Sex Hormones and Pelvic Floor Disorders

Women with pelvic floor disorders (PFDs) usually have weakened pelvic floor muscles, which may cause urinary incontinence, fecal incontinence, or pelvic organ prolapse. Histologically, the pelvic floor musculature in PFD patients displays increased fibrosis and muscle atrophy. However, the underlying molecular mechanism for PFDs has not been fully investigated, and the pharmaceutical therapeutics are limited. The Women Health Initiative (WHI) study showed that estrogen alone or estrogen plus progestin significantly increased the risk for urinary incontinence. Our preliminary study demonstrated that estrogen can cause lower abdominal muscle tissue fibrosis and atrophy, leading to lower abdominal muscle weakness. This study will further define the signaling and action of estrogen and its precursor androgen in the pelvic floor muscle tissue from estrogen transgenic mice and women with PFDs. If successful, this study will provide the foundation on directing the clinical use of estrogen to combat PFDs.