Ingrid Nygaard

University of Utah

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Linda Brubaker

University of California, San Diego

Holly E. Richter

University of Alabama at Birmingham

Janet M. Shaw

University of Utah

Marlene J. Egger

University of Utah

Anthony G. Visco

Duke University

Anne M. Weber

Research Institute for Philosophy Hannover

Robert Hitchcock

University of Utah

Halina M. Zyczynski

University of Pittsburgh Medical Center

Catherine S. Bradley

University of Iowa Hospitals and Clinics

Matthew D. Barber

Open Data Institute

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Health and Human Development (2HD) Research Network

127

Harvard University

111

University of Utah

102

University of Pennsylvania

University of Michigan–Ann Arbor

Monash University

University of Alabama at Birmingham

University College London

Eunice Kennedy Shriver National Institute of Child Health and Human Development

University of Iowa

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Postoperative Activity Restrictions

Obstetrics and Gynecology (2006)

Larissa F. Weir Ingrid Nygaard Jason M. Wilken Debra Brandt Kathleen F. Janz

In Brief OBJECTIVE: Because of a widespread but untested belief that increased intra-abdominal pressure contributes to pelvic floor disorders, physicians commonly restrict various activities postoperatively. Our aim was to describe intra-abdominal pressures during common physical activities. METHODS: Thirty women of wide age and weight ranges who were not undergoing treatment for pelvic floor disorders performed 3 repetitions of various activities while intra-abdominal pressures (baseline and maximal) were approximated via microtip rectal catheters. We calculated median peak and net pressures (centimeters of H2O). We assessed correlations between abdominal pressures and body mass index, abdominal circumference, and grip strength (a proxy for overall strength). P < .025 was considered significant. RESULTS: Median peak abdominal pressures ranged from 48 (lifting 8 lb from a counter) to 150 (lifting 35 lb from the floor), with much variation. Many activities did not raise the intra-abdominal pressure more than simply getting out of a chair, including lifting 8, 13, and 20 lb from a counter, lifting 8 or 13 lb from the floor, climbing stairs, walking briskly, or doing abdominal crunches. Body mass index and abdominal circumference each correlated positively with peak, but not net, pressures. Age and grip strength were not associated with abdominal pressure. CONCLUSION: Some activities commonly restricted postoperatively have no greater effect on intra-abdominal pressures than unavoidable activities like rising from a chair. How lifting is done impacts intra-abdominal pressure. Many current postoperative guidelines are needlessly restrictive. Further research is needed to determine whether increased intra-abdominal pressure truly promotes pelvic floor disorders. LEVEL OF EVIDENCE: III Some activities commonly restricted after gynecologic surgery have no greater impact on intra-abdominal pressures than unavoidable activities like rising from a chair.

Circumference

10.1097/01.aog.0000197069.57873.d6

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Citations (69)

Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3—exercise in the postpartum period

British Journal of Sports Medicine (2017)

Kari Bø Raúl Artal Ruben Barakat Wendy J. Brown Gregory Davies

Exercise and pregnancy in recreational and elite athletes : 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period.

Elite Athletes

Elite

10.1136/bjsports-2017-097964

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Citations (110)

Laparoscopic hysterectomy: weigh harms, but do not dismiss benefits

American Journal of Obstetrics and Gynecology (2015)

Ingrid Nygaard

Laparoscopic hysterectomy

10.1016/j.ajog.2015.03.016

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Citations (3)

Vaginal Wall Descensus and Pelvic Floor Symptoms in Older Women

Obstetrics and Gynecology (2005)

Catherine S. Bradley Ingrid Nygaard

To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms.In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus.Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and feeling a bulge were associated with vaginal descensus. Obstructive urinary symptom scores increased as anterior (P = .04), posterior (P < .01), and maximal (P = .01) vaginal descensus increased. Urinary incontinence or bowel symptoms were not associated with descensus of any vaginal compartment. ''See or feel a bulge,'' reported by 11 women (4%), was associated with descensus in all compartments (P < or = .04 for all) and with prolapse at or beyond the hymen (P < .001). This symptom was specific (100%), but not sensitive (16%) for prolapse, defined as descensus at or beyond the hymen.Vaginal support defects in older women are associated with obstructive urinary symptoms and the symptom of seeing or feeling a bulge. However, symptoms are not useful in discriminating between women with and without milder vaginal wall descensus. Based on these results, we suggest that other etiologies for bothersome bladder or bowel complaints be considered before performing surgery for early pelvic organ prolapse.

Hymen

Etiology

10.1097/01.aog.0000180183.03897.72

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Citations (157)

Early postpartum physical activity and pelvic floor support and symptoms 1 year postpartum

American Journal of Obstetrics and Gynecology (2020)

Ingrid Nygaard Ali E. Wolpern Tyler Bardsley Marlene J. Egger Janet M. Shaw

10.1016/j.ajog.2020.08.033

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Citations (33)

Mindfulness-Based Stress Reduction for Treatment of Urinary Urge Incontinence

Female Pelvic Medicine & Reconstructive Surgery (2011)

Jan Baker Donna Costa Ingrid Nygaard

The objective of the study was to evaluate if a mindfulness-based stress reduction program is a viable treatment worthy of further evaluation for the treatment of urinary urge incontinence.This was a single-arm pilot study of 7 women who participated in an 8-week mindfulness-based stress reduction program to evaluate its effectiveness in reducing urinary leakage episodes. Improvement was measured by 3-day bladder diary, Overactive Bladder Symptom and Quality of Life-Short Form, Health-Related Quality of Life, and Patient Global Impression of Improvement. Outcome data were analyzed by means of paired t tests.Mean incontinence episodes per day decreased from 4.14 (SD, 1.96; range, 2.67-7.67) at baseline to 1.23 (SD, 0.93; range, 0.33-2.67) after treatment (P = 0.0005 for change). After treatment, 5 of 7 women were improved based on the Patient Global Impression of Improvement, and 2 were unchanged. Significant improvements on both Health-Related Quality of Life and Overactive Bladder Symptom and Quality of Life-Short Form were reported after treatment. Results were sustained at 1 year in 4 of 7 women. Two women sought treatment, and one was lost to follow-up at 12 months.Mindfulness-based stress reduction appears to be a treatment worthy of further study, as in the short term, it is as effective as historical studies of drug treatment and bladder training in reducing urge incontinence and incontinence-related quality of life.

Stress incontinence

Urge incontinence

10.1097/spv.0b013e31824107a6

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Citations (85)

Notice of a Second Report of the Same Case

Obstetrics and Gynecology (2005)

Marta J. Van Beek John S. Strauss Ingrid Nygaard

10.1097/01.aog.0000151956.00804.78

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Citations (3)

Older maternal age at first vaginal delivery is associated with increased genital hiatus size at 1 year postpartum

American Journal of Obstetrics and Gynecology (2024)

Carolyn W. Swenson Whitney K. Hendrickson Amanda A. Allshouse Ingrid Nygaard

Hiatus

Sex organ

10.1016/j.ajog.2024.01.021

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Temporal trends in trunk flexor endurance and intra-abdominal pressure in postpartum women

Physiotherapy Theory and Practice (2019)

Russell Hendrycks Meng Yang Robert Hitchcock Monika Leitner Stefan Niederauer

Objectives: To describe change in trunk flexor endurance and intra-abdominal pressure (IAP) associated with trunk flexor assessment and explore factors associated with change in trunk flexor endurance during the first postpartum year.Design: Ancillary analysis of an ongoing prospective cohort study.Methods: Participants (N = 282) were primiparous women delivered vaginally. They completed trunk flexor endurance testing while assessing IAP, body habitus measures (body mass index, waist circumference, and body composition), and questionnaires 5–10 weeks and 11–15 months postpartum. We investigated change in trunk flexor endurance by quartile of improvement and factors associated with improvement (Q4 vs. Q1-Q3) using multivariable models, adjusted for baseline endurance.Results: Mean age was 28 ± 5 years. The median (IQR) trunk flexor hold time increased from early to late postpartum (129/IQR = 68, 217 vs 148/IQR = 80, 265 seconds, p = .01) and mean (SD) IAP decreased (55/SD = 13 vs 48/SD = 14 cmH20, p < .0001). The most improved group (Q4) increased endurance time by 176 seconds (95% CI = 103, 254), were less likely to be Hispanic, more likely to be older, more educated, and have lower measures of body habitus than women in Q1-Q3. Conclusion: Trunk flexor endurance increased and IAP decreased over one year postpartum. Lower body habitus and higher age early postpartum predicted greatest improvement in trunk flexor endurance at 1 year.

Quartile

10.1080/09593985.2019.1686792

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Citations (3)

Risk factors for painful bladder syndrome in women seeking gynecologic care

International Urogynecology Journal (2005)

Colleen M. Kennedy Catherine S. Bradley Rudolph P. Galask Ingrid Nygaard

Specialty

Bladder Pain Syndrome

10.1007/s00192-005-1348-8

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Citations (27)