A gel that regenerates muscle seeks to treat pelvic floor dysfunctions

In vaginal birth, the pelvic muscles are greatly stretched and can be damaged, such as tears. These injuries can lead to pelvic floor disorders, such as pelvic organ prolapse and urinary and fecal incontinence. The most common option to treat them is rehabilitation, although in acute cases surgery can be used. However, damaged fibers do not recover, says Pamela Duran, a bioengineer at the University of California. She and her team have created a hydrogel based on extracellular matrix extracted from pigs that has managed to regenerate that affected tissue. The results of the research, carried out on rats, were recently published in the journal Science Translational Medicine.

Rats suffer injuries similar to those of women during childbirth. In the research, Duran’s team induced these injuries in the animals. The hydrogel was applied to one group as soon as the damage occurred and to another four weeks later (simulating the moment of a postpartum check-up), explains the author. In the first case, scientists found that it helped prevent atrophy and fibrosis in the affected muscles. In the second, in addition to this effect, they observed that the muscle fibers that had been damaged were regenerated, returning to the values ​​before the injury.

Prolapse is the descent of the pelvic organs due to the loss of tension in the ligaments that join the genital apparatus to the bony pelvis, explains Antonio Cano, coordinator of the Women’s Health area from the INCLIVA Foundation. It is the most prevalent problem. The Pelvic Floor unit of the Obstetrics and Gynecology Service of the 12 de Octubre University Hospital in Madrid states that 50% of women over 50 years of age “will have some degree of genital prolapse.” This is followed by urinary incontinence, which ranges between 8% and 50%, depending on the age group. They do not provide specific data on the prevalence of fecal incontinence, but they state that between 5% and 7% will suffer anal sphincter tears of obstetric origin, which can lead to this problem.

Irene Díez, president of the pelvic floor section of the Spanish Society of Gynecology and Obstetrics (SEGO), explains that it is difficult to establish the prevalence of these conditions because the relationship between cause and effect is not immediate. “When we are young, these injuries occur and with the passage of time and other risk factors, such as obesity and aging, they become evident in later stages.” Additionally, many times, tears and other damage to these muscles are not visible to the naked eye and may go unnoticed. That is why she recommends that, after giving birth, women see a specialist to work on strengthening their pelvic muscles.

The importance of physiotherapy

The main treatment when suffering from these ailments is to rehabilitate the muscles. Laura Arcas, a physiotherapist specialized in urogynecological dysfunctions, explains that the first step is to know the control that the patient has over these muscles and the degree of automatism (the ability to contract on their own) that they retain. You also have to evaluate the state of the abdomen because it works in conjunction with the pelvic floor, she adds. In consultation they work on the support function (keeping the pelvic organs in place), continence and sexual function (patients may see their ability to reach orgasm impaired and suffer pain during sexual relations).

Once you know the status of the women, you begin training to increase the volume of muscle fiber. If part of this fiber has been broken, it cannot be recovered, but they try to strengthen the healthy ones. “If the rest replace the one that is broken and manage to do their job well, the damage can be compensated,” says Arcas. In cases where these exercises do not work on their own, other tools are used such as electrotherapy, which applies electrical currents to the muscles.

The physiotherapist warns that the damage suffered by the pelvic muscles during childbirth cannot be prevented. However, “if they maintain good habits, good hydration, do not smoke, are in good physical condition, dilation will surely be better and the pelvic floor will be less affected.”

To this process we must add, he adds, that the use of tools during birth, such as forceps and suction cups, increase the tension to which the muscles are subjected and the risk of tearing. Antonio Cano, from the INCLIVA Foundation, agrees and comments that, if the coupling of the fetus’s head to the birth canal occurs progressively, injuries can be reduced.

[Las disfunciones de suelo pélvico] Many patients are often prevented from participating in various activities due to the discomfort and embarrassment they feel.

Pamela Duran, bioengineer at the University of California

If rehabilitation does not work, other treatments, including surgery, may be used. In the case of prolapse, for example, Irene Díez, from the SEGO, explains that devices are used that adjust to the physiognomy of each woman and keep the pelvic organs in place. If you have to undergo surgery, Cano says that there are two options: the prolapsed organs can be removed directly, or they can be fixed to a higher structure.

There are also surgical options to treat incontinence, but, in any case, Arcas advises that physical therapy must be present. “If you do not see a physiotherapist, the result will be negative because the muscles will not recover their function.”

Irene Díez, from SEGO, and Pamela Duran, the main author of the research, agree on the importance of these pathologies in the daily lives of women. “Incontinence can greatly affect your quality of life because you change your behavioral habits,” says the gynecologist. The bioengineer highlights how stigmatized these problems are. “Many patients are often prevented from participating in various activities due to the discomfort and embarrassment they feel.”

Pamela Duran, the lead author, defends the role of her work within the research of new approaches in regenerative medicine. She also assures that the results obtained with the hydrogel they have developed, its low cost and that it is applied in a minimally invasive way, justify its clinical use. For now, the next step is to continue research in other animal models before being able to begin trials in women, something that is still a long way off. Cano, from INCLIVA, highlights that until now there was no option like this. “[Los investigadores] “They have made it a reality in an animal model.”

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