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

R Tuominen,J Arokoski,T Jahkola,J Vironen,T Saisto

doi:10.1007/s10029-021-02484-8

R Tuominen, J Arokoski + Show 3 more

Open Access

https://doi.org/10.1007/s10029-021-02484-8

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Journal: Hernia	Publication Date: Aug 25, 2021
Citations: 6	License type: open-access

Affiliation: University of Helsinki, Helsinki University Hospital

Abstract

PurposePost-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.MethodsFor 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.ResultsLinea 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.ConclusionMean 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.

Highlights

Linea alba is the fusion of aponeuroses of the external abdominal oblique, internal abdominal oblique and transversus abdominis muscles and consists of a three-dimensional, structured meshwork of collagen fibers [1]
It has been suggested that abdominal rectus diastasis (ARD) contributes to back pain [5, 6]
Our aim was to find out the normal width of linea alba in normal weight women in Finnish population and study the effects of inter-rectus distance (IRD) to back pain, disability and Health-Related Quality of Life (HRQOL)

Summary

Introduction

Linea alba is the fusion of aponeuroses of the external abdominal oblique, internal abdominal oblique and transversus abdominis muscles and consists of a three-dimensional, structured meshwork of collagen fibers [1]. Anterior abdominal wall biomechanically influences the movements and stability of the lumbar spine [2,3,4]. It has been suggested that abdominal rectus diastasis (ARD) contributes to back pain [5, 6]. A recent systematic review concluded that there is no significant association between the presence of ARD and lumbo-pelvic pain or incontinence [7]. Another review concluded that antepartum activity level may have a protective effect on ARD and exercise may improve post-partum symptoms of ARD [8]. There are a few publications of inter-rectus distance (IRD) in nulliparous women, Table 1. Beer et al [9] examined 150 women between 20 and 45 years of age and with

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