Early activity resumption after prolapse surgery leads to improved pelvic floor outcome and increases patient satisfaction.

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Results of a recent RCT established better surgical and psychological outcome in patients who were advised to resume physical activity at their own pace after surgery instead of restricting the activity for several weeks. The study was published ahead of print  in forthcoming issue of obstetrics and gynecology.

ACOG advises “For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid sexual intercourse for several weeks after surgery.” [1]

RCOG recommends “to avoid heavy lifting after surgery and avoid sexual intercourse for 6–8 weeks.”[2]

Study lead Dr. Margaret G. Mueller from Northwestern University Feinberg School of Medicine in Chicago told Reuters Health in an email “For many years’ women have been told to adhere to strict activity restrictions following gynecologic surgery and given the impression that if they perform certain activities, they might threaten their repair,” she explained. “For this reason, many women delay surgery because they are simply uninterested or unable to avoid certain activities.”[3]

This study was designed to assess the difference between patient satisfaction and surgical outcome when they were advised either liberal or restricted postoperative activities.

The study period extended from September 2014 to December 2015, 95 women met the study criteria and randomized into 2 groups. The two groups matched in terms of baseline characteristics, demographics and surgical procedure.

Women in liberal group(n=45) was asked to resume normal daily activities at their own pace with no restriction placed on lifting weights or high impact activities. The other group(n=50) was instructed to avoid lifting weight and strenuous activities for 3 months past the surgery. Both groups received similar instructions for walking, climbing stairs and sexual intimacy.

Women were assessed at 3 months’ post-surgery for satisfaction, difficulty in resuming activity, symptoms of pelvic floor discomfort and anatomical healing.

It was seen that women in both groups reported similar surgical satisfaction rates and anatomical healing at 3 months but, women in the liberal group reported fewer urinary and prolapse symptoms.

The authors concluded “allowing women to resume their normal activities postoperatively may result in improved pelvic floor outcomes.”

Although the study has a drawback of small sample size and all women did not undergo the exact same surgery, but still patient can be told about the advantage of early mobilization post-surgery to make informed decision till larger trials and data are available. 

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[1] http://www.acog.org/Patients/FAQs/Surgery-for-Pelvic-Organ-Prolapse

[2] https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi-pelvic-organ-prolapse.pdf

[3] OK to Liberalize Activity Recommendations After Prolapse Surgery: Study. Medscape. Mar 10, 2017.