Magee-Womens Research Institute & Foundation

There’s no question we’re going to discover the genetic predisposition to pelvic floor disorders, which may then help us identify at-risk women.
Dr. Halina Zyczynski

In a single day in Dr. Halina Zyczynski’s surgical practice — which she describes as “putting Humpty Dumpty together again” — she might see a 27-year-old, a 31-year-old, and three women in their 90s. They arrive with a variety of experiences: nerve and tissue damage from recently giving birth, urinary incontinence, or perhaps a follow-up after surgery to repair a pelvic floor prolapse.

“It’s an exciting field, because it’s easy to positively impact the quality of life for a woman,” she says. “There are so many unanswered questions in women’s care, and there’s such a great need for research to support safe, efficient, effective care. It’s been meaningful building the foundation of the field.”

As the director of the UPMC Magee-Womens Hospital Division of Urogynecology and Reconstructive Pelvic Surgery, Zyczynski leads the Women’s Center for Bladder and Pelvic Health. The UPMC program has been on the forefront of care for pelvic floor disorders in women for more than 25 years, well before establishment of the subspecialty which is still in its infancy — board certification started in 2013 — but addresses a need that has existed with women since the beginning of time.

Bladder symptoms, pelvic pressure, and accidental bowel leakage, caused by a loss in support of a woman’s pelvic organs or nerve and muscle injury after a trauma, such as birth are what dominate the field of female pelvic medicine and reconstructive surgery. In the past, these disorders were drastically understudied, partly because embarrassed women rarely reported them or sought help. Women accepted their symptoms as an inevitable part of aging.

“As a result, the problems were not brought to the attention of clinicians or researchers,” Zyczynski explains. “In turn, they were not prioritized in funding at the NIH until the last 25 years.”

That was around the same time campaigns began elevating the voices of aging women, who are now the fastest-growing population demographic in the United States, according to the U.S. Census Bureau. The women began demanding solutions to maintain active and engaged lives — and Zyczynski is eager to provide them.

“We are what we do,” she says, though the simplicity of her statement belies the complexity of her work. One upcoming clinical trial, for example, will test the efficacy of a biologic scaffold or graft as an alternative to the permanent mesh used for three decades in pelvic floor reconstruction. The graft is expected to reinforce the pelvic floor in place while the patient grows her own tissue to replace it, at which point the graft dissolves. Other lines of investigation include whether a procedure called hysteropexy — or uterine re-suspension — could replace the more common hysterectomy to fix prolapse.

“We have no sacred cows,” says Zyczynski. “As researchers, we are willing to question the dogma of today to prove its value or reject it for a better solution.”

To underscore this point, she notes that recent trials in surgical pain management after prolapse surgery have resulted in substantially reduced opioid administration, faster recovery, and shorter hospitalizations at Magee.

Within the field, Zyczynski says studies also are underway to explore the role of genetics in pelvic floor disorders, such as whether a vulnerability to develop prolapse could be inherited, like weak bones or hyperflexible ligaments.

“There’s no question we’re going to discover the genetic predisposition to pelvic floor disorders, which may then help us identify at-risk women. Obstetricians will be able to use the information to suggest alternative management of their pregnancies and deliveries, or perhaps enhance our counseling on lifestyle choices,” she says. “Genetic vulnerability may influence when and what type of surgeries we offer. The prospect of precision medicine — individualized care plans — is very exciting. I expect it will improve our treatment success and durability.”

“In my short career, I have seen a dramatic expansion of treatment choices for women with pelvic floor symptoms,” Zyczynski says. “We've pushed the envelope, and today's surgical experiences are so much different and so much easier than what our mothers and grandmothers had.”

Zyczynski admits that “there are many unanswered questions and certainly improvements to treatment that have yet to be discovered. But I am encouraged by our progress and am grateful for the investment in women’s health by the NIH and philanthropists as well as the creation of a supportive, inspiring community at the Magee-Womens Research Institute.”