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Published in: International Urogynecology Journal 2/2020

01-02-2020 | Sectio Ceasarea | Original Article

Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study

Authors: Qing Wang, Xiaojie Yu, Gengmin Chen, Xiuli Sun, Jianliu Wang

Published in: International Urogynecology Journal | Issue 2/2020

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Abstract

Introduction and hypothesis

The aim of this study was to compare pelvic floor muscle strength (PFMS) and the prevalence of urinary incontinence (UI) and pelvic organ prolapse(POP) in women with and without diastasis recti abdominis (DRA) at 6–8 weeks postpartum.

Methods

Three hundred and ten women underwent routine examinations, including POP quantification (POP-Q), PFMS measurement, DRA evaluation, and UI determination. Chi-squared tests and independent sample t test were used to compare the differences between women with DRA and without DRA.

Results

Women with DRA presented significantly lower prepregnancy body mass index (BMI), predelivery BMI, and postpartum BMI; greater gestational age; and higher birth weights than women without DRA(p < 0.05). Moreover, DRA incidence was significantly higher in those who underwent cesarean section (CS) than in those who underwent vaginal delivery (VD)(p = 0.045). Although the PFMS of the DRA group was weaker and the prevalence of UI and POP was slightly higher than those of the no DRA group, the results were not statistically significant. The PFMS of the CS group was stronger than that of the VD group. Urinary incontinence and prolapse incidence were higher in the VD group than in the CS group. Women who underwent CS had a shorter genital hiatus (Gh) and smaller Ba and Bp values than those in the VD group. Women without DRA had an increased chance of Bp ≥ −2 and Gh ≥ 3(p < 0.05).

Conclusions

Women with DRA were not more likely to have weakened PFMS and increased UI or POP at 6–8 weeks postpartum.
Literature
1.
go back to reference Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed
2.
go back to reference Vergeldt TF, Weemhoff M, Inthout J, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.CrossRef Vergeldt TF, Weemhoff M, Inthout J, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.CrossRef
3.
go back to reference Diez-Itza I, Arrue M, Ibañez L, et al. Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapse. Int Urogynecol J. 2011;22(12):1505–11.CrossRef Diez-Itza I, Arrue M, Ibañez L, et al. Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapse. Int Urogynecol J. 2011;22(12):1505–11.CrossRef
4.
go back to reference Wu JM, Kawasaki A, Hundley AF, et al. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205(3):230–1.CrossRef Wu JM, Kawasaki A, Hundley AF, et al. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205(3):230–1.CrossRef
5.
go back to reference Cerruto MA, D’Elia C, Aloisi A, et al. Prevalence, incidence and obstetric factors’ impact on female urinary incontinence in Europe: a systematic review. Urol Int. 2013;90(1):1–9.CrossRef Cerruto MA, D’Elia C, Aloisi A, et al. Prevalence, incidence and obstetric factors’ impact on female urinary incontinence in Europe: a systematic review. Urol Int. 2013;90(1):1–9.CrossRef
6.
go back to reference Sangsawang B. Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2014;178:27–34.CrossRef Sangsawang B. Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2014;178:27–34.CrossRef
7.
go back to reference Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082–6.CrossRef Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082–6.CrossRef
8.
go back to reference Wade M. Diastasis recti and low back pain. Orthop Phys Ther Pract. 2005;17(3):20–2. Wade M. Diastasis recti and low back pain. Orthop Phys Ther Pract. 2005;17(3):20–2.
9.
go back to reference Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18:321–8.CrossRef Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18:321–8.CrossRef
10.
go back to reference Bø K, Hilde G, Tennfjord MK, et al. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: prospective cohort study. Neurourol Urodyn. 2017;36(3):716–21.CrossRef Bø K, Hilde G, Tennfjord MK, et al. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: prospective cohort study. Neurourol Urodyn. 2017;36(3):716–21.CrossRef
11.
go back to reference Mota P, Pascoal AG, Carita AI, et al. 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.CrossRef Mota P, Pascoal AG, Carita AI, et al. 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.CrossRef
12.
go back to reference Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bø K. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther. 2018;98(4):260–8.CrossRef Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bø K. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther. 2018;98(4):260–8.CrossRef
13.
go back to reference Parker MA, Millar AL, Dugan SA. Diastasis recti abdominis and lumbo-pelvic pain and dysfunction—are they related? J Womens Health Phys Ther. 2009;33:15–22.CrossRef Parker MA, Millar AL, Dugan SA. Diastasis recti abdominis and lumbo-pelvic pain and dysfunction—are they related? J Womens Health Phys Ther. 2009;33:15–22.CrossRef
14.
go back to reference Sperstad JB, Tennfjord MK, Hilde G, et al. 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.CrossRef Sperstad JB, Tennfjord MK, Hilde G, et al. 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.CrossRef
15.
go back to reference Sapsford RR, Hodges PW, Richardson CA, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31–42.CrossRef Sapsford RR, Hodges PW, Richardson CA, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31–42.CrossRef
16.
go back to reference Critchley D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing. Physiother Res Int. 2002;7(2):65–75.CrossRef Critchley D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing. Physiother Res Int. 2002;7(2):65–75.CrossRef
17.
go back to reference Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2019;105(1):24–34.CrossRef Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2019;105(1):24–34.CrossRef
18.
go back to reference Van de Water ATM, Benjamin DR. Measurement methods to assess diastasis of the recti abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:41–53.CrossRef Van de Water ATM, Benjamin DR. Measurement methods to assess diastasis of the recti abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:41–53.CrossRef
19.
go back to reference Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health. 2005;97:49–54. Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health. 2005;97:49–54.
20.
go back to reference Lo T, Candido G, Janssen P. Diastasis of the recti abdominis in pregnancy: risk factors and treatment. Physiother Can. 1999;51:32. Lo T, Candido G, Janssen P. Diastasis of the recti abdominis in pregnancy: risk factors and treatment. Physiother Can. 1999;51:32.
21.
go back to reference Mota P, Pascoal AG, Sanchos F, et al. Reliability of the inter recti distance measurement by palpation. Comparison of palpation and ultrasound measurement. Manual Ther. 2013;18:294–8.CrossRef Mota P, Pascoal AG, Sanchos F, et al. Reliability of the inter recti distance measurement by palpation. Comparison of palpation and ultrasound measurement. Manual Ther. 2013;18:294–8.CrossRef
Metadata
Title
Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study
Authors
Qing Wang
Xiaojie Yu
Gengmin Chen
Xiuli Sun
Jianliu Wang
Publication date
01-02-2020
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 2/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-019-04005-9

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