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Postoperative Activity Restrictions

Any Evidence?

From the ¹Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; ²Department of Obstetrics and Gynecology, University of Utah College of Medicine, Salt Lake City, Utah; ³Department of Physical Therapy and Rehabilitation Sciences University of Iowa; ⁴Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine; and ⁵Department of Health and Sports Studies University of Iowa, Iowa City, Iowa.

OBJECTIVE: Because of a widespread but untested belief that increased intra-abdominal pressure contributes to pelvic floor disorders, physicians commonly restrict various activities postoperatively. Our aim was to describe intra-abdominal pressures during common physical activities.

METHODS: Thirty women of wide age and weight ranges who were not undergoing treatment for pelvic floor disorders performed 3 repetitions of various activities while intra-abdominal pressures (baseline and maximal) were approximated via microtip rectal catheters. We calculated median peak and net pressures (centimeters of H₂O). We assessed correlations between abdominal pressures and body mass index, abdominal circumference, and grip strength (a proxy for overall strength). P < .025 was considered significant.

RESULTS: Median peak abdominal pressures ranged from 48 (lifting 8 lb from a counter) to 150 (lifting 35 lb from the floor), with much variation. Many activities did not raise the intra-abdominal pressure more than simply getting out of a chair, including lifting 8, 13, and 20 lb from a counter, lifting 8 or 13 lb from the floor, climbing stairs, walking briskly, or doing abdominal crunches. Body mass index and abdominal circumference each correlated positively with peak, but not net, pressures. Age and grip strength were not associated with abdominal pressure.

CONCLUSION: Some activities commonly restricted postoperatively have no greater effect on intra-abdominal pressures than unavoidable activities like rising from a chair. How lifting is done impacts intra-abdominal pressure. Many current postoperative guidelines are needlessly restrictive. Further research is needed to determine whether increased intra-abdominal pressure truly promotes pelvic floor disorders.

LEVEL OF EVIDENCE: III

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