By: Diana Barnes-Brown for Uterus1Female pelvic floor disorders (FPFDs) might sound like the name of an unusual condition, but in fact, recent medical research indicates that as many as 50 percent of American women may be sufferers of FPFDs.
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Though genetic therapies for FPFDs are not yet an option, there are a number of other treatments available. These include:
Performing Kegel exercises – intentional tightening and release of the muscles used to control urine flow – to strengthen weak muscles in the pelvic area.
Use of a pessary, an object inserted into the vagina to help hold weaker structures in place.
Estrogen suppositories and creams can also be helpful, because they help to keep vaginal tissues healthy.
At times, simple surgical procedures can help with serious organ prolapse or incontinence. Typically, the surgeries involve somehow reinforcing weakened areas of tissue, and moving out-of-place organs back into place.
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The long name describes the main sources of symptoms in FPFDs, which are damage, weakening, or abnormalities in the structure of the pelvic floor of the vagina. When the pelvic floor is weakened, any of a host of symptoms and secondary conditions can arise, and may involve the vagina, uterus, bladder, rectum, or the surrounding muscles and support structures. Common problems associated with FPFDs include pelvic organ prolapse, loss of urinary control, and loss of bowel control.
Pelvic organ prolapse occurs when one of the organs in the pelvic region “falls” into the vagina. These include the bladder, uterus, rectum and small intestines. Names for the particular types of pelvic organ prolapse include “cystocele,” “uterine prolapse,” “dropped uterus,” “rectocele” and “enterocele.”
In cases of pelvic organ prolapse, some women may feel, or even see, a bulge at the vaginal opening. Some may have a sensation of vaginal pressure or fullness, while others may have no symptoms at all. Prolapse is not dangerous, but can be frightening and inconvenient, make day-to-day activities such as exercising or vigorous work uncomfortable, or interfere with normal urination.
Sometimes, bladder and bowel problems can occur even without the prolapse of a particular organ, but are simply due to the weakened structures in the area. It may be difficult to prevent the leaking of urine or feces when in certain positions or when coughing or sneezing, for example. Risk factors for FPFDs include vaginal childbirth and aging, but not much is known about the underlying mechanisms causing these disorders.
Because FPFDs and the problems they cause are often embarrassing, and also incredibly common, it is not unusual for women to go years without talking to their doctors about their symptoms. But the good news is that many treatments are available, including non-surgical options. Also, researchers are investigating the causes and possible ways of preventing or repairing FPFDs.
Recently, researchers at the Berman-Gund Laboratory at the Massachusetts Eye and Ear Infirmary (MEEI) and Harvard Medical School (HMS) collaborated on a study that may help to explain an underlying cause of FPFDs. Working with mice, the researchers found that animals that lacked the ability to replenish certain elastic fibers developed pelvic floor disorders similar to those found in female humans.
Elastic fibers are present in skin and other soft or connective tissues throughout the body, and the female reproductive organs need lots of these elastic fibers to function properly. During pregnancy and childbirth, the tissues undergo remarkable transformations, after which they are typically replenished, and can return to their normal shape. In mice, this process happens in part thanks to the presence of lysyl oxides-like protein (LOXL1), critical to elastic fiber maintenance.
In the study, published in the February American Journal of Pathology, Tiansen Li, Ph.D. and fellow researchers found that mice with defective LOXL1 genes developed serious pelvic floor disorders, while those with functional genes did not.
In conclusion, Li and fellow researchers wrote, “our findings raise the possibility that a failure of elastic fiber homeostasis, either due to genetic predisposition or advancing age, could underlie the etiology of pelvic floor dysfunction in women.” These results indicate that, in addition to the currently available options for treating FPFDs, genetic therapies may also be an important treatment modality in the years to come.
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