Feature image | One single endometrial mesenchymal stem cell attaches to and interacts with nanofibres at nanoscale.
Pelvic organ prolapse (POP)
POP is a hidden condition. While the injury happens mostly during childbirth, the patient may not know about the damage until many years later, often during menopause.
There is no reliable cure for pelvic organ prolapse. Hudson Institute researchers are striving to discover an effective, safe treatment option for the many women who are suffering in silence.
What is pelvic organ prolapse?
POP develops when tissues, pelvic floor muscles and ligaments that support the pelvic organs (bladder, uterus and bowel) become damaged, usually in childbirth, causing organs to shift or ‘drop’ into or outside the vagina. POP is essentially a hernia through which organs protrude because supporting tissue is weak. This can lead to debilitating symptoms, including poor bladder or bowel control and pain during sex.
The condition can be exacerbated by age, ethnicity, multiple births, obesity and family genetics. One in five women require surgery – and often multiple surgeries.
Causes of pelvic organ prolapse
Risk factors include
Childbirth
Age – muscles and connective tissue become weaker with age
Weight – vaginal or uterine prolapse is more common in women who are very overweight
Women who have genetically weak tissue.
Pelvic organ prolapse types
Bladder prolapse (cystocele) is the most common type of pelvic organ prolapse. The bladder pushes down against the vaginal wall.
Bowel prolapse the small intestine (enterocele) or the last part of bowel (rectocele) bulge into the vagina.
Uterine prolapse the womb (uterus) drops down into the vagina.
In addition, because the one or more supports for these organs have weakened, several or all organs will often drop down together.
Pelvic organ prolapse symptoms
Mild cases of pelvic organ prolapse often don’t cause any symptoms until the woman is older. But if the organs drop down further, the most common symptoms can be debilitating and include pain, and a feeling of heaviness, fullness or pressure in the vaginal area, and that the uterus, bladder or rectum is bulging or dropping out.
Other common symptoms include difficulty emptying the bladder or bowel and pain during sex.
Pelvic organ prolapse diagnosis
A medical examination by a doctor or urogynecologist is used to diagnose a prolapse and determine the severity.
Pelvic organ prolapse stages
There are four general prolapse stages, defined by how far the bladder, womb or bowel have dropped down.
First-stage prolapse | The organs have only slipped down a little.
Second-stage prolapse | The organs have slipped down to the level of the vaginal opening.
Third-stage prolapse | The vagina or womb has dropped down so much that up to one centimetre of it is bulging out of the vaginal opening.
Fourth stage prolapse | The vagina or womb is completely outside the vagina.
Pelvic organ prolapse treatment
While milder cases of POP may be treated with pelvic floor exercises or pessaries (a removable device that fits in the vagina to support the pelvic organs and vaginal wall), one in five women will need vaginal surgery, which has up to a 30 percent failure rate.
Until recently, transvaginal meshes have been used for treating pelvic organ prolapse, but they are now banned from clinical use in many countries. Transvaginal meshes were banned in Australia in 2017, mainly due to the excessive stiffness resulting in penetration through the vagina into other organs, and undesirable foreign body response to synthetic non-degradable meshes which led to serious complications in some women.
There is an urgent need for safe, effective POP treatments.
VIEW VIDEO | more about Hudson Institute’s pelvic organ prolapse research.
Our pelvic organ prolapse (POP) research
Hudson Institute researchers are committed to finding new treatments for those affected by pelvic organ prolapse.
In a world-first approach, Hudson Institute scientists are using adult stem cells (mesenchymal stem cells) from the lining of a woman’s own uterus engineered with biodegradable materials to develop safe, effective treatments for pelvic organ prolapse. They have dedicated more than ten years to find a safe and effective treatment option for POP and are pioneering world-first treatment approaches.
Initially the team worked with CSIRO to develop a new flexible non-degradable mesh to support the vagina and deliver endometrial mesenchymal stem cells. This tissue engineering construct significantly improved the outcome in pre-clinical models. As a result of this work, the team is focusing on a new degradable biocompatible material that provides a good healing.
Keep up-to-date with our critical pelvic organ prolapse research via our POP newsletter.
New pelvic organ prolapse treatment – nanostructured and 3D bioprinted cellular surgical constructs
This project is investigating a new pelvic organ prolapse treatment using regenerative medicine – a cell-based therapy delivered in degradable biomaterial constructs. The team are examining the effect of using these constructs as surgical implants.
Preparing endometrial mesenchymal stem cells for clinical treatment
The team is investigating using mesenchymal stem cells from the uterus (endometrial mesenchymal stem cells) together with nano biomaterials (such as polymers) to treat and prevent POP. We have developed new methods for culturing the mesenchymal stem cells that improve their performance for clinical translation. We also need to ensure the innovative culture methods we have developed are safe.
Preventing pelvic organ prolapse by treating vaginal injury
Mesenchymal stem cells
This project aims to inject endometrial mesenchymal stem cells in a special nanogel into the pelvic organ support structures damaged during childbirth several weeks after giving birth vaginally with the goal of promoting tissue repair and preventing later development of POP.
View video | Sally Maconochie, POP advocate visit’s our labs at Hudson Institute in Melbourne and speaks with Prof Caroline Gargett, Dr Shayanti Mukherjee and Dr Kallyanashis Pauland shares her story
This project is investigating a new pelvic organ prolapse treatment using regenerative medicine – a cell-based therapy delivered in degradable biomaterial constructs. The team are examining the effect of using these constructs as surgical implants.
