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The relationship between diastasis rectus abdominus, pelvic floor trauma and function in primiparous women postpartum

Abstract

Introduction and hypothesis

A functional interaction exists between the pelvic floor and the abdominal wall. The study was aimed at investigating the clinical and morphological relationships between diastasis rectus abdominus (DRA) and pelvic floor trauma in primiparous women.

Methods

Eighteen women suffering from DRA and 18 women without DRA (non-DRA group), all primiparous with pelvic floor trauma, were enrolled in the study. Ultrasound was performed on the 36 women examining the inter-rectus distance, pelvic floor morphology, abdominal muscle force (MMT), Static Abdominal Flexion Endurance Test (SFET), and Dynamic Abdominal Flexion Endurance Test (DFET), abdominal circumference, visual analog scale, and responses to the Oswestry Low Back Pain Questionnaire and the Pelvic Floor Distress Inventory questionnaire (PFDI).

Results

A significant increase in the urinary symptoms portion of the in PFDI-20 questionnaire was found in the DRA group (non-DRA = 12.5 ± 22.8, DRA = 26.8 ± 18.2, p = 0.01). A significant reduction in abdominal force and endurance was observed in the DRA2–3 group compared with the DRA0–1 group (0.025 < p < 0.04). DFET (average repetitions) in the DRA0–1 group measured 13.4 ± 11.8 and 6.46 ± 4.59 in the DRA2–3 group (p = 0.025). SFET was 20.48 ± 14.46 s in the DRA0–1 group and 10.62 ± 10.6 s in the DRA2–3 group (p = 0.031). MMT was 4 in the DRA0–1 group and 3 in the DRA2–3 group (p = 0.04).

Conclusions

Diastasis rectus abdominus does not correlate with morphological changes in the pelvic floor, but does correlate with higher scores in the urinary symptoms portion of the PFDI-20. Women suffering from DRA do not endure more pain or greater lumbar disability than non-DRA women. In extended DRA, the abdominal muscles are significantly compromised and weaker.

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Funding

There was no external funding for this study.

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Authors

Contributions

V.H. Eisenberg: project development, data collection, data analysis and manuscript writing; L. Sela: project development, data collection, data analysis and manuscript writing; A. Weisman: project development, data analysis and manuscript writing/editing; Y. Masharawi: project development, data collection, data analysis and manuscript writing.

Corresponding author

Correspondence to Youssef Masharawi.

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Eisenberg, V.H., Sela, L., Weisman, A. et al. The relationship between diastasis rectus abdominus, pelvic floor trauma and function in primiparous women postpartum. Int Urogynecol J 32, 2367–2375 (2021). https://doi.org/10.1007/s00192-020-04619-4

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Keywords

  • Diastasis rectus abdomins
  • Pain
  • Pelvic floor trauma
  • Pregnancy
  • Rectus abdominus
  • Ultrasound
  • Urogynaecology