Skip to main content
SpringerLink
Log in

Alterations of the Abdominal Wall During Pregnancy

  • Chapter
  • First Online:
Post-maternity Body Changes

  • 296 Accesses

Abstract

Pregnancy and becoming a mother is one of the most exciting times in a women’s life. Besides all the hormonal and physiological changes affecting women during this period, probably the most obvious morphological alteration during pregnancy is the increasing weight and dimensions of the uterus, influencing maternal trunk musculoskeletal morphology, particularly the abdominal musculature. Diastasis recti abdominis (DRA), or increased inter rectus distance (IRD), is characterized by the separation of the rectus abdominis muscles. It has its onset during pregnancy and the first weeks following childbirth. The lack of evidence for the consequences of this condition and the effect of abdominal strengthening exercises in the reduction of DRA indicates a need for identification of prevalence and risk factors of DRA.

This chapter will cover the anatomy and reliability of the methods for the assessment of the morphology of the abdominal wall, describe DRA prevalence, risk factors and provide an overview of the response on the IRD induced by two typical strengthening exercises: the drawing in and abdominal crunch exercises.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Ellis H. Gray’s anatomy. 37th ed. P. L. Williams, R. Warwick, M. Dyson, L. H. Bannister. 305 × 235mm. pp. 1598. Illustrated. 1989. Edinburgh: Churchill Livingstone. £70.00. Br J Surg. 1989;76:1359.

    Article  Google Scholar 

  2. Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA. The normal width of the linea alba in nulliparous women. Clin Anat. 2009;22:706–11.

    Article  PubMed  Google Scholar 

  3. Axer H, Keyserlingk D, Prescher A. Collagen fibers in linea alba and rectus sheaths. I. General scheme and morphological aspects. J Surg Res. 2001;96:127–34.

    Article  CAS  PubMed  Google Scholar 

  4. Gräβel D, Prescher A, Fitzek S, Keyserlingk DGV, Axer H. Anisotropy of human linea alba: a biomechanical study. J Surg Res. 2005;124:118–25.

    Article  Google Scholar 

  5. Hernández-Gascón B, Mena A, Peña E, Pascual G, Bellón J, Calvo B. Understanding the passive mechanical behavior of the human abdominal wall. Ann Biomed Eng. 2012;41:433–44.

    Article  PubMed  Google Scholar 

  6. Rath A, Attali P, Dumas J, Goldlust D, Zhang J, Chevrel J. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat. 1996;18:281–8.

    Article  CAS  PubMed  Google Scholar 

  7. Lovering RM, Anderson LD. Architecture and fiber type of the pyramidalis muscle. Anat Sci Int. 2008;83:294–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Boissonnault J, Blaschak M. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68:1082–6.

    Article  CAS  PubMed  Google Scholar 

  9. Akram J, Matzen S. Rectus abdominis diastasis. J Plast Surg Hand Surg. 2014;48:163–9.

    Article  PubMed  Google Scholar 

  10. Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008;13:112–21.

    Article  PubMed  Google Scholar 

  11. Benjamin D, van de Water A, Peiris C. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100:1–8.

    Article  CAS  PubMed  Google Scholar 

  12. Turatti R, de Moura V, Cabral R, Simionato-Netto D, Sevillano M, Leme P. Sonographic aspects and anatomy of the aponeurosis of transversus abdominis muscle. Arq Bras Cir Dig. 2013;26:184–9.

    Article  PubMed  Google Scholar 

  13. Mazaki-Tovi S, Vaisbuch E, Tarca AL, Kusanovic J, Than N, Chaiworapongsa T, et al. Characterization of visceral and subcutaneous adipose tissue transcriptome and biological pathways in pregnant and non-pregnant women: evidence for pregnancy-related regional-specific differences in adipose tissue. PLoS One. 2015;10:e0143779.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: risk factors, prevention, and management. Int J Womens Dermatol. 2016;3:77–85.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kim J, Lim H, Lee S, Kim Y. Thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue in adult women: correlation with age, pregnancy, laparotomy, and body mass index. Arch Plast Surg. 2012;39:528–33.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Foti T, Davids J, Bagley A. A biomechanical analysis of gait during pregnancy. J Bone Joint Surg Am. 2000;82:625–32.

    Article  CAS  PubMed  Google Scholar 

  17. Cunningham GF, Gant NF, Leveno KJ, Larry C. Williams obstetrics, 21st edition. J Midwifery Women’s Health. 2003;48:369.

    Article  Google Scholar 

  18. Davies GA, Wolfe LA, Mottola MF, MacKinnon C, Arsenault M-Y, Bartellas E, et al. Exercise in pregnancy and the postpartum period. J Obstet Gynaecol Canada. 2003;25:516–29.

    Article  Google Scholar 

  19. Fast A, Weiss L, Ducommun E, Medina E, Butler J. Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain. Spine. 1990;15:28–30.

    Article  CAS  PubMed  Google Scholar 

  20. Gilleard WL, Crosbie J, Richard S. Effect of pregnancy on trunk range of motion when sitting and standing. Acta Obstet Gynecol Scand. 2002;81:1011–20.

    Article  PubMed  Google Scholar 

  21. da Mota P, Pascoal A, Carita A, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015;20:200–5.

    Article  Google Scholar 

  22. Dumas G, Reid J, Wolfe L, Griffin M, McGrath M. Exercise, posture, and back pain during pregnancy. Clin Biomech. 1995;10:104–9.

    Article  CAS  Google Scholar 

  23. Parker MA, Millar LA, Dugan SA. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related? J Womens Health Phys Ther. 2009;33:15.

    Article  Google Scholar 

  24. Theodorsen N-M, Strand L, Bø K. Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy. 2018;105:315.

    Article  PubMed  Google Scholar 

  25. Bursch S. Interrater reliability of diastasis recti abdominis measurement. Phys Ther. 1987;67:1077–9.

    Article  CAS  PubMed  Google Scholar 

  26. Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med. 1990;43:5–8.

    CAS  PubMed  Google Scholar 

  27. Candido G, Lo T, Janssen P. Risk factors for diastasis of the recti abdominis. J Assoc Charter Physiotherap Womens Health. 2005.

    Google Scholar 

  28. Spitznagle TM, Leong F, Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18:321–8.

    Article  Google Scholar 

  29. Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Ther. 2005;29:11.

    Article  Google Scholar 

  30. Mota P, Pascoal A, Carita A, Bø K. Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract. 2018;35:34–7.

    Article  PubMed  Google Scholar 

  31. Mota P, Pascoal A, Sancho F, Bø K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther. 2012;42:940–6.

    Article  PubMed  Google Scholar 

  32. Rett M, Braga, Bernardes N, Andrade S. Prevalência de diástase dos músculos retoabdominais no puerpério imediato: comparação entre primíparas e multíparas. Braz J Phys Ther. 2009;13:275–80.

    Article  Google Scholar 

  33. Noble E. Essential exercises for the childbearing year: a guide to health and comfort before and after your baby is born. New Life Images. Harwich. 1995.

    Google Scholar 

  34. Mota P, Pascoal A, Sancho F, Carita A, Bø K. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther. 2013;18:294–8.

    Article  PubMed  Google Scholar 

  35. Teyhen DS, Miltenberger CE, Deiters H, Del Toro Y, Pulliam JN, Childs JD, et al. The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J Orthop Sports Phys Ther. 2005;35:346–55.

    Article  PubMed  Google Scholar 

  36. Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother. 2000;46:301–7.

    Article  PubMed  Google Scholar 

  37. Brækken I, Majida M, Ellstrøm-Engh M, Dietz H, Umek W, Bø K. Test–retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function. Int Urogynecol J. 2007;19:227–35.

    Article  Google Scholar 

  38. Hides JA, Miokovic T, Belavý DL, Stanton WR, Richardson CA. Ultrasound imaging assessment of abdominal muscle function during drawing-in of the abdominal wall: an intrarater reliability study. J Orthop Sports Phys Ther. 2007;37:480–6.

    Article  PubMed  Google Scholar 

  39. de Mendes D, Nahas F, Veiga D, Mendes F, Figueiras R, Gomes H, et al. Ultrasonography for measuring rectus abdominis muscles diastasis. Acta Cir Bras. 2007;22:182–6.

    Article  PubMed  Google Scholar 

  40. Whittaker JL, Warner MB, Stokes MJ. Induced transducer orientation during ultrasound imaging: effects on abdominal muscle thickness and bladder position. Ultrasound Med Biol. 2009;35:1803–11.

    Article  PubMed  Google Scholar 

  41. Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther. 2016;46:580–9.

    Article  PubMed  Google Scholar 

  42. Beamish N, Green N, Nieuwold E, McLean L. Differences in linea alba stiffness and linea alba distortion between women with and without diastasis recti abdominis: the impact of measurement site and task. J Orthop Sports Phys Ther. 2019;49:656–65.

    Article  PubMed  Google Scholar 

  43. Liaw L-J, Hsu M-J, Liao C-F, Liu M-F, Hsu A-T. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther. 2011;41:435–43.

    Article  PubMed  Google Scholar 

  44. Stokes IA, Gardner-Morse MG, Henry SM. Intra-abdominal pressure and abdominal wall muscular function: spinal unloading mechanism. Clin Biomech (Bristol, Avon). 2010;25:859–66.

    Article  PubMed  Google Scholar 

  45. Mannion A, Pulkovski N, Toma V, Sprott H. Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects. J Anat. 2008;213:173–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Richardson CA, Jull G, Hodges P, Hides JA. Therapeutic exercise for spinal segmental stabilization in low back pain: scientific basis and clinical approach. 1999.

    Google Scholar 

  47. Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Womens Health Phys Ther. 2012;36:131–42.

    Article  Google Scholar 

  48. Mota P, Pascoal A, Carita A, Bø K. The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthop Sports Phys Ther. 2015;45:781–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal

    Patrícia Mota

  2. Univ Lisboa, Fac. Motricidade Humana, CIPER, LBMF, P-1499-002, Lisbon, Portugal

    Patrícia Mota

Authors
  1. Patrícia Mota
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrícia Mota .

Editor information

Editors and Affiliations

  1. Department Obstetrics and Gynecology, MS Medical Institutes, Lisbon, Portugal

    Mónica Gomes-Ferreira

  2. Department Plastic Reconstructive and Aesthetic Surgery, MS Medical Institutes, Lisbon, Portugal

    Jesús Olivas-Menayo

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mota, P. (2023). Alterations of the Abdominal Wall During Pregnancy. In: Gomes-Ferreira, M., Olivas-Menayo, J. (eds) Post-maternity Body Changes. Springer, Cham. https://doi.org/10.1007/978-3-030-43840-1_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-43840-1_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43839-5

  • Online ISBN: 978-3-030-43840-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation