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

• Published in: International Urogynecology Journal Vol. 32; no. 9; pp. 2367 - 2375
• Main Authors: Eisenberg, Vered H., Sela, Lee, Weisman, Asaf, Masharawi, Youssef
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2021; Springer Nature B.V
• Subjects: Abdomen; Gynecology; Medicine; Medicine & Public Health; Morphology; Original Article; Pelvis; Questionnaires; Urology; Pregnancy; Rectus abdominus; Pain; Pelvic floor trauma; Urogynaecology; Ultrasound; Diastasis rectus abdomins
• DOI: 10.1007/s00192-020-04619-4
• ISSN: 0937-3462

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.