NIH awards OHSU researcher $1.2 million to determine causes of, risk factors for pelvic floor injury

February 26, 2008

PORTLAND, Ore. - One of the world's pre-eminent experts in urogynecology at Oregon Health & Science University has received $1.2 million in grants from the National Institutes of Health to study the extent of pelvic floor injury in women before, during and after pregnancy.

The pelvic floor comprises the muscle group that supports the pelvic organs and maintains bowel continence. Pelvic floor injury, which is caused by damage to pelvic muscles or nerves, can lead to a wide array of disorders, including incontinence and the displacement of organs, also known as organ prolapse.

"We hope to be able to determine if some women have inherent characteristics that may make them more susceptible to pelvic floor injury," said W. Thomas Gregory, M.D., F.A.C.O.G., assistant professor of obstetrics and gynecology (urogynecology), OHSU School of Medicine, and member of the OHSU Center for Women's Health. "We also hope to be able to conclusively determine whether vaginal birth truly affects pelvic floor strength and coordination; or if there are other factors, such as the pregnancy itself, in play."

In order to map the extent of pelvic floor injury throughout the length of the study, Gregory will use a neurophysiology test frequently used to diagnose injuries or disease outside of the pelvic region, such as carpal tunnel syndrome or amytrophic lateral sclerosis (ALS), commonly known as Lou Gehrig's disease. In this test, a tiny needle inserted into the muscle mass reads the electrical impulses sent by engaged and active muscles; the readings are then examined to determine the function of nerves and muscles in the tested area.

Using this technique to map pelvic floor injury is unusual because it requires training in both neurophysiology and urogynecology, a still nascent subspecialty of obstetrics and gynecology. Gregory is one of the few urogynecologists in the world trained to use this technique.

The need for this kind of research has become increasingly apparent in recent years as a groundswell of health care providers and the public alike have suggested that giving birth via Caesarean section may decrease the risk of sustaining pregnancy-related pelvic floor injuriy. While retrospective studies seem to indicate that this may be the case, this study, to the best of the researchers' knowledge, is the first large-scale prospective study to track pelvic floor damage before and after a number of birthing scenarios.

"One day we hope to be able to offer women informed choices about preventing pelvic floor disorder - maybe we will find C-sections do reduce the risk of pregnancy-related pelvic floor injuries for some women. Maybe we will find that C-sections do not prevent pelvic floor injury in most women," Gregory said.

Some pelvic floor injury is inevitable throughout a person's lifetime, and disorders resulting from this injury are common among women; recent studies have indicated that one in nine women will at one time undergo surgery to treat the symptoms related to pelvic floor dysfunction.
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About the Center for Women's Health

On a day-to-day basis, the OHSU Center for Women's Health is fundamentally changing the health care experience for women by bringing together outstanding clinical care, cutting-edge research and innovative patient and community education in one vibrant location.

The center has been awarded the designation as a National Center of Excellence for women's health by the U.S. Department of Health and Human Services. It is one of only 21 institutions in the country to earn this distinction, and the only institution in the Northwest.

About OHSU

Oregon Health & Science University is the state's only health and research university, and only academic health center. As Portland's largest employer and the fourth largest in Oregon (excluding government), OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves more than 184,000 patients, and is a conduit for learning for more than 3,900 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to each county in the state.

Oregon Health & Science University

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