Diastasis Recti Abdominis Research Articles

A Multidimensional Investigation of Diastasis Recti Abdominis Treatment and Assessment in Postpartum Women: A Systematic Review and Meta-Analysis

Introduction: Diastasis recti abdominis (DRA) is prevalent among postpartum women, with various physiotherapy treatments utilized. Despite the effectiveness of diverse DRA treatment methods and the importance of evaluating its levels and methods, limited attention has been given to this aspect. This study comprehensively investigates DRA, examining evaluation levels and methods, and assessing the efficacy of diverse physiotherapy interventions. Materials and Methods: Online search was conducted in Cochrane, ProQuest, PubMed, Embase, Scopus, Web of Science, Google Scholar, and Magiran databases until the end of 2022, employing the population, intervention, comparison, and outcome framework (population = DRA, intervention = physiotherapy, comparison = control, and outcome = inter- rectus-distance [IRD]). The JBI checklist and Cochrane Collaboration RoB 2.0 tool evaluated critical appraisal and bias risk. Meta-analysis was performed using the RevMan software. Results: The study included 16 articles with 650 postpartum women. The findings revealed no significant differences in various measurement methods (P=0.25) and levels (P=0.10). Combination therapy demonstrated greater effectiveness than exercise alone in reducing IRD (P=0.04), with tape being particularly impactful (P=0.009). Conclusion: Although sonography evaluation of IRD above the umbilicus is recommended, the study highlights the limitation of diverse measurement methods and levels in determining the optimal physiotherapy intervention. Despite the preference for combined interventions, especially tape alongside exercise for women with DRA, further research is essential due to limited evidence, aiming to provide greater insights into this issue.

Correlation between self-reported low back pain and morphological changes in abdominal wall muscles.

Morphological changes in the abdominal wall muscle in diastasis recti abdominis (DRA) patients with low back pain (LBP) symptoms and whether there is a wider interrectus distance (IRD) remain unclear. The aim of this study was to determine the correlation between DRA severity and LBP and the morphological differences in abdominal wall muscles between patients who presented with symptoms of LBP and those who were asymptomatic. A total of 57 postpartum DRA patients were enrolled, including 21 without LBP, 36 with LBP, and 30 healthy nulliparous women. The numerical rating scale (NRS) was used to evaluate the degree of LBP. The IRD and muscle thickness of the abdominal muscles were measured via an ultrasonography device at the end of a natural breathing cycle. The abdominal muscles of the rectus abdominis (RA), external oblique muscle (EO), and transversus abdominis (TrA) in the DRA patients were significantly thinner than those in the control group (p< 0.05), whereas the difference in the internal oblique muscle (IO) was not significant (p> 0.05). There were no statistically significant differences in abdominal muscle thickness or the IRD regardless of whether the patients with DRA had LBP symptoms, with similar findings between the NRS score and DRA severity (P> 0.05). In DRA patients within one year postpartum, no significant difference was found in the severity of DRA or abdominal muscles, regardless of whether they were complicated by LBP symptoms. Shortening the IRD alone may not be beneficial for improving LBP symptoms in DRA patients. The relationship between DRA and LBP and the role of the abdominal muscles in postpartum LBP should be interpreted with caution.

Prevalence and risk factors of diastasis recti abdominis in the long-term postpartum: a cross-sectional study

The aim of this study was to investigate the prevalence of diastasis recti abdominis (DRA) and to find the possible risk factors for DRA based on two diagnostic criteria among women in long-term postpartum period. A cross-sectional study was conducted on 1000 postpartum women at five different time points (3, 5, 10, 20, and 30 years after partum, respectively). Inter-recti distance (IRD) was assessed using ultrasound imaging, while basic data were collected through self-reported questionnaires. Two diagnostic criteria, IRD > 2 cm and IRD > 3 cm, were used to present the prevalence of DRA. Univariate and multivariate analyses were employed to explore the risk factors for DRA. When using the diagnostic criterion of IRD > 2 cm for DRA, the prevalence was 36%, 31%, 22%, 26%, and 30% at 3, 5, 10, 20, and 30 years postpartum, respectively. When using the diagnostic criterion of IRD > 3 cm for DRA, the prevalence was 13%, 8%, 6%, 8%, and 10%, respectively. The results revealed that higher body mass index (BMI) was a risk factor for DRA at 10 years postpartum (p = 0.000), bigger number of parturitions was a risk factor at 3, 5, and 10 years postpartum (p = 0.000, 0.004 and 0.000), twins was a risk factor at 3 years postpartum (p = 0.001), and diabetes was a risk factor at 20 and 30 years postpartum (P = 0.000 and 0.004). (1) The prevalence of DRA in the long-term postpartum period was high, especially when IRD > 2 cm was used as the diagnostic criterion. (2) Higher BMI, bigger number of parturitions, twins and diabetes were independently associated with higher odds of DRA at different long-term postpartum time points. (3) The diagnostic criterion for DRA should be further improved to avoid excessive clinical diagnosis and treatment. (1) This study elucidated the prevalence and risk factors associated with long-term postpartum DRA, thereby enhancing clinical awareness and advocating for early intervention and prevention measures to mitigate serious adverse outcomes. (2) This study presented the research results using two diagnostic criteria, increasing comparability with existing studies. In addition, discussions on reasonable diagnostic criterion for DRA were also conducted to avoid excessive clinical diagnosis and treatment.

Convolution neural network based multi-class classification of rehabilitation exercises for diastasis recti abdominis using wearable EMG-IMU sensors

PurposeGlobally, postnatal women endure a prominent issue caused by midline separation of abdominal recti muscles, characterized by a sagging and pouch-like appearance of the belly termed as Diastasis Recti Abdominis (DRA). The necessity of ensuring the efficacy of rehabilitative workouts for individuals with DRA cannot be overstated, as inaccurate exercises can exacerbate the condition and deteriorate the health of affected women. The purpose of these exercises is to specifically focus on the rectus abdominis muscles to facilitate the reapproximation of the linea alba. The primary aim of this research work is to assess the effectiveness of rehabilitation exercises for DRA women obtained from Inertial Measurement Unit (IMU) and Electromyography (EMG) sensors.Design/methodology/approachConvolutional neural networks (CNN) employs convolutional activation functions and pooling layers. Recently, 1D CNNs have emerged as a promising approach used in various applications, including personalized biomedical data classification and early diagnosis, structural health monitoring and anomaly detection. Yet another significant benefit is the feasibility of a real-time and cost-effective implementation of 1D CNN. The EMG and IMU signals serve as inputs for the 1D CNN. Features are then extracted from the fully connected layer of the CNN and fed into a boosting machine learning algorithm for classification.FindingsThe findings demonstrate that a combination of sensors provides more details about the exercises, thereby contributing to the classification accuracy.Practical implicationsIn real time, collecting data from postnatal women was incredibly challenging. The process of examining these women was time-consuming, and they were often preoccupied with their newborns, leading to a reluctance to focus on their own health. Additionally, postnatal women might not be fully aware of the implications of DRA and the importance of rehabilitation exercises. Many might not realize that neglecting DRA can lead to long-term issues such as back pain, pelvic floor dysfunction, and compromised core strength.Social implicationsDuring our data collection camps, there were educational sessions to raise awareness about the DRA problem and the benefits of rehabilitation exercises. This dual approach helped in building trust and encouraging participation. Moreover, the use of wearable sensors in this study provided a non-invasive and convenient way for new mothers to engage in rehabilitation exercises without needing frequent visits to a clinic, which is often impractical for them.Originality/valueThe utilization of discriminating features retrieved from the output layer of 1D CNN is a significant contribution to this work. The responses of this study indicate that 1D convolutional neural network (1D CNN) and Boosting algorithms used in a transfer learning strategy produce successful discrimination between accurate and inaccurate performance of exercises by achieving an accuracy of 96%.

Long-Term Outcomes of Diastasis Recti Abdominis in Postpartum Women: A Retrospective Cohort Study.

The objective was to investigate whether diastasis recti abdominis (DRA) can cause adverse outcomes for different long-term postpartum women. We recruited 437 long-term postpartum women at five different time points (3, 5, 10, 20, and 30years postpartum respectively). Inter-recti distance (IRD) and linea alba or umbilical hernia were measured by ultrasound. Strength of abdominal muscle was measured by a manual muscle test. Low back pain (LBP), urinary incontinence (UI) and quality of life (QOL) were measured by questionnaires including the Oswestry Disability Index, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, 36-Item Short Form Health Survey respectively. Women with DRA experienced more severe LBP, and poorer QOL only 10years postpartum according to the diagnostic criterion of IRD > 2cm. However, when the diagnostic criterion was raised to IRD > 3cm, women with DRA reported weaker abdominal muscle strength, more severe LBP 3, 5, and 10years postpartum, poorer QOL 3, 5, 10, and 20years postpartum, and higher incidence of linea alba or umbilical hernia 5 and 20years postpartum. When using IRD > 2cm as the diagnostic criterion, the impact of DRA is minimal. However, when utilizing IRD > 3cm as the diagnostic criterion, DRA is associated with increased linea alba or umbilical hernia, weakened abdominal muscle strength, increased LBP, and decreased QOL. Most of the effects are particularly evident within 3-10 years postpartum, but becomes insignificant 20 and 30years postpartum. Therefore, it is necessary to consider whether the diagnostic criterion of DRA need to be improved.

Correlation of Spinal Curvature in Postpartum Women with and without Diastasis Recti Abdominis: A Cross-sectional Study

Correlation of Spinal Curvature in Postpartum Women with and without Diastasis Recti Abdominis: A Cross-sectional Study

Immediate effects of corrective exercise versus curl-up in women with diastasis recti abdominis

Background/aimIt is still unclear what types of exercise, beneficial to prevent and/or decrease diastasis recti abdominis (DRA). This study purposed to examine immediate effects of corrective exercise versus curl-up exercise on interrecti distance (IRD) and linea alba (LA) distortion in women with DRA. Materials and methodsTwenty-three women with DRA were included. The IRD and the LA distortion (with distortion index formula) were measured with ultrasound imaging at rest, during curl-up and corrective exercise. ResultsThe IRD, measured at above and below umbilicus, and the distortion index were different between the measurements at rest, during curl up and correction exercise (p < 0.05). In corrective exercise, the change in the IRD at above umbilicus decreased more than rest (p = 0.009) and curl-up (p = 0.004). The change in the IRD at below umbilicus decreased more in corrective exercise than rest (p = 0.033) and curl-up (p = 0.028). The distortion index increased more in corrective exercise than rest (p = 0.006). The index increased more in curl-up than rest (p = 0.029). ConclusionThe corrective exercise may be helpful in the treatment of DRA. Moreover, different muscle contractions that will provide the LA distortion should be taken into account in the treatment of DRA.

Could Abdominoplasty with Diastasis Recti Abdominis Correction Improve Stress Urinary Symptoms? A 1-Year Follow-up Prospective Study.

Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms. This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery. The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire. The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Hemorrhoids, Anorectal Symptoms, and Related Risk Factors in Pregnancy and the Postpartum Period: A Follow-up Study

Purpose: To investigate the presence of hemorrhoids and anorectal signs/symptoms and to identify various risk factors including anthropometric/musculoskeletal contributors associated with hemorrhoids in pregnancy and the postpartum period. Background: Pregnancy and the postpartum period may predispose women to develop hemorrhoids and anorectal symptoms because of hormonal and musculoskeletal changes. Methods: Fifty-one pregnant women with no history of anorectal disease were included in the study. The occurrence of hemorrhoids and other anorectal signs/symptoms was examined at 4 different times: first, second, and third trimesters, and postpartum 6th week. The Rome III criteria and the Bristol Stool Scale were used to confirm the presence of constipation and to determine stool type, respectively. Waist and hip circumference (as anthropometric contributors), bi-iliac and bitrochanteric width (as diameter measurements), diastasis recti abdominis, joint hypermobility, and lumbar lordosis (as musculoskeletal contributors) were evaluated. Personal, demographic, and clinical characteristics of the patients as well as postpartum period information were also recorded. Results: Hemorrhoids, perianal discomfort, perianal pain, and protrusion were significantly more frequent at postpartum than at the first trimester (P &lt; .008). According to the multivariate analysis, body mass index, the presence of constipation, joint hypermobility, and birth weight were significant determinants of hemorrhoids at the third trimester and postpartum (odds ratio = 1.25-2.67). Conclusions: Body mass index, constipation, joint hypermobility, and increased birth weight of the newborn were potential risk factors for the development of hemorrhoids during pregnancy and postpartum. Hemorrhoids and anorectal complaints should be kept in mind and managed to increase the quality of life during pregnancy and the postpartum period.

Розлади функції органів малого таза в жінок із діастазом прямих м’язів живота

Diastasis rectus abdominis (DRM), pelvic organ dysfunction are common pathological conditions after pregnancy. Abdominal muscles are weakened with DRM, which leads to inefficient participation of the anterior abdominal wall in the processes of functioning of the main pelvic organs: bladder and rectum. Аim - to evaluate the main determinants of the development of DRM and to establish the relationship between the presence of diastasis and disorders of the pelvic organs in women who have given birth. Materials and methods. We analyzed pelvic organ disorders in 151 patients with diastasis recti abdominis. which were divided into types according to the Nahas classification. Type A diastasis recti abdominis in 21 (13.9%) patients, type B in 81 (53.6%), and types C/D in 49 (32.5%). The endpoint of the study was DRM: significance between its severity and potential pelvic organ disorders was assessed using Fisher's exact test or chi-square test for categorical variables. Results. The frequency of postpartum disorders depended on the severity of diastasis recti abdominis. In patients with type A, the frequency of pain/discomfort, urinary incontinence, and gas/liquid stool incontinence was 52.4%, 61.9%, and 66.7%, respectively. In patients with severe diastasis recti abdominis, the rates were 81.6%, 75.5%, and 79.6%, respectively. Excess weight and episiotomy during delivery were much stronger determinants than the severity of diastasis recti abdominis. The higher risk of the pelvic organ dysfunction was noted in older patients, active smokers, and those who developed gestational diabetes. Conclusions. The severity of DRM depends on age, body mass index, number of pregnancies, episiotomy during delivery, smoking, gestational diabetes. There is no strong dependency on delivery by cesarean section or the use of vacuum/forceps, nor on the presence of hypothyroidism in patients. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. The authors declare no conflict of interest.

Удосконалена мініінвазивна ретромускулярна алопластика в пацієнтів із діастазом прямих м’язів живота

Diastasis recti abdominis contributes to the occurrence of defects with the formation of hernias of the white line. The recurrence of diastasis after alloplasty may also be associated with the presence of thinned posterior aponeurotic walls of the rectus abdominis muscles. Aim - to іncrease the effectiveness of surgical treatment of diastasis recti abdominis by using minimally invasive retromuscular techniques. Materials and methods. An analysis of surgical treatment of patients with diastasis recti abdominis was conducted in 126 patients. Average age - 51±1.2 years old. Diastasis width from 3 to 10 cm. In the I (main) group (n=64) surgical treatment it was performed according to the mini-invasive method we improved retromuscular technique. In the II group (comparison) (n=62) surgical treatment was performed according to the traditional «onlay» technique. In the postoperative period in patients of the I and II groups evaluated term stay of a patient in a hospital, direct and remote results. The methods of variational statistics were used: the averages for each studied feature, the errors of the arithmetic mean. Results. Term stay in a hospital patients of the I group was 2.1 days, the II group - 6.2 days. Among complications and on the side of the surgical wound in patients of the I group, a hematoma was observed in 2 (3.1%), seroma - in 4 (6.2%), wound infection was not observed, while in patients of the II group a hematoma was observed in 6 (9.7%), seroma - in 10 (16.1%), wound infection - in 3 (4.8%). Distant the results in terms of 2 to 36 months showed that among 35 patients of the II group, chronic postoperative pain was relapses were diagnosed in 2 (3.1%). diastasis direct muscles occurred in 7 (11.3%), and among 34 patients of the I group chronic postoperative pain diagnosed in 6 (9.7%) and relapse only in 1 (1.5%). Conclusions. Advanced mini-invasive retromuscular alloplasty is more effective, which is confirmed by a decrease in hospital stay and a decrease in postoperative complications. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the specified institution. Informed consent of the patients was obtained for the research. The authors declare no conflict of interest.

Diastasis Recti Abdominis: A Practical and Effective Width-Length Classification Based on Ultrasound Measurements and its Clinical Validation.

This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility. We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment. The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%. This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.

IMMEDIATE EFFECTS OF PELVIC FLOOR MUSCLE EXERCISES IN WOMEN WITH DIASTESIS RECTI ABDOMINIS

Aim:The aim of this study was to find immediate effect of pelvic floor muscles exercise in women with diastasis recti abdominis. Method: In this experimental study, 34 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Result:Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively). Conclusion:Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD.

Effects of Manual Therapy in Management of Diastasis Recti - A Case Study

ABSTRACT: Background: The patient was a 32 years old postpartum female with complaint of back pain which was radiating to abdominal area, she was functional limitations and abdominal muscle weakness. Methods and Measures: patient was treated 8 sessions over a period of 4 weeks. Study: Case study Intervention: Intervention included KT for rectus abdominis muscle and PF strengthening exercises to stabilize and strengthen the weakened muscles and to reduce IRD. Results: Following treatment, the patient demonstrated in an increase in functional ability and resolution of functional limitations. Statistical analysis of the data showed significant differences from pre to post intervention from session 1 to session 8. There was clinical and statistical significance found in PFS and IRD. Conclusion: Findings suggest that KT and PF strengthening exercises are more effective in reducing IRD and improving function in patient with Diastasis Recti Key words: Inter-Recti Distance(IRD), Rectus Abdominis (RA), Rectus Diastasis (RD), Diastasis Recti Abdominis(DRA), Ultrasound (Usd), Kinesio taping (KT), Physical Function Scale (PFS),Pelvic Floor (PF), Rate of Perceived Exertion (RPE), Linea Alba (LA).

Mothers' experiences living with diastasis recti abdominis - an interview study.

Diastasis recti abdominis (DRA) is a common postpartum condition. Knowledge is scarce on how mothers perceive living with DRA. The interaction between healthcare providers and patients plays a significant role in shaping the healthcare service experience. Women suffering from typical women's diseases tend to experience not being taken seriously or listened to when seeking healthcare. The aim of this study was to explore mothers' experiences living with DRA. Semi-structured individual interviews were conducted with six Norwegian mothers, age 32-41, presenting with a clinically significant DRA. Topics discussed were how the condition is experienced, how it affects different aspects of day-to-day life and experiences with healthcare services. The data was analyzed using systematic text condensation. DRA had an impact on everyday life among the mothers included in this study. Three major themes emerged: (I) The path to obtaining knowledge and understanding of DRA, (II) DRA - intertwined with health issues and physical limitations and (III) A changed belly - on self-image & social interactions. The mothers experienced uncertainties and frustration when trying to learn about DRA. The limited knowledge of the condition made it hard to differentiate if the experienced symptoms were caused by presence of DRA or from other health issues. Several mothers felt misunderstood. DRA is a multifaceted condition affecting many aspects of day-to-day life in various dimensions, like physical, emotional, and social. This study contributes to a wider understanding of living with DRA, which might guide healthcare professionals in providing support for mothers with this condition.

Does research support the current conservative care recommendations for pregnancy-related diastasis rectus abdominis? A scoping review

Pregnancy-related diastasis rectus abdominis (DRA) is a widespread condition. The current evidence for its conservative management is contradictory, as are the criteria for making a diagnosis, which has stimulated debate among practitioners. The aim of this scoping review was to synthesize the existing peer-reviewed literature to determine whether there is evidence to support or refute recently published recommendations for the conservative care of perinatal DRA. These guidelines suggest that it should be approached from the perspective of considering the linea alba (LA) as an integrative component of the thoracopelvic abdominal system, which assumes functional relationships between the structures of the thorax and pelvis. Specifically, the present authors explored whether relationships exist between: (1) the LA and breathing mechanics; (2) pelvic floor muscle (PFM) function; (3) lumbopelvic pain (LPP) control; and (4) aspects of the structure and function of the abdominal wall. Of the 31 studies included, none were found relating to the LA and breathing mechanics, 11 investigated PFM function, 10 explored LPP, and 18 examined the LA with respect to the structure and/or function of the abdominal wall. The research reviewed does not appear to substantiate several of the recommendations for the conservative care of DRA, but does align with cited gaps in knowledge about this condition. The studies included neither support nor necessarily refute the relationships between breathing, PFM function and LPP. This scoping review also highlights the limitations of the current characterization of DRA and related assessment strategies, particularly the reliance on heterogeneous measurements of inter-recti distance as the primary and sometimes only measurement to inform clinical reasoning with respect to the condition.

A prospective study of two-dimensional ultrasonography combined with shear wave elastography for pregnancy-related diastasis recti abdominis.

To compare the inter-rectus distance (IRD), rectus abdominis thickness (RAT), and stiffness in women during pregnancy and postpartum and identify the risk and protective factors affecting diastasis recti abdominis (DRA). A total of 171 pregnant women who volunteered to participate in this study were recruited. Using an ultrasonographic diagnostic instrument with shear wave elastography function, IRD, RAT and the Young's modulus of the rectus abdominis muscles were measured at 12weeks, 37weeks of pregnancy, and 6weeks postpartum. The IRD at 37weeks was significantly higher than that at 12weeks and then decreased at 6weeks postpartum, but it was still higher than that at 12weeks (p < 0.001). RAT and Young's modulus decreased significantly at 37weeks compared with those at 12weeks and then recovered at 6weeks postpartum, but they were lower than those at 12weeks (p < 0.001). IRD at 12weeks was significantly higher in multiparae than in primiparae (p < 0.001). Moreover, positive correlation between the RAT and Young's modulus of rectus abdominis muscles at 12 and 37weeks of gestation and 6weeks postpartum (p < 0.001) was observed. Multiple linear regression analysis showed that the regression equation was significant (f = 24.856, p < 001). Our study identified differences in IRD, thickness and stiffness of the rectus abdominis muscle between early and advanced pregnancy and the postpartum period. The risk and protective factors of DRA may guide pregnant women's protection and treatment.

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study.

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12months postpartum. In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance. At 3months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12months. The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12months postpartum. Physical therapists should encourage women to start with low-impact exercise early after pregnancy. This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

Is Diastasis Recti Abdominis Rehabilitation after Childbirth Able to Prevent the Onset of Stress Urinary Incontinence? A Case-Control Study.

Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.