The purpose of this video is to illustrate the relative changes in intra-abdominal pressure during activities of daily living in comparison to physiological episodes such as cough or strain. There are large inconsistencies in post-operative advice given to patients as to which activities to avoid and for how long. Evidence is based on the assumption that certain activities raise intra-abdominal pressure to the point where healing of the repair may be compromised. We have selected eight activities from the iUGA at RCOG websites as activities to avoid post-operatively. The time period for abstinence varies but the activities are similar. We have previously developed a novel wireless pressure sensing system consisting of a small silicone balloon molded in the shape of vaginal anatomy. The balloon is filled with five mils of sterile water with a one millimeter diameter solid state Miller pressure catheter. Pressure data is recorded at a frequency of one kilohertz using lab chart seven. Pressure is transmitted wirelessly to a receiver situated outside the body. The balloon and the tubing is disposable. The sensor was self-inserted above the levator plate into the posterior fornix of the vagina shown here on this ultrasound image. This ensures that any involuntary contraction of the pelvic floor muscles should not confound the pressure measurement. Two age BMI and parity matched subjects are performing the selected activities. The subjects were aware on how to contract their pelvic floor muscles and how to perform an effective valsalva. There is minimal change in pressure during the pelvic floor muscle contractions. This would be expected when the pressure sensor is located above the levator plate. Intra-abdominal pressure measurements while lying are low. The mean pressure when standing is also only approximately three kilopascals or 20 millimeters of mercury. The change from sitting to standing is comparable to vacuuming. There is a substantial increase in pressure by 13 kilopascals during a cough compared to the baseline of three kilopascals. The rise in intra-abdominal pressure during strain is often substantial. Although peak pressures may not be as high as for a cough, the pressure is more sustained. This underlines the importance of not becoming constipated. The change in pressure from walking slowly at three kilometers an hour to a medium pace of six kilometers an hour is between two and 2.5 kilopascals. The change from walking to running is much greater, between five and 7.6 kilopascals. RCOG guidelines restrict lifting loads to a kettle, a small saucepan, or one liter of water. Here we illustrate lifting and pouring from a two kilogram milk bottle. The change in pressure is again minimal between two and 2.6 kilopascals, which is comparable to getting up out of a chair. Only small changes were seen with either lifting or carrying shopping bags. Lifting and carrying a basket of washing shows minimal rise in pressure. However, when squatting to lift, the pressure has a twofold increase. It may be protective for your back, but not for your pelvic floor. For many women, being told they are unable to lift their child or toddler is extremely limiting. For this subject, the rise in pressure was only five kilopascals and was only apparent when lifting the child. The IUGA website recommends avoiding lifting anything heavier than five to seven kilograms. Although the pressure changes are more apparent, the range is still small. This video provides a visual aid to clinicians and patients, demonstrating that the relative changes in intra-abdominal pressure during some common activities of daily living are minimal compared to physiological episodes, such as cough or strain. Future work using this technology will provide information on intra-abdominal pressure fluctuations in post-operative patients, helping guide clinical practice.

intra-abdominal pressure

daily activities

coughing

straining

post-operative advice