PRIMIPAROUS WOMEN’S KNOWLEDGE OF DIASTASIS RECTI ABDOMINIS, ABDOMINAL APPEARANCE CONCERNS, TREATMENTS, AND PERCEIVED ABDOMINAL MUSCLE STRENGTH 6-8 MONTHS POSTPARTUM

S. Gluppe¹, M. Ellström Engh², K. Bø¹

¹Norwegian School of Sport Sciences, Institute of Sports Medicine, Oslo, Norway, ²Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway

Background: Diastasis recti abdominis (DRA) is a prevalent condition in the postpartum period. To date, there is scant knowledge on how DRA influences physical, mental, and emotional health. Physiotherapists working within women`s health are approached by women who seek help for DRA but have low level of scientific evidence to rely on.

Purpose: This study investigates primiparous women`s knowledge about DRA, concerns about abdominal appearance, perceived abdominal muscle strength, and received treatments, comparing women with and without reported abdominal protrusion.

Methods: This was a cross-sectional comparison study. Data were collected by a web-based questionnaire, mainly through social media in Norway. To be included in the study women had to be primiparous and 6-8 months postpartum. The questionnaire contained questions regarding women`s knowledge about DRA, perceived protrusion, received treatment, concerns with abdominal appearance and muscle strength. Abdominal body image was measured through the shape concern questions from The Eating Disorder Examination Questionnaire (EDE-Q 6.0). Demographic and other descriptive variables are presented as means with standard deviations (SD) or as frequencies with percentages. Chi-square test of independence and independent sample t-tests were used to compare differences between women with and without abdominal protrusion for categorical and continuous variables, respectively.

Results: Our sample consisted of 460 women. Knowledge about DRA was reported by 415/440 (94.3%) women and 116 (26.5%) reported a protrusion along the midline of their abdomen. A total of 73.3% reported to have been worried during pregnancy about abdominal appearance postpartum. Mean degree of concern about present abdominal appearance was 5.5/10 (SD 2.4). Almost 80% of the sample experienced weaker abdominal muscles than pre-pregnancy. Twenty six percent of women with reported abdominal protrusion had tried one or more treatment options postpartum. The most frequently reported treatments were abdominal muscle exercises (86.2%) and PFM exercises (82.8%) and these were mostly accessed through social media 14/29 (48.3%). Eleven (37.9%) had information from physiotherapists. Significantly more women with protrusion reported lax skin and weaker abdominal muscles than women without protrusion. Mean score on the EDE-Q, shape concern questions, was higher in women with reported protrusion (mean score: 2.58 (SD 1.6)) than women without protrusion (mean score: 1.95 (SD 1.4)), p < 0.001.

Conclusions: Our study found that primiparous women are concerned about abdominal appearance. Women with protrusion experience weaker abdominal muscles and are less satisfied with their abdominal appearance than women without protrusion. Social media is the most common place where women with protrusion find treatments options for DRA.

Implications: This study contributes to improved knowledge about women`s health concerns in the postpartum period. There is a need for future follow-up assessments of women in the postpartum period concerning DRA, abdominal strength, and abdominal body image. Further high quality RCTs on the effect of different exercise programs in prevention and treatment of DRA are warranted to be able to guide women returning to exercise after childbirth.

Funding acknowledgements: The study was fully funded by The Norwegian Women`s Public Health Association.

Keywords:
Diastasis recti abdominis
Postpartum
Health

Topics:
Pelvic, sexual and reproductive health
Musculoskeletal
Mental health

Did this work require ethics approval? Yes

Institution: Norwegian School of Sport Sciences

Committee: Regional Medical Ethics Committee and Norwegian Centre for Research Data

Ethics number: 2018/2312, 440860