Pelvic floors and glass ceilings: uOttawa researcher advances knowledge in women’s health

Research
Research and Innovation
Research and innovation
Faculty of Health Sciences
Faculty of Engineering

By University of Ottawa

Office of the Vice-President, Research and Innovation, OVPRI

Linda McLean in her lab
Linda McLean, full professor at the School of Rehabilitation Sciences at the Faculty of Health Sciences and holder of the uOttawa Endowed Chair in Women’s Health Research.
Professor Linda McLean combines her love of physiotherapy with her graduate training in engineering to fill important knowledge gaps about pelvic floor disorders in women.

“My academic journey was atypical, I would say. It certainly wasn’t linear. And by embracing that, I was able to broaden my skill set and forge my own path,” says University of Ottawa researcher Linda McLean, who, after two years as a physiotherapist, decided to change gears and pursue graduate training in biomedical engineering.

“I basically created my own PhD program called interdisciplinary studies in biomedical engineering, from which I was the first graduate — and perhaps the only graduate. It allowed me to combine knowledge and skills in rehabilitation science and electrical engineering.”

Today, McLean and her team at the Faculty of Health Sciences study the mechanisms that underly pelvic floor disorders in women, particularly urinary incontinence, sexual pain disorders and endometriosis.

“We study the support provided by connective tissues and the strength, tone and co-ordination in women’s pelvic floor muscles, as well as their excitability,” McLean says, standing under a graffiti representation of a woman’s pelvic musculature created by former PhD student Nicole Beamish.

“These are considered women’s health conditions because their prevalence is so much higher among women compared to men, and that’s related to differences in anatomy. The female pelvic structures tend to lose their support because the muscles are smaller and thinner, they bear loads differently than in men, and due to the demands of reproduction.”

Research scientist Flavia Ignacio Antonio running on a treadmill and research associate Grace Collins taking notes on a clipboard
Research scientist Flavia Ignacio Antonio (left) and research associate Grace Collins (right) demonstrate a test they run to study how pelvic floor support is affected during running. Almost half of women experience urinary incontinence during exercise.

Building the tools to grow the knowledge

Along with exercise equipment, electromyography systems and ultrasound machines, McLean’s cutting-edge lab also includes a workshop with 3D printers and soldering tools, which they use to design and build the devices they need to conduct their research.

“That’s where my electrical engineering background comes in handy,” says McLean. “To stimulate the brain and look at the motor pathways to the pelvic floor, we need to place specialized electrodes inside the body, right over the muscles in the vagina. Since commercial tools for this kind of research don’t exist, we build our own in the lab.”

The team has also designed a dynamometer, which measures the strength of the pelvic floor muscles, and 3D printed plastic coverings to ensure comfort, positioning and proper sanitation.

“We’ve put all the design blueprints for our tools out in the public domain, so anyone who needs them for their research can build their own,” she says. “We’re also conscious of generating waste so we’re currently exploring options to replace the plastic.”

McLean recruits volunteers and CO-OP students from undergraduate engineering programs to help build the tools the team has designed. “We get the help we need in our lab. They learn about 3D printing and soldering techniques and are exposed to health sciences. It’s a win-win,” she says.

Electrodes secured to a hand (left) and dynamometer covers in a 3D printer (right)
The research tools the team designed: electrodes secured to a hand, left, and dynamometer covers in a 3D printer, right.

Two passions coming together

In her first faculty position, teaching rehabilitation science at Dalhousie University, McLean was approached by a pelvic health physiotherapist looking to solve a problem.

“She said, ‘I have this biofeedback equipment and it’s not working, and everyone tells me you’re the person I need to go to,’” says McLean.

“With my expertise in electromyography from my PhD, I recognized that the tool she was using didn’t make sense in terms of science. The electrodes in their biofeedback system were not right. They were probably recording signals from other muscles and not necessarily the ones they thought.”

To investigate, McLean spoke with system vendors at conferences. When her questions went unanswered, she made it her mission to improve how electromyography is used both by clinicians as a biofeedback tool and by scientists to improve our understanding of pelvic disorders, specifically urinary incontinence and pelvic pain. “I found that you can’t study the mechanisms of pain for too long before you want to help people,” she says.

Building on that urge to help women, McLean’s research program at the University of Ottawa is now composed of three parts: creating new research tools, using these tools to understand the body’s physiological responses and using that understanding to develop interventions to help patients.

Linda McLean and postdoctoral researcher Marina Petter Rodrigues examining an ultrasound of a patient’s pelvic floor.
Linda McLean and postdoctoral researcher Marina Petter Rodrigues examining an ultrasound of a patient’s pelvic floor.

“A lot of women suffer,” says McLean. “These are conditions that can come with a lot of embarrassment or shame. It’s personal and intimate information, especially when you get into some of the sexual pain disorders. These are unseen impairments or disabilities, and they can have a huge impact on psychological health, social and sexual interactions and quality of life.”

Additionally, McLean and her team are collecting information around access to pelvic health physiotherapy services. The goal is to understand barriers and facilitators for women trying to access these services, to influence policy.

“I’m finding that the longer I’m in this field doing this research, the more I need to be an advocate as well,” McLean says. “Because it’s great to have treatments that are effective, but they can only be effective if people can access them.”

Research scientist Flavia Ignacio Antonio and visiting doctoral student Tatiana de Bem Fretta demonstrate a treatment protocol using repetitive transcranial magnetic stimulation.
Research scientist Flavia Ignacio Antonio (right) and visiting doctoral student Tatiana de Bem Fretta (left) demonstrate a treatment protocol using repetitive transcranial magnetic stimulation the group is evaluating to treat pain due to endometriosis.