Urinary Incontinence research lines

Research into the causes of the different disorders (urinary incontinence, anal incontinence, genital prolapse) is essential for establishing preventative strategies. The future with respect to pathologies that affect the female pelvic floor therefore focuses on two objectives: prevention and treatment.

Recent technological advances in imaging tests allow for more detailed identification of anatomical structures in the urethra, bladder and pelvic floor muscles, leading to improved diagnosis. Defining normal and abnormal conditions in these structures and relating these findings to symptoms improve the diagnosis of pelvic floor dysfunctions. For example, 3D technology incorporated into ultrasound has made it possible to study the levator ani muscle in detail; thus linking the rupture of its fibres - which sometimes occurs during childbirth - with the future onset of pelvic organ prolapse.

Similarly, there are many causes of the symptoms of overactive bladder syndrome (e.g. repeated urinary tract infections, neurological diseases, diabetes and a poor urethral sphincter). Functional tests (such as urodynamics) and improvements in urine cultures also help classify women with this syndrome into different groups, enabling more personalised treatments. Research is also ongoing into various drugs to relax the detrusor muscles in women with bladder filling disorders, as well as increasingly more effective drugs with fewer side effects.

The surgical materials industry is also making progress in the treatment of stress urinary incontinence, seeking to improve mesh architecture and thus reduce complications. Regarding prevention, although no studies have yet provided hard evidence of the long-term preventative effect, data show that pelvic floor muscle contraction exercises can prevent urinary incontinence and genital prolapse from developing after childbirth. With respect to anal incontinence, prevention is the key because women who suffer a tear in the anal sphincter during childbirth have a greater predisposition for anal incontinence.

In terms of treatment, there are currently effective methods for the different pelvic floor disorders, but they only treat the symptoms and do not address the causes of the problem. For example, stem cell regeneration of a urethral sphincter in a woman with stress urinary incontinence could treat her symptoms; or regenerating damaged fibres after childbirth could prevent the long-term onset of genital prolapse. In other words, these treatments neither stop the condition from progressing nor do they cure an existing lesion.

The key to reducing pelvic floor dysfunction will undoubtedly be prevention strategies. A number of risk factors are non-modifiable, such as age-related tissue degeneration and genetic predisposition. However, maintaining adequate body weight, protecting the pelvic floor from impact and avoiding injuries during childbirth are very important in preventing pelvic floor dysfunction. In fact, some data show that performing pelvic floor muscle contraction exercises can prevent postpartum urinary incontinence as well as the progression of genital prolapse, although there are no studies as yet demonstrating a long-term preventive effect. Similarly, protecting the perineum during childbirth, as well as avoiding forceps delivery whenever possible, reduces injuries to the levator ani muscle (a risk factor for prolapse) and the anal sphincter (a risk factor for anal incontinence).