Trisha
Jenkyns PT, DPT, WCS
11-5-2014
Pelvic PT Distance Journal Club
OBJECTIVE: To quantify and compare
intraabdominal pressures (IAPs) in women with pelvic floor dysfunction… during
standard activities.
STUDY DESIGN:
Prospective,
descriptive study done at the University of Hawaii between 2007-2008. Women were sequentially recruited when
presenting for urodynamic testing with
dysfunctions of POP and /or UI
Exclusion
criteria: younger than 18 years old,
Pregnancy, mental o physical disability, or inability to safely perform the
activities in the study.
PROCEDURE
STARTED WITH CATHING TO EMPTY THE BLADDER, THEN…
Bladder
& vaginal pressure catheters were placed.
Bladders
were filled until the women reported a strong urge to void.
With the
vaginal pressure catheter in place to measure IAP, each subject performed
certain tasks in the same order.
- Standing up from a chair
- Coughing once
- Lifting 10 lbs by bending &
grasping a handle with one hand & standing
- Lifting 20 lbs, 10 lbs in each
hand
- Pushing 20 lbs on wheels for 3-4 feet
Net IAP was
recorded along with age, height, weight, indication for Urodynamic testing and
degree of POP for 147 women ( but the degree of POP was not included in the
findings)
Mean age was 57 with ages spanning 36-83
years), SUI was the most common reason for urodynamics
68.7% had
SUI,
18.4% for
POP, and
6.8% POP
& SUI
6.1 %
urinary urgency was
RESULTS:
Table I has more specific demographic data
Table II looks at the IAP (CM H2O) generated
by each activity.
Standing up
and coughing produced greatest IAP
What I find
very interesting here is not just the pressure induced by the coughing and
standing up, but also the tremendous variation.
For example with standing, in some women it was as little as 5 cm H2O or as high as 89 cm H2O …and with coughing
the minimum was 14 cm H2o and the maximum of 150 cm H2O. I wonder if the participants with higher IAPs
were holding their breath & bearing
down as they stood up.
When
looking at Table III, where they
make comparisons between activities
you can see
there was a significant difference between lifting 10 lbs and 20 lbs, but there
was still more IAP generated with coughing and standing up
Table IV describes the IAP according to
BMI. They found that IAP was
significantly greater for overweight women in all activities, except with standing.
Because BMI
was shown to be a significant factor … the authors concluded that this
population may benefit from stricter post-op restrictions then women with lower
BMI’s.
IN Table V…they looked at different age
groups and amount of IAP generated
Age was associated with a difference in IAP
only for standing. The 70-89 year group
generated significantly less IAP the younger than those younger than 70 years
old.
IAP during lifting did not vary by age group,
so the authors concluded that age might not be a factor in post-op
restrictions.
They also
pointed out that IAP did not differ with the presence of POP for any of the
activities
LIMITATIONS:
Things not factored in: hx of pelvic surgery, menopausal state and
parity, IAP during the activities was not different in women with POP, but
degree of POP was not identified when comparing data.
DISCUSSION:
- This study presents helpful quantitative data to
consider when advising pre and post-op gyne repairs and for promoting PT
pre & post op
- Reminder that patients would likely benefit from
education & training with breathing during all functional activities
to avoid excessive increased IAP.
- In particular the activity of sit to stand should
be discussed with patients
- What is the significance of this article compared
to other studies we have previously discussed looking at post gyne surgery
guidelines?
- It would be beneficial to study if IAP can be reduced by altering techniques for lifting, pushing or standing up and can we impact IAP with training & education?
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