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Effectiveness of Abdominal Strengthening Exercises in the Treatment of Diastasis Recti in Postpartum Period

Authors:
Ali Yalfani at Buali Sina University
Ali Yalfani
Nahid Bigdeli at Buali Sina University
Nahid Bigdeli
Mohammad Reza Ahmadi at University of Tehran
Mohammad Reza Ahmadi
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Abstract

Background and Aims: During and after pregnancy, many women experience an increase in the inter-recti abdominal muscle due to increased uterine volume as well as stretching and thinning of the linea alba. This disease, on average, affects 66% of women and is associated with spinal pain and instability, pelvic floor muscle weakness, abdominal muscle weakness, and abdominal hernia. The aim of the present review article was to study the effectiveness of abdominal strengthening exercises in the treatment of diastasis recti in postpartum period, based on the results of the recent studies. Materials and Methods: Google scholar, EM base, Medline, and PubMed databases as well as Google search were searched using the following keywords: pregnancy, diastasis rectus, diastasis recti, linea alba, rectus abdominal muscles, and strengthening exercises. Our study includes different researches on abdominal muscle strengthening exercises in the treatment of diastasis recti. Results: Generally, 800 articles were found in the field of case studies, pilot studies, and clinical trials. From among these studies, only 11 studies were selected according to the inclusion criteria. The results of these studies showed that abdominal strengthening exercises have been effective in minimizing low back pain and decreasing functional, postural instability as well as muscle weakness. Conclusion: According to the results and quality of the studies, abdominal muscles strengthening exercises can be an effective method in the treatment of diastasis recti in postpartum period.
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Review Article
Published Online: 2019.May.18
J Rehab Med. 2020; 8 (4): 280-290

Effectiveness of Abdominal Strengthening Exercises in the Treatment
of Diastasis Recti in Postpartum Period
Ali Yalfani1 , Nahid Bigdeli*2 , Mohammad Reza Ahmadi3
1. Associate Professor in Sport Rehabilitation, Department of Sport Injuries and Corrective Exercises, Bu Ali
Sina University, Hamedan, Iran
2. Master of Sport Injuries and Corrective Exercises, Department of Sport Injuries and Corrective Exercises,
Bu Ali Sina University, Hamedan, Iran
3. Master of Sport in Injuries and Corrective Exercises, Department of Sport Injuries and Corrective Exercises,
Bu Ali Sina University, Hamedan, Iran
Received: 2019.January.30 Revised: 2019. April.14 Accepted: 2019.May.04
Abstract
Background and Aims: During and after pregnancy, many women experience an increase in the
inter-recti abdominal muscle due to increased uterine volume as well as stretching and thinning of the
linea alba. This disease, on average, affects 66% of women and is associated with spinal pain and
instability, pelvic floor muscle weakness, abdominal muscle weakness, and abdominal hernia. The
aim of the present review article was to study the effectiveness of abdominal strengthening exercises
in the treatment of diastasis recti in postpartum period, based on the results of the recent studies.
Materials and Methods: Google scholar, EM base, Medline, and PubMed databases as well as
Google search were searched using the following keywords: pregnancy, diastasis rectus, diastasis
recti, linea alba, rectus abdominal muscles, and strengthening exercises. Our study includes different
researches on abdominal muscle strengthening exercises in the treatment of diastasis recti.
Results: Generally, 800 articles were found in the field of case studies, pilot studies, and clinical
trials. From among these studies, only 11 studies were selected according to the inclusion criteria. The
results of these studies showed that abdominal strengthening exercises have been effective in
minimizing low back pain and decreasing functional, postural instability as well as muscle weakness.
Conclusion: According to the results and quality of the studies, abdominal muscles strengthening
exercises can be an effective method in the treatment of diastasis recti in postpartum period.
Keywords: Pregnancy; Diastasis Recti; Linea Alba; Rectus Abdominal Muscles; Strengthening
Exercises.
Cite this article as: Ali Yalfani, Nahid Bigdeli, Mohammad Reza Ahmadi. Effectiveness of strengthening
exercises in the treatment of diastasis recti abdominis in postpartum period. J Rehab Med. 2020; 8 (4):280-290
* Corresponding Author: Nahid. Bigdeli. Master of Sport Injuries and Corrective Exercises, Department of
Sport Injuries and Corrective Exercises, Bu Ali Sina University, Hamedan, Iran
Email: Nahid.bigdeli@yahoo.com
DOI: 10.22037/jrm.2019.111509.2045
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Nahid.bigdeli@yahoo.com
Review Article
Published Online: 2019.May.18
J Rehab Med. 2020; 8 (4): 280-290
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

cmcmcm cm
cm 
]
[

DRA
LA

]
[
DRA

]
[


]
[

IRD
]
[


]
[

IRD-
     
IRD
]
[
DRA

RAD
]

[
DRA 
      
]

[
   





1
Inter-rectus Distance
2
Linea Alba
3
Xiphoid
4
Pubic Symphysis
5
Abdominals Diastasis Recti

–


Google Scholar ، EM Base، Medline ،PubMed-
""""""""""""

      DRA     

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

6
Repeated Measures, Between Factors
Review Article
Published Online: 2019.May.18
J Rehab Med. 2020; 8 (4): 280-290
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
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DRA
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

DRA   

IRD
        
]

[
    
 
]

[
 
PF1020-PFDI
]

[














Tuttle et al.
2018




±










Izadi et al.
2018












Ali Thabet et
al. 2018
















Pereira et al.
2018



≤

-








7
Manual Assessment

–

Kamel et al.
2017














Walton et al.
2016












Mahalakshmi
et al. 2016
















Khandale et
al. 2016











Gursen et al.
2015












Litos. 2014







-






Mekawy et
al. 2013

















DRA
]

[


DRAIRD
]

[



DRA
DRALA

]

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
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DRA
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
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
DRA
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
8
Pereira et al
9
Khandale et al
10
Litos
11
Mekawy et al
12
Kamel et al
Review Article
Published Online: 2019.May.18
J Rehab Med. 2020; 8 (4): 280-290
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
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

IRD
 

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IRD

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 
]
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 IRD
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
Tuttle et al. 2018




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

Izadi et al. 2018



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
Ali Thabet et al.
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

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


Pereira et al. 2018






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


Kamel et al. 2017


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
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


Walton et al. 2016








Mahalakshmi et al.
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





13
Gursen et al
14
Tuttle et al
15
Izadi et al
16
Walton et al
17
Ali Thabet et al

–

Khandale et al. 2016







Gursen et al. 2015



Litos. 2014





Mekawy et al. 2013

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
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
SD
mean
SD
mean

Tuttle et al. 2018





PFDI-20
Izadi et al. 2018



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

Ali Thabet et al.
2018


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



Pereira et al. 2018


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
Kamel et al. 2017



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
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

Walton et al. 2016





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
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
Gursen et al. 2015






VAS-

Litos. 2014



VAS 
Mekawy et al.
2013


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

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



-
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]
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[
 
Review Article
Published Online: 2019.May.18
J Rehab Med. 2020; 8 (4): 280-290

LA
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 
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LADRA

18
Follow Up
19
Transverse Muscle
20
Pelvic Floor Muscle

–


]

[

   
DRA
DRA







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... Pregnancy is thus the most common cause of Diastasis of the Rectus Abdominis Muscle (DRAM), occurring with a prevalency of 100% at the 35 th week of gestation and on an average affecting about 66% of women and may continue for about 6 weeks to 6 months postnatally 1,2 . Though it is the most commonly occurring condition following pregnancy, it's not painful in most cases and thus often goes unnoticed and untreated which further gives rise to increasing separation of the rectus muscle and discomfort associated with it 3 . ...
... The results concluded significant intergroup improvement in the inter recti distance, strength of the muscle as well as in reduction of low back pain in Group A. Thus, though there was significant intragroup clinical progress in both the groups, group ' A' revealed greater improvement in all the measured parameters. Studies support the above findings by suggesting that application of electrical stimulation along with abdominal strengthening exercises given in combination help improving the muscle strength faster and thus promotes recovery 3,23 . A study by Kamel DM, Yousif AM also reveal that application of NMES helps in the recruitment of the deep muscle fibers as it activates the type II i.e., the large nerve fibers at relatively low intensities. ...
Effectiveness of NMES and Taping on Diastasis Recti in Postnatal Women
Article
Full-text available
  • Sep 2021
The release of hormones like relaxin and estrogen occur during the gestational period and the fetal growth takes place which expands the uterus resulting in increased pressure against the abdominal wall. This causes stretching of the connective tissue, linea alba and as the weeks proceed the fetal growth occurs more and more rapidly resulting in further stretching of the connective tissue and the abdominal muscles causing an eventual decrease contraction strength weakening of muscles and can lead to a separation and widening of the space between the two rectus abdomen is muscles known as Diastasis of Recti Abdominis Muscles (DRAM). Diastasis recti is thus most common during pregnancy having a prevalence of 100% at gestational week 35 and can lead to various secondary problems like low back pain, shallow breathing and pelvic region pain. Though it is the most commonly occurring condition, it might not be painful in most cases initially and thus goes unnoticed and untreated. Purpose of the study was to compare the effects of Neuro- Muscular Electrical Stimulation (NMES) and Kinesiotaping along with core stabilization exercises on diastasis recti in postnatal women, in terms of inter recti distance, abdominal muscle strength and low back pain. A total of 40 women with significant diastasis recti, 6 weeks postnatal, participated in the study. They were equally divided with random selection of 20 subjects in two groups each, Group A was treated with NMES and Group B received Kinesiotaping and both the groups in addition received core stabilization exercises. The results revealed very significant improvement in both the groups in all the measured parameters, (p<0.05). However, the intergroup comparisons showed significant improvement in all the measured parameters in group A (p<0.05). Thus, the study concluded that NMES along with core stabilization exercises is effective in recovery of diastasis recti and increasing abdominal muscle strengthas well as improvement in its complications like low back pain.
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... abdominal muscles in the core region were recovered to the pre-pregnancy period more quickly in women who started these exercises immediately after childbirth recovery compared to those who were inactive (12,13). In a study, Walton et al. (2016) investigated the effects of abdominal stabilization exercises along with plank and Kegel exercises for 6 weeks after childbirth. ...
... This method of training includes traditional abdominal exercises such as drawing in, three-dimensional breathing, Kegel, crunch, plank, Bosu alphabet, and Bosu ball squat. The results of some studies have shown that these exercises have a positive effect on improving DRA and such complications as low back pain, disability, and abdominal muscle strength (13,15). ...
The effects of Suspension (TRX) versus core stabilization training on postural stability, lumbopelvic control and proprioception in women with DiastasisRecti Abdominis: A Randomized Controlled Trial
Preprint
Full-text available
  • May 2021
Background: This study compared the effectiveness of eight weeks of suspension training (TRX) with that of isometric-isotonic (ISOM-ISOT) core stabilization exercises in the treatment of diastasis recti abdominis (DRA) and its secondary complications such as impairment in proprioception, postural stability, and lumbopelvic control as well as low back pain and the disability in doing daily activities. Methods: Thirty-six women with DRA with a mean age of 29.11 (4.85) from whose delivery 2 to 4 months had passed participated in this study. They were divided into the three groups of TRX, ISOM-ISOT training, and control. DRA, proprioception, lumbopelvic control, postural balance, low back pain, and disability were respectively assessed with a digital caliper, a goniometer, a lateral step-down test, a Biodex balance system, VAS, and Oswestry questionnaire. Then, two intervention groups from these subjects underwent training for 8-week and the subjects in the control group resumed their normal lives. Results: After eight-week of intervention, significant differences were observed in the inter-recti distance (IRD) (p=0.001), lumbopelvic proprioception (p=0.001), lumbopelvic control (p=0.001), static balance (overall stability) (p=0.010), dynamic balance (overall stability) (p=0.012), pain (p=0.001), and disability (p=0.001). The results of the LSD test showed that there was no significant difference between the TRX and ISOM-ISOT training groups in the studied parameters (P≥0.05). Conclusion: It seems that the TRX exercises had a positive effect on women with DRA and like the ISOM-ISOT exercises can be used to treat this disorder. Trial registration: The Iranian Registry of Clinical Trials (code: IRCT20190219042761N1; 06/07/2019).
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... The results of two systematic review studies demonstrated that the inter-recti distance (IRD) of pregnant women who participated in a training course for the isometric-isotonic strengthening of the abdominal muscles with focus on transverse muscle contraction was significantly less than that of those who did not exercise or had no training. In addition, the strength and endurance of the abdominal muscles in the core region were recovered to the prepregnancy period more quickly in women who started these exercises immediately after childbirth recovery compared to those who were inactive (Benjamin, Van de Water, and Peiris, 2014;Yalfani, Bigdeli, and Ahmadi, 2019). One of the resistance exercise programs used in this study was isometric-isotonic training (ISoM-ISoT). ...
Comparing the effects of suspension and isometric-isotonic training on postural stability, lumbopelvic control, and proprioception in women with diastasis recti abdominis: a randomized, single-blinded, controlled trial
Article
Background: Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. Objective: This study compared the effectiveness of suspension training system (STS) with that of isometric-isotonic (ISoM-ISoT) exercises in the treatment of DRA and its secondary complications. Methods: Thirty-six women with DRA participated in this study. They were divided into the three groups of STS, ISoM-ISoT, and control. Inter-recti distance (IRD), proprioception, lumbopelvic control, postural stability, low back pain, and disability were assessed using a digital caliper, a goniometer, a lateral step-down test, a Biodex balance system, a visual analogue scale (VAS), and the Oswestry Disability Index (ODI), respectively. Two intervention groups underwent training for 8-week and the control group resumed their normal lives. Results: Positive effects were observed in the STS and ISoM-ISoT groups compared with the control group in: IRD (P = .001); lumbopelvic proprioception (P = .001); lumbopelvic control (P = .001); overall static balance (P = .010); overall dynamic balance (P = .012); low back pain (P = .001); and disability (P = .001). However, there was no significant difference between the training groups in: IRD (P = .12, MD = −2.76); lumbopelvic proprioception (P = .48, MD = −0.50); lumbopelvic control (P = .14, MD = 1.53); static balance (P = .62, MD = 0.07); dynamic balance (P = .27, MD = 0.33); pain (P = .25, MD = −0.52); and disability (P = .48, MD = −1.74). The results of the minimal clinically important difference (MCID) and minimal detectable change (MDC) suggested that the STS exercises outperformed ISoM-ISoT training regarding IRD, pain, disability, and proprioception, whereas ISoM-ISoT training had a better effect in lumbopelvic control and balance. Conclusion: The results of our study showed that the STS had a positive effect on women with DRA and like the ISoM-ISoT exercises can be used to treat this dysfunction.
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The Effect of Isometric-Isotonic Exercises of Core Stability in Women with Postpartum Diastasis Recti and Its Secondary Disorders (Randomized Controlled Clinical Trial)
Article
Full-text available
  • Aug 2020
Background and aim: Increasing of gap between the inter-recti abdominal muscles during pregnancy and postpartum, called diastasis recti, which is the result of weakness and transverse stretching of the linea alba. In this disorder, lumbopelvic control is impaired, which is one of the causes of lumbar pain and disability after childbirth. One of the treatment methods for this disorder is rehabilitation training in the core area of the trunk. This study aimed to evaluate the effect of isometric-isotonic exercises on improving the width of linea alba, lumbopelvic control, pain, and disability in women with diastasis recti after postpartum. Methods: This study is a randomized controlled double-blind clinical trial in which 24 women with diastasis recti were participated and divided into two groups of exercise and control (n=12) with a mean age of 29.66 (4.97) and 28.25 (4.55), respectively. We used the digital caliper for the assessment of diastasis recti and lateral step down test for assessment of lumbopelvic control. Also, vas scale and Oswestry questionnaire were used for assessing pain and disability. The exercise group exercised for 8 weeks and 3 sessions per week and the control group continued their normal life routine. Results: By comparing the mean results of the intervention and control groups after eight weeks of isometric-isotonic training, a significant difference was observed in the rate of rectus diastasis and lumbopelvic control, pain, and disability (p≤ 0.05). Also, ETA squared of the effect size of exercise showed that these exercises had a very strong effect on the transverse distance of Lina Alba (0.846), the degree of pelvic lumbar control (0.850), the degree of disability (0.720), but had a moderate effect on pain variable (0.546). Conclusion: Isometric-isotonic exercises of core stability can improve lumbopelvic control by reducing the width of Linea Alba and thus reduce lumbopelvic pain and disability in people with diastasis recti. According to the results, the exercises presented in this study can be used to treat diastasis recti.
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Effects of Abdominal Exercises on Reduction of Diastasis Recti in Postnatal Women
Article
Full-text available
  • Jun 2016
  • Int J Health Sci
Background: Diastasis recti is condition in which the rectus abdominis muscle separates in midline at linea Alba, that can be seen in women during and after pregnancy. Specific therapeutic exercises and early initiation of treatment help to reduce the diastasis recti. Objectives: To determine effects of abdominal exercises on reduction of diastasis recti in postnatal women. Method: For this study pre post design was incorporated. A number of (N=40) female participants immediately after delivery with diastasis recti were selected. Diastasis recti were measured by using finger palpation technique and caliper technique. Results: A total (N=40) participants selected in this study with an age from 18-30 years. Total 30 participants included in this study. The result of finger palpation method, mean diastasis rectus at above umbilicus pre intervention was 2.733 ± 0.254, post intervention was 1.800±0.362. Diastasis rectus at below umbilicus at pre intervention was 2.067 ±0.172, and post intervention was 1.233±0.365. Diastasis rectus by caliper technique at above umbilicus pre intervention was 25.3197±0.8088, post intervention was 21.8583±0.8023 Diastasis rectus at below umbilicus at pre intervention was 21.9730±0.9814, and post intervention was 19.0093±1.3659. Conclusion: The result of this study shows that abdominal exercises are very effective in reducing diastasis recti in early postpartum women and inter recti distance. And support the prescription of an abdominal exercise programme for postnatal women and useful in reducing complications of it.
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Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial
Article
Full-text available
  • Mar 2019
Objectives: This study was aimed at discovering the efficacy the deep core stability exercise program has on the closure of diastasis recti and on the overall improvement in the quality of life for postpartum women. Methods: The study group consisted of forty women with diastasis recti, aged between 23 and 33 who were randomly divided into two groups. The 20 women in the first group underwent a deep core stability-strengthening program plus traditional abdominal exercises program, 3 times a week, for a total duration of 8 weeks. The other 20 women, forming the second group, only underwent the traditional abdominal exercises program, 3 times a week for 8 weeks. Following this procedure, the inter-recti separation was measured using digital nylon calipers while the quality of life was measured by Physical Functioning Scale (PF10) for all the participants. Results: As a result of the use of the deep core stability exercise program, inter-recti separation had a high statistically relevant decrease, (P<0.0001), showing a highly statistically relevant improvement with regard to the quality of life in the study groups (p<0.0001). Conclusions: The deep core stability exercise program is effective in treating diastasis recti and improving postpartum women's quality of life.
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Effect of exercise on diastasis recti abdominis among the primiparous women: a quasi-experimental study
Article
Full-text available
  • Dec 2016
Background: Diastatis rectii abdominis (DRA) occurs most commonly in pregnant women owing to weakness of the abdominal musculature resulting from maternal hormone influences and increased stretch of the rectus abdominis induced by the expanding uterus. As there are musculoskeletal complications following DRA, there is a need to implement DRA corrective exercises in preventing or treating DRA following child birth. The objective of the study was to investigate the effects of Diastasis rectus abdominis corrective exercises in reducing DRA among the primiparous women. Methods: Primiparous women who had DRA of more than 2 finger width at their umbilical level or a bulging rectus abdominis on contraction following a vaginal delivery (VD) or cesarean section (LSCS) were included as per the inclusion and exclusion criteria. Results: Fifty four and forty two women in the VD and LSCS group respectively participated in the study. Among them only 12 and 9 women from each group respectively performed the DRA corrective exercises for 6 weeks. There was a significant improvement in the reduction of DRA within the groups at p < 0.01. Comparison of reduction in DRA between VD and LSCS did not show any significant difference at p > 0.05 which indicated that both the groups showed the same level of improvement. Conclusions: DRA corrective exercises performed by the primiparous women with DRA in their postpartum period immediately following ND or a month after the LSCS for 6 weeks were found to be effective in reducing DRA. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000): 4441-4446]
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The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, oswestry disability index (ODI) and pelvic floor disability index scores (PFDI)
Article
Full-text available
  • Jan 2016
Purpose/Hypothesis: The purpose of this randomized controlled study was to determine if there was a significant difference between a six week traditional treatment program compared to an experimental treatment program consisting of core stabilization plank exercise routine in the closure of diastasis recti abdominis (DRA) and to determine the relationship between DRA measurements, pain, Oswestry Disability Index (ODI), and Pelvic Floor Disability Index scores (PFDI). Study design: Subjects were recruited in the local community utilizing a purposive sampling technique that considered women (postpartum 3 months to 3 years) between the ages of 18-45. Nine subjects volunteered to be in the study, signed an informed consent, and were randomly selected to be in either in a traditional or experimental group. Each participant completed both pre and post test diagnostic ultrasound and caliper measurements for DRA, health questionnaire, PFDI, and ODI scores. Materials and methods: A pilot study (n=5) was performed prior to the full study and indicated significant and strong inter-rater and intra-rater reliability for the diagnostic ultrasound DRA measurement at (r=0.945-0.989, p<0.0005). All participants were measured prior to being randomly placed into either the traditional or experimental group. Co-researchers who were in charge of DRA measurement were blinded from the group designation. The traditionalgroup received a supine strengthening program and the experimental group received a dynamic core stabilization program including the addition of plank exercise to approximate the DRA. Results: Overall, in both groups there was a measured, significant decline in the DRA measurement at the umbilicus (F=7.28, p=0.036), but the traditional group showed a slightly greater decline from pre to posttest (M(pre)=10.97+/-1.96; M(post)=6.63+/-1.65) compared to the experimental group (M(pre)=8.75+/-0.87) (M(post)=7.58+/-2.01). Disability scores also revealed a significant decline with respect to the ODI for both the traditional group (Z=-1.95, p=0.50) (M(pre)=5.50+/-5.51) (M(post)=3.50+/-3.00) and the experimental group (M(pre)=14.40+/-15.39) (M(post)=4.40+/-3.58). A significant difference was not found within groups, from pre to post-test, for the overall PFDI scores and its components (UDI and POPDI). However, a significant difference was found, within group, with respect to CRADI scores (Z=-2.032, p=0.042). In addition, a significant difference was not found between women who reported participation in pre-natal exercises compared with those who did not participate in pre-natal exercises with respect to baseline DRA measurements (above umbilicus: Z=-0.980, p=0.327), (at umbilicus: Z=-0.735, p=0.462), and (below umbilicus: Z=-0.980, p=0.327). Finally, a negative but non-significant correlation was found between PFDI scores and DRA closure measurements (r=0.605, r2=0.366, p=0.084). Conclusions: Both the traditional and experimental group showed significant reduction in DRA measurement from pre to posttest, with the traditional program exhibiting a slightly greater decline from pre to post DRA measurement than the experimental group. These findings suggest that either strengthening program, traditional or experimental, could be effective at reducing DRA measurement in postpartum women. However, this study was limited by a small sample size and would benefit from future research focused on specific exercise prescription progression.
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Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles
Article
  • Jun 2017
Objective To assess the effect of neuromuscular electrical stimulation (NMES) on the recovery of abdominal muscle strength in postnatal women with diastasis of recti abdominis muscles (DRAM). Methods Sixty women, 2 months postnatal, participated in this study. They were divided randomly into two equal groups. Group A received NMES in addition to abdominal exercises; group B received only abdominal exercises. The intervention in both groups was for three times per week for 8 weeks. The outcome measures were body mass index (BMI), waist/hip ratio, inter recti distance (IRD), and abdominal muscle strength in terms of peak torque, maximum repetition total work, and average power. Results Both groups showed highly significant (p < 0.05) improvement in all outcomes. Further, intergroup comparisons showed significant improvement (p < 0.05) in all parameters in favor of group A, except for the BMI.Conclusion NMES helps reduce DRAM in postnatal women; if combined with abdominal exercises, it can augment the effects.
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Management Strategies for Diastasis Recti
Article
  • Aug 2018
Diastasis recti is a relatively common condition in which there is a midline abdominal bulge that can affect a variety of individuals. The etiology and diagnosis is well understood and optimal management depends on the degree of severity. Patients at high risk for diastasis recti include multiparous women, obese patients, and those with multiple previous operations. Diagnosis includes clinical examination and assessment of symptoms. Physical characteristics include a midline abdominal bulge without a fascial defect. Classification systems are based on the degree of separation between the paired midline rectus and myofascial deformity. Optimal management varies and includes simple plication of the midline defect, extensive plication of the anterior abdominal wall, and sometimes the use of resorbable or nonresorbable mesh.
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Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: Comparison between primiparae and multiparae
Article
  • Jul 2009
Objectives: To investigate the prevalence of diastasis of the rectus abdominis muscles (DRAM) among primiparae and multiparae immediately after vaginal delivery, and to compare DRAM above and below the umbilicus and correlate these with the mother's age, body mass index, gestational age and duration of labor. Methods: A cross-sectional study was carried out. Personal information, obstetric history and DRAM measurements 4.5 cm above and below the umbilicus were recorded. DRAM was graded by the number of fingerbreadths (approximately 1.5 cm each) between the medial edges of this muscle. DRAM was considered present and relevant if the separation was > 2 cm at any measurement point. Results: Data from 467 women were analyzed. Above the umbilicus, the prevalence of DRAM >2 cm was 68%. Below the umbilicus, the prevalence of DRAM > 2 cm was 32%. The prevalence of DRAM above the umbilicus among primiparae and multiparae was identical (68%), and the prevalence below the umbilicus was greater among multiparae (19.8% and 29.2%). The mean DRAM above the umbilicus was 2.8 cm (±1.2) and the mean DRAM below the umbilicus was 1.5 cm (±1.1), representing a significant difference (p=0.0001) and a weak correlation (r=0.461). The mean DRAM below the umbilicus was significantly greater among the multiparae (p<0.018) and there was no correlation with the mother's age, body mass index, gestational age or duration of labor. Conclusions: The prevalence of DRAM and mean DRAM were greater above the umbilicus both among multiparae and primiparae. Below the umbilicus, the mean DRAM was significantly greater among multiparae. DRAM below the umbilicus presented a weak correlation with DRAM above the umbilicus.
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