This proposal seeks to improve care for the women who suffer the priority health conditions of urinary incontinence and pelvic organ prolapse. These problems arise due to women's unique role in giving birth and, therefore, occur much less often in men. Each year 3 million women deliver babies and 11 % of women need surgery for incontinence and prolapse. A lack of basic understanding of the mechanisms involved in these conditions and their implications for treatment impedes progress. We propose a SCOR to unite 5 existing multidisciplinary researchers and to add 4 new investigators to expedite development of new knowledge needed to improve treatment and prevention. Project 1, """"""""Biomechanics"""""""" will test hypotheses concerning basic mechanisms of pelvic floor structure and function. It will analyze the mechanical arrangement and properties of the components of the pelvic floor as well as how vaginal birth damages their integrity. Project 2, """"""""Clinical Mechanisms"""""""" will test continent and stress incontinent women to detect the unique failure of component parts that, singularly and in combinations, are associated with stress incontinence. Project 3, """"""""Treatment Selection"""""""" will identify the effects of birth induced muscle damage in women with stress incontinence and from these data, build and test a model to determine which defects will predict success or failure of pelvic muscle treatment. Core A, Administrative/Human Subjects/Biostatistics core provides project support by recruiting subjects, compiling and analyzing data and protecting subject safety. In Core A, two study groups will be formed concerning 1) Gender Impact and 2) Basic Sciences Futures to discuss expanding the issues raised by this research. Core B, Measurement & Imaging will provide technical support for the projects along with integrated image analysis for 2 and 3 dimensional spatial data gathered across projects. This research will produce needed insights to help women with pelvic floor dysfunction.
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