Long-Term Outcomes of Diastasis Recti Abdominis in Postpartum Women: A Retrospective Cohort Study

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2024 Sep 24

PMID 39316114

Authors

Lilu Wang

Chenxi Zhu

Jiaqi Zhang

Shuting Sun

Haoyue She

Lu Meng

Hongbo Xu

Yechun Gu

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: The objective was to investigate whether diastasis recti abdominis (DRA) can cause adverse outcomes for different long-term postpartum women.

Methods: We recruited 437 long-term postpartum women at five different time points (3, 5, 10, 20, and 30 years postpartum respectively). Inter-recti distance (IRD) and linea alba or umbilical hernia were measured by ultrasound. Strength of abdominal muscle was measured by a manual muscle test. Low back pain (LBP), urinary incontinence (UI) and quality of life (QOL) were measured by questionnaires including the Oswestry Disability Index, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, 36-Item Short Form Health Survey respectively.

Results: Women with DRA experienced more severe LBP, and poorer QOL only 10 years postpartum according to the diagnostic criterion of IRD > 2cm. However, when the diagnostic criterion was raised to IRD > 3cm, women with DRA reported weaker abdominal muscle strength, more severe LBP 3, 5, and 10 years postpartum, poorer QOL 3, 5, 10, and 20 years postpartum, and higher incidence of linea alba or umbilical hernia 5 and 20 years postpartum.

Conclusions: When using IRD > 2cm as the diagnostic criterion, the impact of DRA is minimal. However, when utilizing IRD > 3cm as the diagnostic criterion, DRA is associated with increased linea alba or umbilical hernia, weakened abdominal muscle strength, increased LBP, and decreased QOL. Most of the effects are particularly evident within 3-10 years postpartum, but becomes insignificant 20 and 30 years postpartum. Therefore, it is necessary to consider whether the diagnostic criterion of DRA need to be improved.

References

Michalska A, Rokita W, Wolder D, Pogorzelska J, Kaczmarczyk K . Diastasis recti abdominis - a review of treatment methods. Ginekol Pol. 2018; 89(2):97-101. DOI: 10.5603/GP.a2018.0016. View

Fei H, Liu Y, Li M, He J, Liu L, Li J . The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study. BMC Womens Health. 2021; 21(1):68. PMC: 7885475. DOI: 10.1186/s12905-021-01194-8. View

RANNEY B . Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med. 1990; 43(10):5-8. View

Sperstad J, Tennfjord M, Hilde G, Ellstrom-Engh M, Bo K . Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016; 50(17):1092-6. PMC: 5013086. DOI: 10.1136/bjsports-2016-096065. View

Fernandes da Mota P, Pascoal A, Carita A, Bo K . Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2014; 20(1):200-5. DOI: 10.1016/j.math.2014.09.002. View

Spitznagle T, Leong F, van Dillen L . Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 18(3):321-8. DOI: 10.1007/s00192-006-0143-5. View

Kulli H, Gurses H . Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol. 2022; 279:40-44. DOI: 10.1016/j.ejogrb.2022.10.001. View

Benjamin D, Frawley H, Shields N, van de Water A, Taylor N . Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2018; 105(1):24-34. DOI: 10.1016/j.physio.2018.07.002. View

Gluppe S, Ellstrom Engh M, Kari B . Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy. 2021; 111:57-65. DOI: 10.1016/j.physio.2021.01.008. View

10.

Wang Q, Yu X, Chen G, Sun X, Wang J . Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Int Urogynecol J. 2019; 31(2):277-283. DOI: 10.1007/s00192-019-04005-9. View

11.

Bo K, Hilde G, Tennfjord M, Sperstad J, Ellstrom Engh M . Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourol Urodyn. 2016; 36(3):716-721. DOI: 10.1002/nau.23005. View

12.

Tuominen R, Jahkola T, Saisto T, Arokoski J, Vironen J . The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study. Hernia. 2021; 26(2):599-608. PMC: 9012726. DOI: 10.1007/s10029-021-02484-8. View

13.

Gorst C, Kwok C, Aslam S, Buchan I, Kontopantelis E, Myint P . Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis. Diabetes Care. 2015; 38(12):2354-69. DOI: 10.2337/dc15-1188. View

14.

Du J, Ye J, Fei H, Li M, He J, Liu Y . Relationship Between Gestational Diabetes Mellitus and Postpartum Diastasis Recti Abdominis in Women in the First Year Postdelivery. Phys Ther. 2023; 103(10). PMC: 10661657. DOI: 10.1093/ptj/pzad102. View

15.

Liaw L, Hsu M, Liao C, Liu M, Hsu A . 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(6):435-43. DOI: 10.2519/jospt.2011.3507. View

16.

Fairbank J, Pynsent P . The Oswestry Disability Index. Spine (Phila Pa 1976). 2000; 25(22):2940-52; discussion 2952. DOI: 10.1097/00007632-200011150-00017. View

17.

Al-Shaikh G, Al-Badr A, Al Maarik A, Cotterill N, Al-Mandeel H . Reliability of Arabic ICIQ-UI short form in Saudi Arabia. Urol Ann. 2013; 5(1):34-8. PMC: 3643321. DOI: 10.4103/0974-7796.106964. View

18.

Dedering A . Lumbar muscle fatigue and subjective health measurements in patients with lumbar disc herniation 2 years after surgery. Eur Spine J. 2011; 21(4):646-54. PMC: 3326128. DOI: 10.1007/s00586-011-2109-7. View

19.

van de Water A, Benjamin D . Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2015; 21:41-53. DOI: 10.1016/j.math.2015.09.013. View

20.

Yuan S, Wang H, Zhou J . Prevalence and Risk Factors of Hernia in Patients With Rectus Abdominis Diastasis: A 10-Year Multicenter Retrospective Study. Front Surg. 2021; 8:730875. PMC: 8481825. DOI: 10.3389/fsurg.2021.730875. View