Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study

Wang, Qing; Yu, Xiaomei; Chen, Gengmin; Sun, Xiuli; Wang, Jianliu

doi:10.1007/s00192-019-04005-9

Cited by 39 publications

(48 citation statements)

References 18 publications

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“…IRD-associated abdominal weakness may be related to a weak connective tissue, which may then affect thoracic, abdominal, and pelvic dynamics, resulting in the application of a force from the diaphragm in the thorax and the abdomen to the pelvic floor muscles, according to the theory of pelvic dynamics. Thus, IRD may be one of the risk factors for female pelvic floor dysfunction, characterized by painful urination, constipation or bowel strains, LBP, and PVP [ 25 ]. According to Benjamin et al, a widening >2.7 cm at the level of the umbilicus is considered a pathological diastasis of RA [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in our study, CS women presented a wider IRD (CS: 25.55 ± 6.48 mm, NU: 12.69 ± 6.28 mm, VA: 20.75 ± 7.41 mm) and duration of SP, which correlated moderately with IRD. It has been found that IRD incidence was significantly higher in CS than in VA women [ 25 ]. CS can cause a greater risk for increased IRD; in addition, a wider IRD may contribute to altering the normal gliding between fascial layers, weakening the abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

et al. 2020

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Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

et al. 2020

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“…POP was assessed by the gynaecologists and the physiotherapist using Pelvic Organ Prolapse Quantification System (POP-Q) in lithotomy position. POP was considered as a POP-Q stage ≥ 2 for any parts, no POP as a POP-Q of 0 or 1 [6]. The situation of UI was assessed by the medical history.…”

Section: Measurementsmentioning

confidence: 99%

“…The situation of UI was assessed by the medical history. A history of uncontrolled urine leakage determined UI postpartum, which was defined as the automatic leakage of urine occuring ≥ 2 times/week, whether stress incontinence, urgency incontinence or mixed incontinence [6].…”

Section: Measurementsmentioning

confidence: 99%

“…Diastasis of rectus abdominis (DRA) is a condition defined as a separation of the rectus abdominis from the linea alba [1,2]. Numerous studies have described the prevalence of DRA was between 27 and 100% [1,3,4]in the middle and late of pregnancy respectively, 30-68% in the postpartum period [4][5][6][7]. DRA is common in pregnancy and postpartum women [3].…”

Section: Introductionmentioning

confidence: 99%

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The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study

Fang

Liu

et al. 2021

BMC Women's Health

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Background Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba. This study aimed to investigate the association with the severity of DRA for developing pelvic floor dysfunction among women during the first year postpartum. Methods This is a retrospective cohort study which collected data from 229 postpartum women. DRA was defined as a separation of ≥ 20 mm at any point 4.5 cm above, at and 4.5 cm below the umbilicus. The data for analysis includes pelvic organ prolapse quantification (POP-Q), medical history of urinary incontinence (UI), the strength of rectus abdominis muscle and pelvic floor muscle. The differences in women with and without DRA were compared with independent samples t-test and Chi-square test. Results Prevalence of DRA was 82.6% during the first postpartum year. Cesarean section and multiple parturitions are recognized as risk factors for DRA due to the odds ratio in our study were 3.48 (95% CI 1.42–8.56), 3.20 (95% CI 1.59–6.45) respectively. There was no difference in the occurrence of UI and pelvic organ prolapse (POP) comparing women with and without DRA, even changing the cut-off values (inter-rectus distance = 20 mm, 30 mm, 40 mm, 50 mm) for determining DRA. The women with weak rectus abdominis muscle and pelvic floor muscle have no statistical difference in two group. Conclusion The relationship of the diastasis recti abdominis and pelvic floor dysfunction has no connection, even with the severity of inter-rectus distance increasing.

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Multidimensional Ultrasound Evaluation of Diastasis Recti Abdominis During Different Gestational Periods

Guo,

Wang,

Chen

et al. 2023

J of Ultrasound Medicine

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ObjectiveThe purpose of this study is to explore the application value of two‐dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of diastasis recti abdominis (DRA) during different gestational periods.MethodsA cohort of 202 gravidas that were examined in our hospital between June 2021 and September 2022 were selected for the purpose of the study, which included 26 cases with <14 weeks of pregnancy, 36 cases in the 14th–27th week of pregnancy, 36 cases in the 28th–34th week of pregnancy, 32 cases in the 35th–38th week of pregnancy, 45 cases at 42 days postpartum, and 27 cases at 3 months postpartum. The inter‐rectus distance (IRD) and the thickness in each gestational period were measured, and Young's modulus of the rectus abdominis at different gestational periods was measured using SWE by two sonographers. The differences in IRD, thickness, and elasticity characteristics during different periods, and the correlation between rectus abdominis elasticity and IRD, thickness, body mass index (BMI), neonatal weight, and delivery mode were analyzed and compared. The consistency of SWE parameters obtained by different sonographers was also compared.ResultsThere were significant differences in IRD, thickness, and Young's modulus during different gestational periods (P = .000, P < .001, P < .001). Early postpartum IRD and Young's modulus did not restore to the level of early pregnancy (P < .001, P < .001), while the thickness of rectus abdominis was not significantly different from that of early pregnancy (P = .211). The Young's modulus of rectus abdominis was negatively correlated with the IRD (r = .515), positively correlated with the thickness of rectus abdominis (r = .408), and weakly negatively correlated with maternal BMI (r = −.296). There was no significant correlation with neonatal weight or delivery mode (P = .147, .648). The Bland–Altman plot showed that the two sonographers had good consistency in evaluating the elasticity of rectus abdominis by SWE.ConclusionThe multidimensional evaluation of DRA by ultrasound is feasible and IRD and Young's modulus can be used to evaluate the postpartum recovery of DRA. The combination of the two can objectively reflect the severity of DRA morphology and function.

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Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study

Cited by 39 publications

References 18 publications

Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study

Multidimensional Ultrasound Evaluation of Diastasis Recti Abdominis During Different Gestational Periods

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