Elsevier

Manual Therapy

Volume 20, Issue 1, February 2015, Pages 200-205
Manual Therapy

Original article
Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain

https://doi.org/10.1016/j.math.2014.09.002Get rights and content

Abstract

Diastasis recti abdominis (DRA) is an impairment characterized by a midline separation of the rectus abdominis muscles along the linea alba. It has its onset during pregnancy and the first weeks following childbirth. There is scant knowledge on both prevalence and risk factors for development of the condition.

The aim of this study was to investigate the prevalence of DRA at gestational week 35 and three timepoints postpartum, possible risk factors, and the relationship between DRA and lumbo-pelvic pain.

Ultrasound images of inter rectus distance (IRD) were recorded in 84 healthy primiparous women, at three locations on the linea alba. The IRD was measured at: gestational week 35 and 6–8, 12–14, and 24–26 weeks postpartum. Diagnosis of DRA was defined as 16 mm at 2 cm below the umbilicus. Independent sample t-test and binary logistic regression was used to assess differences and risk factors in women with and without DRA and women with and without lumbo-pelvic pain. P < 0.05 was considered statistically significant.

The prevalence of DRA decreased from 100% at gestational week 35–39% at 6 months postpartum. No statistically significant differences were found in prepregnancy body mass index (BMI), weight gain, baby's birth weight or abdominal circumference between women with and without DRA at 6 months postpartum. Women with DRA at 6 months postpartum were not more likely to report lumbo-pelvic pain than women without DRA.

DRA is prevalent at 6 months postpartum, but is not linked with lumbo-pelvic pain.

Introduction

Diastasis recti abdominis (DRA) has been defined as an impairment characterized by the separation of the two rectus abdominis muscles along the linea alba (Axer et al., 2001). This increased inter rectus distance (IRD) may be present congenitally, but most commonly develops during pregnancy and in the early postpartum period (Boissonnault and Blaschak, 1988, Gilleard and Brown, 1996).

Studies have found that DRA may affect between 30% and 70% of pregnant women (Boissonnault and Blaschak, 1988), and that it may remain separated in the immediate postpartum period in 35%–60% of women (Bursch, 1987). However the condition has also been found in 39% of older, parous women undergoing abdominal hysterectomy (Ranney, 1990) and in 52% of urogynecological menopausal patients (Spitznagle et al., 2007). Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis (Bursch, 1987, Boissonnault and Blaschak, 1988, Gilleard and Brown, 1996, Rath et al., 1996, Chiarello et al., 2005, Spitznagle et al., 2007, Beer et al., 2009) and use of different measurement methods. Most prevalence studies are based on palpation (Bursch, 1987, Boissonnault and Blaschak, 1988, Mantle et al., 2004) or calipers (Boxer and Jones, 1997, Hsia and Jones, 2000) which may be less reliable than ultrasonography (Mota et al., 2013). To date there are few studies about the normal width of the IRD in postpartum women (Coldron et al., 2008, Liaw et al., 2011), and there is scant knowledge about risk factors for DRA (Benjamin et al., 2014).

There are some theories stating that failure to treat DRA successfully can lead to long term sequelae (Candido et al., 2005), including abnormal posture (Boissonnault and Blaschak, 1988), lumbo-pelvic pain and cosmetic defects (Candido et al., 2005). However, to our knowledge there are no high quality clinical studies to support these statements.

The aims of the present study were to investigate:

  • 1.

    the prevalence of DRA at gestational week 35, and 6–8, 12–14, and 24–26 weeks postpartum;

  • 2.

    possible risk factors related to the presence of DRA at 6 months postpartum;

  • 3.

    whether women with DRA at 6 months postpartum have more lumbo-pelvic pain than women without DRA.

Section snippets

Methods

This was a longitudinal observational study following first time pregnant women from gestational week 35 till 6 months postpartum.

Results

Eighty-four of 123 first time pregnant women concluded the longitudinal study (Fig. 1). Twenty-two women were excluded before the first measurement: 11 because of pregnancy complications, 3 lived too far away to attend the measurements after birth, 6 were not able to meet for the first measurement and 2 for unknown reasons. Seventeen women missed at least one measurement due to personal issues, and were excluded.

The mean age of the 84 participants was 32.1 years (range 25–37) and 81% of the

Discussion

The present study found that prevalence of DRA at 2 cm below the umbilicus decreased from 100% in late pregnancy to 39% at 6 months postpartum. No significant risk factors were found for the presence of DRA at 6 months postpartum. Women with DRA were not more likely to report lumbo-pelvic pain than women without DRA.

Criteria and cut off point for the diagnosis of DRA vary in the literature (Bursch, 1987, Boissonnault and Blaschak, 1988, Ranney, 1990, Gilleard and Brown, 1996, Rath et al., 1996,

Conclusion

At 6 months postpartum, 39% of the women were diagnosed with DRA. No risk factors were identified for the presence of DRA in the present study. Women with DRA were not more likely to report lumbo-pelvic pain than women without DRA.

Conflict of interest

None of the authors had a conflict of interest.

Financial interest

We confirm that we have no financial affiliation (including research funding) or involvement with any commercial organization that has direct financial interest in any matter included in this manuscript.

Acknowledgements

The authors wish to thank the subjects studied, and Tatiana Dominguez, Miguel Basto, and all the team from Centro Pré e Pós Parto (Lisboa, Portugal), and Fatima Sancho and the team from R'Equilibrius Clinic (Oeiras, Portugal) for access facilitation to the pregnant and postpartum women. We also wish to thank Dr. José Luís García (Centro Hospitalario Policlinico San Carlos, Denia, Spain) for counseling on ultrasound imaging issues and suggestions for data collection and Gill Brook (Women's

References (33)

  • E.K. Bjelland et al.

    The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

    BJOG

    (2013 Jan)
  • E.K. Bjelland et al.

    Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum

    Am J Obstet Gynecol

    (2013 Apr)
  • K. et al.

    Do elite athletes experience low back, pelvic girdle and pelvic floor complaints during and after pregnancy?

    Scand J Med Sci Sports

    (2007 Oct)
  • J.S. Boissonnault et al.

    Incidence of diastasis recti abdominis during the childbearing year

    Phys Ther

    (1988 Jul)
  • S.G. Bursch

    Interrater reliability of diastasis recti abdominis measurement

    Phys Ther

    (1987 Jul)
  • G. Candido et al.

    Risk factors for diastasis of the recti abdominis

    J Assoc Chart Physiother Womens Health

    (2005)
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