Prevalence of diastasis recti abdominis in a urogynecological patient population

Abstract

A urogynecologist's examination typically includes assessment of the abdominal musculature, including the determination of whether a diastasis recti abdominis (DRA) is present. The purposes of the current study were to examine the (1) prevalence of DRA in a urogynecological population, (2) differences in select characteristics of patients with and without DRA, and (3) relationship of DRA to support-related pelvic floor dysfunction diagnoses. A retrospective chart review was conducted by an independent examiner. Fifty-two percent of the patients examined presented with DRA. Patients with DRA were older, reported higher gravity and parity, and had weaker pelvic floor muscles than patients without DRA. Sixty-six percent of all the patients with DRA had at least one support-related pelvic floor dysfunction (SPFD) diagnosis. There was a relationship between the presence of DRA and the SPFD diagnoses of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse.

Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain

“…The cut-off value for normal IRD proposed by Beer et al (2009) was set for nulliparous women, and may be considered narrow for women during pregnancy and in the postpartum period. However, our prevalence of DRA of 39% is within the range of other prevalence studies (Bursch 1987;Boissonnault and Blaschak 1988;Spitznagle et al 2007). Published case reports indicate a partial resolution of the DRA at 4 weeks (Hsia and Jones 2000) and 8 weeks postpartum (Boissonnault and Blaschak 1988), which confers with the results of our study, where the prevalence of DRA decreased from 100% during pregnancy to 52.4% at 4-6 weeks after childbirth.…”

“…Criteria and cut off point for the diagnosis of DRA vary in the literature (Bursch 1987;Boissonnault and Blaschak 1988;Ranney 1990;Gilleard and Brown 1996;Rath et al 1996;Candido et al 2005;Spitznagle et al 2007;Beer et al 2009;Akram and Matzen 2014), and to date there is no international consensus on the measurement location. In a cadaver study , Rath et al (1996) defined a widening of the IRD more than 10 mm above the umbilicus, 27 mm at the level of the umbilicus and 9 mm below the umbilicus, as pathological DRA.…”

“…Identification of possible risk factors related to the presence of DRA at 6 months postpartum was based in former published studies (Candido et al 2005;Spitznagle et al 2007;Beer et al 2009;Liaw et al 2011) and included: women's age, pre-pregnancy body mass index (BMI), weight gain during pregnancy, BMI at 6 months postpartum, hypermobility score, baby weight at birth, abdominal circumference in late pregnancy and level of exercise training.…”

“…However the condition has also been found in 39% of older, parous women undergoing abdominal hysterectomy (Ranney 1990) and in 52% of urogynecological menopausal patients (Spitznagle et al 2007). Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis (Bursch 1987;Boissonnault and Blaschak 1988;Gilleard and Brown 1996;Rath et al 1996;Chiarello et al 2005;Spitznagle et al 2007;Beer et al 2009) and use of different measurement methods. Most prevalence studies are based on palpation (Bursch 1987; Boissonnault and Blaschak 1988;2004) or calipers (Boxer and Jones 1997;Hsia and Jones 2000) which may be less reliable than ultrasonography (Mota et al 2013).…”

Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements

“…During pregnancy the Linea Alba reduces the resistance to tension and the two bellies of the rectus abdominis (RA) curve round the abdominal wall, increasing the midline separation of the two RA muscles along the Linea Alba (Boissonnault and Blaschak, 1988;Fast et al, 1990;Gilleard and Brown, 1996). This gap, the Inter Rectus Distance (IRD) is often referred as diastasis recti abdominis (DRA) (Noble, 1995;Spitznagle et al, 2007;Coldron et al, 2008). Studies have found that an increased DRA may affect between 30% and 70% of women during pregnancy (Boissonnault and Blaschak, 1988), and that it may remain separated in the immediate postpartum in 34.9% (Boissonnault and Blaschak, 1988) to 60% of women (Bursch, 1987;Boissonnault and Blaschak, 1988;Boxer and Jones, 1997).…”