KNAW Early Career Award winner Anique Bellos-Grob offers new perspective on pelvic floor dysfunction

If it were up to Anique Bellos-Grob, there would be a major push to find answers to the problem of pelvic floor dysfunction: ‘Pelvic floor dysfunction is a taboo topic. No one likes to talk about prolapses or urinary and faecal incontinence, but in fact these problems are very common. On top of that, there’s still a lot of uncertainty about the right treatment.’  

Why do we know so little about such a common issue? Bellos-Grob: ‘Many studies still make use of very basic methods, such as physical examinations, patient questionnaires and simple ultrasound imaging. My research team and I are exploring innovative techniques, such as MRI scanners that allow women to be examined in an upright position. That gives us a much more realistic picture of women’s symptoms, since most experience them while standing up.’ 

Applying research findings in clinical practice 

Anique Bellos-Grob obtained her Master’s degree in Technical Medicine from the University of Twente and then pursued a PhD in the Department of Gynaecology at UMC Utrecht. Her work, which she divides across three different jobs, centres on pelvic floor dysfunction. Bellos-Grob: ‘I work as a technical physician in the gynaecology outpatient department of Ziekenhuisgroep Twente (ZGT), I conduct research and I teach at the University of Twente. This variety suits me, because it puts me in direct contact with my research target group while allowing me to apply my research findings in clinical practice. I also train entry-level health care professionals.’ 

Upright MRI scanners 

The use of an upright MRI scanner is what sets Bellos-Grob apart from other medical researchers in her field, and it was also one of the reasons she was selected by the jury for a 2023 KNAW Early Career Award. Bellos-Grob: ‘The manufacturer of the upright MRI scanner actually developed it for orthopaedic use. The scanner’s open design also makes it highly suitable for educational purposes, which is in fact why the University of Twente acquired it. But when I saw that device standing there, I thought: wow, that would be interesting for studying prolapses. So we decided to experiment with it, and it turned out that there are shockingly huge disparities between pelvic measurements when a woman is standing up and when she’s lying down.’ 

The disparity between standing up and lying down is important, for example when fitting a pessary. Bellos-Grob: ‘The pessary is a widely used medical device, but unfortunately around 40% of women find it ineffective. Why does it stay in place in some women and not in others? We don’t really know. Some studies have looked at the internal position of the pessary in women lying prone in an MRI scanner, but I don’t think that’s ever going to give us the whole answer. There’s a world of difference between standing up and lying down: the position of the pessary and the forces exerted on it when standing up and when lying down are completely different.’ 

Clinical versus technical 

It seems obvious that a patient who suffers symptoms mainly while standing up should be examined in an upright position. Why was the upright MRI not used for this purpose before? Bellos-Grob: ‘To some degree, it’s a question of availability. Whenever I publish, a common remark is that my results are useless for clinical practice because many women simply don’t have access to an upright MRI. However, without an initial, more fundamental understanding, we won’t be able to improve the pessary.’  

Bellos-Grob believes that a multidisciplinary approach will produce new findings: ‘Pelvic floor research is situated in a clinical domain and I think that part of the hiccup comes down to the unilaterally clinical approach to the problem. In addition to technical physicians, pelvic physiotherapists, gynaecologists and other clinicians, my team is made up of biomedical technologists and computer scientists. We take a strongly multidisciplinary approach that involves practical clinical experience on the one hand and a technical approach to problems on the other.’ 

Studying full ruptures 

Bellos-Grob also intends to take a multidisciplinary approach to studying full ruptures, a project in which she aims to invest the €15,000 she received as a 2023 KNAW Early Career Award winner. Bellos-Grob: ‘I plan to spend some of the prize money on a working visit to London. There’s a group of researchers there who specialise in ultrasound examinations of women who’ve suffered a full rupture. Until now, we’ve generally used fairly simple ultrasound devices in such instances, but they only allow us to examine the anatomical side of things. What we also need to study is muscle function. For example, do the muscles still contract adequately? I have an idea for a technical tool that will allow us to evaluate muscle function based on ultrasound images. I’d love to work with this group on developing this tool.’ 

In hope of better treatment for pelvic floor dysfunction  

So far, the Early Career Award has brought Bellos-Grob plenty of exposure – which is not a bad thing, either for her research or her job. Bellos-Grob: ‘I was recently interviewed in two regional newspapers, Tubantia and de Gelderlander. All of a sudden, the outpatient clinic saw a mass influx of patients with faecal incontinence issues. Ultimately, my hope is that women who suffer these symptoms realise they’re not alone and that our research will lead to more effective treatment. Sometimes I have to wonder why we can put a man on the moon, but don’t know why a pessary stays in place. How hard can it be?’ 

About the KNAW Early Career Award  

Bellos-Grob is one of the 12 winners of the 2023 KNAW Early Career Award. With this award, the Royal Netherlands Academy of Arts and Sciences recognises innovative and original research and encourages the continued professional development of a broad, diverse group of early-career researchers in various fields of scientific practice. If you would like to read about the other award-winning researchers, you can find more information here: KNAW Early Career Award for 12 young researchers.