In addition, about 12 percent of women in the U.S. can expect to have surgery for prolapse or incontinence.
As common as prolapse is, many practitioners believe they can do better than a one-size-fits-all approach to treatment.
"When someone is diagnosed with heart disease, doctors don't just prescribe him some pills and hope they work," says John DeLancey, M.D., a pelvic medicine and reconstructive surgery specialist at U-M and director of the Pelvic Floor Research Group. "The patient would undergo a battery of tests to determine how to treat the specific causes of his heart disease most effectively. Why should care for a women's gynecologic condition be any different?"
We're currently working on being able to predict the outcome of surgery before the surgery is done.John DeLancey, M.D.
Case in point: Gynecologists at University of Michigan Von Voigtlander Women's Hospital have teamed up with biomechanical engineers from the U-M School of Engineering to use 3D stress MRI to determine ways to evaluate each individual woman's risk of prolapse — and then the best way to prevent it. They are also using engineering techniques to zero in on the best surgical treatments for women with prolapse.
Studies by the Pelvic Floor Research Group at the University of Michigan have shown that prolapse develops after the levator ani muscle, commonly known as the Kegel muscle, is torn from the pubic bone during vaginal birth. Risks include bigger babies, older moms and forceps delivery. Women who have never had a vaginal birth typically don't have prolapse.
The researchers have used 3-D modeling to simulate birth on a computer, examining how the levator ani muscle is affected by several factors, such as the shape of the muscle, where it attaches, variations in the birth canal and the size of the fetal head in relation to the birth canal.
"What we're working on now is the idea that we could do an ultrasound and measure the size of the opening of the birth canal and the size of the fetal head and estimate for a woman what her likelihood of having an injury is so that she could consider that" in her birth plan, says DeLancey. The research could lead to an algorithm that would objectively estimate a woman's risk.
The value of 3-D modeling
The researchers are also using 3-D stress MRI to evaluate all the parts of the pelvic floor — muscles, ligaments, fasciae — in women without prolapse and comparing those measurements to women with prolapse. The engineers develop 3-D models on the computer and simulate stresses on the pelvic floor to see how it is affected. It's comparable to the way they would test the strength of a planned bridge.
They use the information to create personalized 3-D models of a woman's prolapse and then to simulate various surgical options. "We're currently working on being able to predict the outcome of surgery before the surgery is done," DeLancey says.
Gynecologists' opinions on the best prolapse treatments vary, based primarily on their patient experiences, DeLancey says. But by taking an engineer's approach and developing an objective algorithm for prevention and personalized models for treatment, researchers can potentially reduce the number of women dealing with the complications of prolapse.