Skip to main content
Top
Published in: Hernia 2/2022

Open Access 01-04-2022 | Diastasis Recti | Original Article

The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study

Authors: R. Tuominen, T. Jahkola, T. Saisto, J. Arokoski, J. Vironen

Published in: Hernia | Issue 2/2022

Login to get access

Abstract

Purpose

Post-pregnancy abdominal rectus diastasis (ARD) has raised attention in the field of surgery in recent years, but there is no consensus about when to consider surgery. Our aim was to find out what is the normal inter-rectus distance in fertile aged, female population in Finland and to examine whether there is a linea alba width that would predispose to diastasis-related problems after pregnancy.

Methods

For this prospective cohort study, women participating early pregnancy ultrasound in Helsinki University Hospital Department of Obstetrics and Gynecology during 1.1.2018–8.3.2019, were recruited. The width of linea alba was measured by ultrasound during the early pregnancy ultrasound. Symptoms were measured by questionnaire including Health-Related Quality of Life (RAND-36) and Oswestry Disability Index for back symptoms and disability.

Results

Linea alba width was measured in total of 933 women. The average inter-rectus distance (IRD) among nulliparous women was 1.81 ± 0.72 cm. After one previous pregnancy, the average linea alba width was 2.36 cm ± 0.83 cm and after more pregnancies 2.55 ± 1.09 cm. There was a positive correlation between previous pregnancies and the increased linea alba width (p = 0.00004). We did not perceive any threshold value of linea alba width that would predispose to back pain or movement control problems in this cohort, in which severe diastasis (over 5 cm) was rare.

Conclusion

Mean inter-rectus distance in parous population exceeds stated normative values. Moderate ARD (3.0–5.0 cm) alone does not seem to explain low back pain or functional disability in population level. Severe post-pregnancy diastasis (over 5.0 cm) is rare.
Literature
2.
go back to reference Hodges PW, Eriksson AE, Shirley D, Gandevia SC (2005) Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech 38(9):1873–1880CrossRefPubMed Hodges PW, Eriksson AE, Shirley D, Gandevia SC (2005) Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech 38(9):1873–1880CrossRefPubMed
3.
go back to reference Gunnarsson U, Stark B, Dahlstrand U, Strigard K (2015) Correlation between abdominal rectus diastasis width and abdominal muscle strength. Dig Surg 32(2):112–116CrossRefPubMed Gunnarsson U, Stark B, Dahlstrand U, Strigard K (2015) Correlation between abdominal rectus diastasis width and abdominal muscle strength. Dig Surg 32(2):112–116CrossRefPubMed
4.
go back to reference Kim HJ, Chung S, Kim S et al (2006) Influences of trunk muscles on lumbar lordosis and sacral angle. Eur Spine J 15(4):409–414CrossRefPubMed Kim HJ, Chung S, Kim S et al (2006) Influences of trunk muscles on lumbar lordosis and sacral angle. Eur Spine J 15(4):409–414CrossRefPubMed
5.
go back to reference Toranto IR (1990) The relief of low back pain with the WARP abdominoplasty: a preliminary report. Plast Reconstr Surg 85(4):545–555CrossRefPubMed Toranto IR (1990) The relief of low back pain with the WARP abdominoplasty: a preliminary report. Plast Reconstr Surg 85(4):545–555CrossRefPubMed
6.
go back to reference Emanuelsson P, Gunnarsson U, Dahlstrand U, Strigard K, Stark B (2016) Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 160(5):1367–1375CrossRefPubMed Emanuelsson P, Gunnarsson U, Dahlstrand U, Strigard K, Stark B (2016) Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 160(5):1367–1375CrossRefPubMed
9.
go back to reference Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA (2009) The normal width of the linea alba in nulliparous women. Clin Anat 22(6):706–711CrossRefPubMed Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA (2009) The normal width of the linea alba in nulliparous women. Clin Anat 22(6):706–711CrossRefPubMed
10.
go back to reference Mota P, Pascoal AG, Carita AI, Bo K (2018) Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract 35:34–37CrossRefPubMed Mota P, Pascoal AG, Carita AI, Bo K (2018) Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract 35:34–37CrossRefPubMed
11.
go back to reference Ranney B (1990) Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 43(10):5–8PubMed Ranney B (1990) Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 43(10):5–8PubMed
13.
go back to reference Sperstad JB, Tennfjord MK, Hilde G, Ellstrom-Engh M, Bo K (2016) Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 50(17):1092–1096CrossRefPubMed Sperstad JB, Tennfjord MK, Hilde G, Ellstrom-Engh M, Bo K (2016) Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 50(17):1092–1096CrossRefPubMed
16.
go back to reference Aalto A-M, Aro A, Teperi J (1999) Rand-36 as a measure of health-related quality of life: reliability, construct validity and reference values in the finnish general population. STAKES, Helsinki, Finland. Research report 101 Aalto A-M, Aro A, Teperi J (1999) Rand-36 as a measure of health-related quality of life: reliability, construct validity and reference values in the finnish general population. STAKES, Helsinki, Finland. Research report 101
20.
go back to reference van de Water AT, Benjamin DR (2016) 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 21:41–53CrossRefPubMed van de Water AT, Benjamin DR (2016) 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 21:41–53CrossRefPubMed
22.
go back to reference DeCherney AH, Pernoll ML (1996) Current obstetric and gynecologic diagnosis and treatment, 9th edn. Lande Medical book, New York DeCherney AH, Pernoll ML (1996) Current obstetric and gynecologic diagnosis and treatment, 9th edn. Lande Medical book, New York
24.
go back to reference Coldron Y, Stokes MJ, Newham DJ, Cook K (2008) Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther 13(2):112–121CrossRefPubMed Coldron Y, Stokes MJ, Newham DJ, Cook K (2008) Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther 13(2):112–121CrossRefPubMed
25.
go back to reference Tuominen R, Vironen J, Jahkola T (2019) Case series of a novel open plication supported by mesh (PSUM)—technique for symptomatic abdominal rectus diastasis repair with or without concomitant midline hernia: early results and a review of the literature. Int J Abdominal Wall Hernia Surg 2(4):142–148CrossRef Tuominen R, Vironen J, Jahkola T (2019) Case series of a novel open plication supported by mesh (PSUM)—technique for symptomatic abdominal rectus diastasis repair with or without concomitant midline hernia: early results and a review of the literature. Int J Abdominal Wall Hernia Surg 2(4):142–148CrossRef
27.
go back to reference Rett MT, Braga MD, Bernardes NO, Andrade SC (2008) Prevalência de diástase dos músculos retoabdominais no puerpério imediato: Comparação entre primíparas e multíparas. Rev Bras Fisioter 13(4):275–280CrossRef Rett MT, Braga MD, Bernardes NO, Andrade SC (2008) Prevalência de diástase dos músculos retoabdominais no puerpério imediato: Comparação entre primíparas e multíparas. Rev Bras Fisioter 13(4):275–280CrossRef
28.
go back to reference Mota P, Pascoal AG, Carita AI, Bo K (2015) 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 45(10):781–788CrossRefPubMed Mota P, Pascoal AG, Carita AI, Bo K (2015) 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 45(10):781–788CrossRefPubMed
29.
go back to reference Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U (2011) Prevalence of diastasis recti abdominis in the population of young multiparous adults in turkey. Ginekol Pol 82(11):817–821PubMed Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U (2011) Prevalence of diastasis recti abdominis in the population of young multiparous adults in turkey. Ginekol Pol 82(11):817–821PubMed
Metadata
Title
The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study
Authors
R. Tuominen
T. Jahkola
T. Saisto
J. Arokoski
J. Vironen
Publication date
01-04-2022
Publisher
Springer Paris
Published in
Hernia / Issue 2/2022
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-021-02484-8

Other articles of this Issue 2/2022

Hernia 2/2022 Go to the issue