Many activities after pelvic surgery appear safe

NEW YORK (Reuters Health) - Many of the activities that are normally restricted following surgery for pelvic-floor disorders are no more taxing than common everyday activities, such as rising from a chair or bed, new study findings suggest. It may thus be time for doctors to reconsider the advice they give to their patients.

Pelvic-floor disorders involve a weakening of the muscles or ligaments that support the uterus, bladder, and rectum. In mild cases, these organs can protrude into the vagina, whereas in severe cases, they may actually protrude outside the body. Treatment typically involves special "Kegel" exercises for mild cases and surgery for more severe cases.

Based on the fact that increased abdominal pressure can disturb the operative repair, it is common for doctors to advise women not to engage in exercise and heavy labor after pelvic-floor surgery, Dr. Ingrid Nygaard and her associates note in their report, published in the medical journal Obstetrics and Gynecology. These restrictions can be life altering, preventing women from caring for children, working and exercising.

To investigate whether these limitations are warranted, Nygaard, from the University of Utah College of Medicine in Salt Lake City, and her team recruited 30 women between 20 and 60 years old who had no medical conditions that limited their daily activities.

The researchers measured abdominal pressures as the women performed a variety of activities, including coughing, rising from a chair, climbing stairs, jumping jacks, abdominal crunches and lifting weights.

Compared with standing from a chair with hands on thighs, lifting 13 pounds from the floor or 20 pounds from a counter, performing abdominal crunches, climbing steps, and walking on a treadmill at 2.7 miles per hour all caused less abdominal pressure.

Other activities, such as forceful coughing and lifting 35 pounds from the floor, caused higher abdominal pressures and probably should still be avoided after surgery.

Being overweight or obese also increased abdominal pressures and therefore "it might be beneficial to focus on preoperative weight loss and postoperative low-impact exercise" in women with these issues, the authors suggest. By contrast, age seemed to have little impact on abdominal pressure.

"This study helps lay the foundation for evidence-based activity restrictions as we await more long-term studies that will show us the true clinical impact of activity and...abdominal pressure on pelvic floor dysfunction," Nygaard's team concludes.

SOURCE: Obstetrics and Gynecology, February 2006.