2023-08-02 20:00:03
Injectable Gels May Help Repair Pelvic Floor Damage After Childbirth, American Study Shows
After giving birth, many women experience complaints such as prolapse or incontinence because the pelvic floor is damaged. Injectable gels, which help repair muscle tissue, may reduce those problems in the future. This shows an American study published this week Science Translational Medicine popped up.
During a vaginal delivery, the pelvic floor muscles have to endure enormous forces and stretch considerably to allow the baby to pass. As a result, the muscle tissue can become thinner and weaker (atrophy) and hard scar tissue can develop (fibrosis), the researchers describe.
To understand how this works, the California scientists conducted experiments with rats. With a balloon inserted vaginally, they simulated the pressure and stretch that occurs during a human delivery. The rats showed the same kind of transformation in the pelvic floor muscles: they also developed atrophy and fibrosis.
Forming new tissue
The biotechnologists in San Diego then tested their self-developed hydrogel on the lab animals. These gels are not new. More research is underway, including in the Netherlands, into hydrogels that promote tissue repair after a heart attack, for example. Such a gel consists of water and polymers that form a flexible network in the body in which cells can form new tissue. Depending on the purpose, different substances can be added, such as drugs, hormones or growth factor. Components from pig muscles were used in the American gel.
An injection is less invasive than surgery. And the advantage of their hydrogel, the researchers write, is that it contains no cells. Such a gel has a longer shelf life and is less expensive than when stem cells are used – a second avenue for this type of research.
The rats in the lab were injected with the hydrogel into the pelvic floor muscles at the onset of injury or four weeks later. Within a week you could see that the production of new muscle tissue was starting. Atrophy and fibrosis were less likely. The gel thus helped to somewhat dampen the effects of the damage during childbirth.
Research in women
The researchers emphasize that it is necessary to understand what goes wrong in the muscle tissue in order to find a ‘regenerative’ treatment: a means that enables the tissue to produce new muscle cells itself. This first trial should pave the way for research in women.
It will be years before women can be helped with a hydrogel, says professor of urogynaecology Jan-Paul Roovers (Amsterdam UMC). He is involved in Dutch research into hydrogels and sees this as a promising new generation for tissue repair therapy. He does, however, have questions about the American investigation. “For example, to be able to predict how scar tissue develops in people, you also have to take into account the forces that exert tension on the pelvic floor when walking or lifting. We also do research on sheep, which are more like humans than rats.”
It is also not yet clear at what times and where exactly the injections will be given. “I have not yet read how this should be done in humans.” Nevertheless, Roovers is pleased with the attention paid to the pelvic floor.
Tip of the iceberg
All women, says Roovers, have some degree of pelvic floor damage after giving birth. “A quarter of women suffer from urine loss, the five thousand operations for this are the tip of the iceberg. One in three women suffers from prolapse.” The uterus, bladder and intestines can even descend beyond the vagina. 10 percent of this group of women undergoes surgery.
Placing pelvic floor mats has caused serious complications in many women. The guidelines are now stricter and there are soluble materials that do the same as implants. “But my dream is that in the future there will be a very simple intervention to better protect all women against pelvic floor damage.” He advises women to explicitly ask about the pelvic floor during the follow-up, and to come back if sex is difficult.
“Less vaginal deliveries are not a solution, a cesarean section also has risks.” Roovers sees more benefit in early diagnosis and joint efforts by midwives, general practitioners, pelvic physiotherapists, and gynecologists. “If you do nothing, the damage will continue.”]
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