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Activity Restriction After Pelvic Floor Surgery?



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Am Fam Physician. 2006 Sep 1;74(5):842-844.

After having pelvic floor surgery, most women are advised not to lift more than 10 lb (4.5 kg) and to avoid exercise or heavy work. Weir and colleagues found little evidence in the research literature that such activity restrictions are associated with improved outcomes. They conducted experiments to assess the intra-abdominal pressures associated with lifting and other common activities in women differing in age, body habitus, and grip strength.

The authors recruited 30 healthy women, mainly by newspaper advertisements. One half of the women had a body mass index (BMI) of 30 kg per m2 or greater. The study group was designed to include women of each age decile between 20 and 60 years. Intra-abdominal pressure was measured by rectal catheter during the performance of several common activities, including rising from a chair, coughing, climbing stairs, performing jumping jacks, walking on a treadmill at different speeds, and lifting weights (8, 13, 20, and 35 lb [3.6, 5.9, 9.1, and 15.9 kg]). Each activity was repeated three times, and the mean pressure was recorded. For each woman, height, weight, waist circumference, and grip strength (as a proxy for overall strength) were documented.

Each activity was associated with a fairly consistent change in abdominal pressure relative to other activities. The highest intra-abdominal pressures were associated with forceful coughing and the lifting of 20- and 35-lb weights from the ground. The lowest pressures were documented during the lifting of 8-lb weights from counter height, low table height, and overhead. However, pressures for the same activity varied widely among participants, with the most strenuous activities showing the greatest variation.

As a baseline, the researchers selected pressure associated with rising from a chair without using the arms. Several activities, such as performing abdominal crunches, climbing stairs, and walking on a treadmill, did not raise intra-abdominal pressure above this baseline. Some activities that commonly are prohibited after surgery (e.g., lifting 13-lb weights from the floor, lifting 20-lb weights from a counter) were associated with lower intra-abdominal pressure than baseline (see accompanying table). The participant’s BMI affected the peak pressure recorded but not the net pressure. None of the other patient variables recorded had a significant impact on intra-abdominal pressure.

Intra-abdominal Peak Pressures During Activities

Activity Median* Minimum Maximum

Lifting 8 lb (3.6 kg) from counter

47.7

20.7

84.0

Lifting 13 lb (5.9 kg) from counter

59.0

33.7

102.7

Lifting 20 lb (9.1 kg) from counter

63.0

34.0

122.5

Performing crunch-type sit-up

68.0

19.7

174.0

Standing from chair

70.0

36.0

229.0

Climbing steps

70.0

34.0

116.3

Walking on treadmill at 3.3 miles (5.3 km) per hour

79.0

48.0

190.0

Medium coughing while sitting

92.3

56.7

208.0

Rising from supine

100.3

64.3

249.7

Performing jumping jacks

126.7

59.0

189.7

Forceful coughing while standing

136.0

73.0

252.7

Lifting 35 lb (15.9 kg) from floor

149.3

65.5

335.0


*—With the exception of the treadmill activities, values are derived from the mean of three repetitions of each activity per participant. Pressures are expressed in centimeters of water.

Adapted with permission from Weir LF, Nygaard IE, Wilken J, Brandt D, Janz KF. Postoperative activity restrictions. Any evidence? Obstet Gynecol 2006;107:307.

Intra-abdominal Peak Pressures During Activities

View Table

Intra-abdominal Peak Pressures During Activities

Activity Median* Minimum Maximum

Lifting 8 lb (3.6 kg) from counter

47.7

20.7

84.0

Lifting 13 lb (5.9 kg) from counter

59.0

33.7

102.7

Lifting 20 lb (9.1 kg) from counter

63.0

34.0

122.5

Performing crunch-type sit-up

68.0

19.7

174.0

Standing from chair

70.0

36.0

229.0

Climbing steps

70.0

34.0

116.3

Walking on treadmill at 3.3 miles (5.3 km) per hour

79.0

48.0

190.0

Medium coughing while sitting

92.3

56.7

208.0

Rising from supine

100.3

64.3

249.7

Performing jumping jacks

126.7

59.0

189.7

Forceful coughing while standing

136.0

73.0

252.7

Lifting 35 lb (15.9 kg) from floor

149.3

65.5

335.0


*—With the exception of the treadmill activities, values are derived from the mean of three repetitions of each activity per participant. Pressures are expressed in centimeters of water.

Adapted with permission from Weir LF, Nygaard IE, Wilken J, Brandt D, Janz KF. Postoperative activity restrictions. Any evidence? Obstet Gynecol 2006;107:307.

The researchers conclude that many activities that commonly are restricted following surgery have no greater effect on intra-abdominal pressure than normal daily activities. They call for additional research to clarify guidance given to patients after surgery.

Weir LF, et al. Postoperative activity restrictions. Any evidence?. Obstet Gynecol. February 2006;107:305–9.


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