Strenuous physical activity has been linked to pelvic floor disorders in women. Using a novel wireless intra-vaginal pressure transducer, intra-abdominal pressure was measured during diverse activities in a laboratory. Fifty-seven women performed a prescribed protocol using the intra-vaginal pressure transducer. We calculated maximal, area under the curve and first moment of the area intra-abdominal pressure for each activity. Planned comparisons of pressure were made between levels of walking and cycling and between activities with reported high pressure in the literature. Findings indicate variability in intra-abdominal pressure amongst individuals doing the same activity, especially in activities that required regulation of effort. There were statistically significant differences in maximal pressure between levels of walking, cycling and high pressure activities. Results for area under the curve and first moment of the area were not always consistent with maximal pressure. Coughing had the highest maximal pressure, but had lower area under the curve and first moment of the area compared to most activities. Our data reflect novel findings of maximal, area under the curve and first moment of the area measures of intra-abdominal pressure, which may have clinical relevance for how physical activity relates to pelvic floor dysfunction.

Introduction Many surgeons recommend rest and restricting activities to their patients after surgery. The aim of this review is to summarize the literature regarding types of activities gynecologic surgeons restrict and intra-abdominal pressure during specific activities and to provide an overview of negative effects of sedentary behavior (rest). Methods We searched Pubmed and Scopus for years 1970 until present and excluded studies that described recovery of activities of daily living after surgery as well as those that assessed intra-abdominal pressure for other reasons such as abdominal compartment syndrome and hypertension. For our review of intra-abdominal pressure, we excluded studies that did not include a generally healthy population, or did not report maximal intra-abdominal pressures. Results We identified no randomized trial or prospective cohort study that studied the association between post-operative activity and surgical success after pelvic floor repair. The ranges of intra-abdominal pressures during specific activities are large and such pressures during activities commonly restricted and not restricted after surgery overlap considerably. There is little concordance in mean peak intra-abdominal pressures across studies. Intra-abdominal pressure depends on many factors, but not least the manner in which it is measured and reported. Conclusions Given trends towards shorter hospital stays and off work intervals, which both predispose women to higher levels of physical activity, we urge research efforts towards understanding the role of physical activity on recurrence of pelvic organ prolapse and urinary incontinence after surgery.

Aims In the urodynamics laboratory setting, a wireless pressure transducer, developed to facilitate research exploring intra-abdominal pressure (IAP) and pelvic floor disorders, was highly accurate. We aimed to study reproducibility of IAP measured using this transducer in women during activities performed in an exercise science laboratory. Methods Fifty seven women (mean ± SD: age 30.4 ±9.3 years; body mass index=22.4 ± 2.68 kg/m2) completed two standardized activity sessions using the same transducer at least three days apart. Pressure data for 31 activities were transmitted wirelessly to a base station and analyzed for mean net maximal IAP, area under the curve (AUC) and first moment of the area (FMA.) Activities included typical exercises, lifting 13.6 to 18.2 kg, and simulated household tasks. Analysis for test-retest reliability included Bland-Altman plots with absolute limits of agreement (ALOA), Wilcoxon signed rank tests to assess significant differences between sessions, intraclass correlations, and kappa statistics to assess inter-session agreement in highest vs. other quintiles of maximal IAP. Results Few activities exhibited significant differences between sessions in maximal IAP, or in AUC and FMA values. For 13 activities, the agreement between repeat measures of maximal IAP was better than ± 10 cm H20; for 20 activities, better than ± 15 cm H20. ALOA increased with mean IAP. The highest quintile of IAP demonstrated fair/substantial agreement between sessions in 25 of 30 activities. Conclusion Reproducibility of IAP depends on the activity undertaken. Interventions geared towards lowering IAP should account for this, and maximize efforts to improve IAP reproducibility.

Aims To test the feasibility of monitoring intra-abdominal pressure (IAP) outside the laboratory environment and to compare IAP while 1) carrying 13.6 kg (similar to a 3-month old in car seat) in 6 different ways while walking 100 meters; and 2) walking 400 meters at self-selected slow, normal, and fast pace. Methods Forty-six healthy women between 19 and 54 years completed the walking and lifting activities; the order for each was randomized. IAP was monitored with an intra-vaginal pressure transducer that wirelessly transmitted pressure data to a portable base station. We analyzed maximal peak IAP and area under the curve (AUC) IAP. Results Monitoring IAP outside of the laboratory was feasible. Mean maximal IAP during walking increased as pace increased; 42.5 (SD 10.2), 50.5 (10.9), and 62.0 (12.1) cm H2O for slow, medium, and fast speeds, respectively (p < 0.0001 by mixed model ANOVA). The corresponding AUC of IAP for walking decreased as pace increased. The ‘awkward carry’, ‘side carry’, and ‘front carry’ activities each resulted in higher mean maximal IAP (65.8 (10.6), 67.7 (12.8), 77.3 (13.1) cm H2O, respectively) than the ‘carry in backpack’ activity (55.5 (11.4) cm H2O; p < 0.0001). Conclusion Subtle variations in walking speed or method of carrying a toddler-size load can produce significant changes in IAP. Whether these increase the risk of pelvic floor disorders is not yet clear. However, these data suggest further inquiry into optimal methods and appliances to assist women in carrying may enable achieving a lower IAP profile.

Activities thought to induce high intra-abdominal pressure (IAP), such as lifting weights, are restricted in women with pelvic floor disorders. Standardized procedures to assess IAP during activity are lacking and typically only focus on maximal IAP, variably defined. Our intent in this methods paper is to establish the best strategies for calculating maximal IAP and to add area under the curve and first moment of the area as potentially useful measures in understanding biologic effects of IAP. Thirteen women completed a range of activities while wearing an intra-vaginal pressure transducer. We first analyzed various strategies heuristically using data from 3 women. The measure that appeared to best represent maximal IAP was an average of the three, five or ten highest values, depending on activity, determined using a top down approach, with peaks at least 1 second apart using algorithms written for Matlab computer software, we then compared this strategy with others commonly reported in the literature quantitatively using data from 10 additional volunteers. Maximal IAP calculated using the top down approach differed for some, but not all, activities compared to the single highest peak or to averaging all peaks. We also calculated area under the curve, which allows for a time component, and first moment of the area, which maintains the time component while weighting pressure amplitude. We validated methods of assessing IAP using computer-generated sine waves. We offer standardized methods for assessing maximal, area under the curve and first moment of the area for IAP to improve future reporting and application of this clinically relevant measure in exercise science.