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S. Gluppe1, M.E. Engh2, K. Bø1,2
1Norwegian School of Sport Sciences, Department of Sport Medicine, Oslo, Norway, 2Akershus University Hospital, Department of Obstetrics and Gynaecology, Oslo, Norway
Background: Diastasis recti abdominis (DRA) is defined as an impairment with midline separation of the two rectus abdominis muscles along the linea alba. Prevalence of DRA have been reported to be 60 %, 45.4 % and 32.6 %, 6 weeks, 6 months and 12 months postpartum, respectively. To date there is a lack of studies investigating possible consequences of DRA, especially in the subgroups of women with moderate or severe DRA.
Purpose: To investigate whether women with DRA have weaker abdominal muscles and higher prevalence of pelvic floor disorders (PFDs), low back, pelvic girdle and abdominal pain compared to women without DRA.
Methods: This was a cross sectional study of women with and without DRA. Inclusion criteria were; primi- and multiparous women > 6 weeks postpartum. 2D real-time ultrasonography was conducted to include women, using a cut-off point of DRA ˃ 25 mm, 2 cm above or 2 cm below the umbilicus during a curl-up. Maximal abdominal muscle strength was assessed using a dynamometer and abdominal endurance was assessed with a curl-up test. PFDs was assessed with Pelvic Floor Distress Inventory-short form 20 (PFDI-20), low back pain with Oswestry Disability Index (ODI), pelvic girdle pain with Pelvic Girdle Questionnaire (PGQ) and questions about abdominal pain.
Results: Seventy-two parity and age matched women with and without DRA were included. Eighteen (51.4 %) women were classified with mild, 13 (37.2 %) with moderate and four (11.4 %) with severe DRA. Maximal abdominal strength at 30° was significantly lower in women with DRA compared to women without DRA, -12.9 Nm (CI: -24.4, -1.5); p = 0.028, adjusted analyses showed no significant difference (mean difference: -11.9 Nm (CI: -26.5, 2.6), p = 0.106. Adjusted analyses showed significant more abdominal pain (OR: 0.018, CI: 0.001-0.611, p = 0.026) in women with DRA. There was no difference between women with and without DRA in PFDs, low back and pelvic girdle pain. Comparing a subgroup of women with moderate and severe DRA with women without DRA, no significant differences in outcome measures were found.
Conclusion(s): Women with DRA tend to have weaker abdominal muscles and higher prevalence of abdominal pain, but not higher prevalence of PFDs, low back or pelvic girdle pain than women without DRA.
Implications: To the authors` knowledge, this is the first study to investigate possible consequences of DRA in a subgroup of women with moderate and severe diastasis. The results contradict the common belief that there is an association between DRA and PFDs, low back and pelvic girdle pain. The results may assist clinicians in giving more nuanced information to patients with DRA.
Funding, acknowledgements: The study was fully funded by The Norwegian Women`s Public Health Association.
Keywords: Diastasis recti abdominis, Women`s health, Postpartum
Topic: Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: Norwegian School of Sport Sciences
Committee: The Regional Medical Ethics Committee
Ethics number: 2018/2312
All authors, affiliations and abstracts have been published as submitted.
