Benjamin D1, Frawley H2,3, Sheilds N1, van de Water A4, Taylor N5,6
1La Trobe University, Physiotherapy, Melbourne, Australia, 2Monash University, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia, 3Centre of Allied Health Research & Education - Cabrini Hospital, Allied Health, Melbourne, Australia, 4Saxion University of Applied Sciences, Physiotherapy, Enscede, Netherlands, 5LaTrobe University, Physiotherapy, Melbourne, Australia, 6School of Allied Health, Allied Health Clinical Research Office, Eastern Health, Allied Health, Melbourne, Australia
Background: Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy with incidences between 66- 100%. DRAM has also been identified in non-obstetric cohorts such as urogynecological, menopausal, older populations and in populations with abdominal aortic aneurysm. This widening has been postulated to be associated with adverse health consequences such as lumbo-pelvic instability, low back pain and incontinence. There is also much time and resources directed to its assessment, management and prevention. However, to date, there has been little evidence to support the postulated associations.
Purpose: To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes
Methods: This systematic review sourced data from six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro). Studies were included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life. Methodological quality was assessed using the Effective Public Health Practice Project tool. Qualitative analysis was performed to determine: if there is an association between the presence of DRAM and low back pain, lumbo-pelvic pain, pelvic pain, incontinence, pelvic organ prolapse, abdominal performance and health-related quality of life; and between DRAM width and severity of these outcomes.
Results: Twelve studies involving 2242 participants were included. . There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain.There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence.
Conclusion(s): There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity.
Implications: Based on our findings, clinical assessment of DRAM may be relevant in pregnant, postnatal, urogynaecological, menopausal and older populations presenting with pelvic organ prolapse, low back pain or impaired abdominal strength. This association may be due to underlying connective tissue pathophysiology that explains the association. This identified association does not imply causation. In these at-risk populations, assessment and identification of DRAM may increase the likelihood of clinical observation of pelvic organ prolapse, low back pain or impaired abdominal strength. Further research is required to determine the most effective interventions to manage DRAM, and whether they also influence or affect the associated conditions.
Keywords: Rectus abdominis, Abdominal muscle, pelvic organ prolapse
Funding acknowledgements: None
Purpose: To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes
Methods: This systematic review sourced data from six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro). Studies were included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life. Methodological quality was assessed using the Effective Public Health Practice Project tool. Qualitative analysis was performed to determine: if there is an association between the presence of DRAM and low back pain, lumbo-pelvic pain, pelvic pain, incontinence, pelvic organ prolapse, abdominal performance and health-related quality of life; and between DRAM width and severity of these outcomes.
Results: Twelve studies involving 2242 participants were included. . There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain.There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence.
Conclusion(s): There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity.
Implications: Based on our findings, clinical assessment of DRAM may be relevant in pregnant, postnatal, urogynaecological, menopausal and older populations presenting with pelvic organ prolapse, low back pain or impaired abdominal strength. This association may be due to underlying connective tissue pathophysiology that explains the association. This identified association does not imply causation. In these at-risk populations, assessment and identification of DRAM may increase the likelihood of clinical observation of pelvic organ prolapse, low back pain or impaired abdominal strength. Further research is required to determine the most effective interventions to manage DRAM, and whether they also influence or affect the associated conditions.
Keywords: Rectus abdominis, Abdominal muscle, pelvic organ prolapse
Funding acknowledgements: None
Topic: Women's & men's pelvic health; Women's & men's pelvic health
Ethics approval required: No
Institution: La Trobe University
Ethics committee: La Trobe Ethics Committee
Reason not required: It is a systematic review which does not require ethics
All authors, affiliations and abstracts have been published as submitted.
