Background Diastasis recti abdominis (DRA) has been defined as an impairment characterised by a midline separation of the 2 rectus abdominis (RA) muscles along the linea alba (LA) aponeurose. This increased interrectus distance (IRD) has its onset during pregnancy, immediately after birth, or in the first weeks following it. With the fetus growth, the two muscle bellies of the RA, connected by the LA, elongate the abdominal wall and it expands. The DRA affects between 30%–70% of pregnant women and remains in the immediate postpartum period in 34.9% 9% to 60% of women and in 38.7% of older, parous women undergoing abdominal hysterectomy and in 52% of urogynecological menopausal patients. Laparoscopic cholecystectomy is the gold standard for sympthomatic cholelithiasis. It consists on small incisions through abdominal muscles (rectus abdomini, internal and external obliques, transversal abdominis and their aponeurosis).The aim of this study are to describe that conventional treatment for the DRA should be considered to modifications in patients after abdominal surgery.
Methods A 34 year-old-woman, after 2 years of having given birth underwent surgery for cholecistectomy laparotomy in January 2016. The patient presented an small DRA.
After the abdominal palpation, ultrasound images were taken using a Logic P9 ultrasound scanner (GE Medical Systems Ultrasound, Hatfield, Hertfordshire, UK), with a ML6–15 linear probe (55 mm footprint). The image was frozen and then downloaded to a computer using a frame grabber and measured off-line with on-screen callipers. During image acquisition the bottom edge of the transducer was positioned at the same location and during the same conditions 2 cm above the umbilicus by one of the physical therapists. Physical therapists recorded the values of resting RA thickness and the IRD with the subject in supine position and performing a RA contraction, transversus contraction, transversus plus leg levation, doing core exercises; at every exercise and relaxed. The mean of two measurements were recorded. After 2 min rest the procedure was repeated by the second physical therapist.
Results The DRA reduced when performing core exercises. However, the DRA increased when performing a RA contraction, transversus contraction, transversus plus leg levation.
Conclusions This case shows the importance of ultrasound assessment while working with patients in uroginecological area. More studies with RCT design should be done to support this idea.
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