Can rectus abdominis diastasis cause pelvic floor dysfunction?

Authors

DOI:

https://doi.org/10.33233/fb.v23i5.5171

Keywords:

diastasis, muscle, rectus abdominis, pelvic floor disorders

Abstract

Introduction: The pelvic floor dysfunction is defined as any deviation from the normal function of the pelvic floor muscles: prolapses, incontinence, pelvic pain, sexual dysfunctions. Among the many conditions, rectus abdominis diastasis is a recurrent condition defined as an impairment of the midline separation of the two rectus abdominis muscles along the linea alba. Objective: To review the literature of studies from the last 10 years, in order to answer whether rectal diastasis may be involved in any pelvic floor dysfunction. Methods: This is an integrative literature review carried out through a search in the period from 2011 to 2021, in the electronic databases Pubmed, BVS and Academic Google. Results: Most studies have been carried out in women up to 12 months postpartum and did not find a relationship between pelvic floor dysfunctions associated with the presence of rectus abdominis diastasis. However, a study carried out in pre and post-menopausal women describes that diastasis proved to be a predictive factor for pelvic floor dysfunction. Conclusion: The variability between data made comparisons between studies difficult, so studies with higher methodological quality are needed in order to fill knowledge gaps.

Author Biographies

Michele Portal da Silveira, UniRitter

Graduanda do Curso Fisioterapia, Centro Universitário Ritter dos Reis (UniRitter), Porto Alegre, RS, Brasil

Yasmin Podlasinski da Silva, ULBRA

Graduada do Curso de Medicina, Universidade Luterana do Brasil (ULBRA), Porto Alegre, RS, Brasil

Magda Patrícia Furlanetto, UniRitter

Docente da Disciplina de Fisioterapia Urogenital, Centro Universitário Ritter dos Reis (UniRitter), Porto Alegre, RS, Brasil

References

Lawson S, Sacks A. Pélvico floor physical therapy and women’s health promotion. J Midwifery Womens Health 2018;1-8. doi: 10.1111/jmwh.12736

Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol. Urodyn 2021;40:1217-60. doi: 10.1002/nau.24658

Messelink B, Benson T , Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: Report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurourol Urodyn 2005;374-80. doi: 10.1002/nau.20144

Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol 2014;123(1):141-8. doi: 10.1097/AOG.0000000000000057

Evangelista DR, Gazeta FA, De Assis C, Calamita Z. Prevalence of urinary incontinence in elderly women and impact on quality of life. Brazilian Journal of Health Review 2021;4(1):1588-1602. doi: 10.34119/bjhrv4n1-133

Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther 2016;46(7). doi: 10.2519/jospt.2016.6536

Chiarello CM. Pregnancy-related pelvic girdle pain and diastasis rectus abdominis. J Womens Health Phys Therap 2017;41(1). doi: 10.1097/JWH.0000000000000068

Bø K, Stuge B, Hilde G. Specific musculoskeletal adaptations in pregnancy: pelvic floor, pelvic girdle, and low back pain: implications for physical activity and exercise. Exercise and Sporting Activity During Pregnancy. Springer;2019. p.135-55. doi: 10.1007/978-3-319-91032-1_6

Kaufmann RL, Reiner CS, Dietz UA, Clavien PA, Vonlanthen R, Käser SA. Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia 2022;26(2):609-18. doi: 10.1007/s10029-021-02493-7

Michalska A, Rokita W, Wolder D, Pogorzelska J, Kaczmarczyk K. Diastasis recti abdominis - a review of treatment methods. Ginekol Pol 2018;89(2):97-101. doi: 10.5603/GP.a2018.0016

Da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015;20(1):200-5. doi: 10.1016/j.math.2014.09.002

Rett MT, Araújo FR, Rocha I, Silva RA. Diastasis of rectus abdominis muscle immediately postpartum of primiparous and multiparous after vaginal delivery. Fisioter Pesqui 2012;19(3):236-41. doi: 10.1590/S1809-29502012000300008

Werner LA, Dayan M. Diastasis recti abdominis-diagnosis, risk factors, effect on musculoskeletal function, framework for treatment and implications for the pelvic floor. Curr Women Health Rev 2019;15:86-101. doi: 10.2174/1573404814666180222152952

Bø K, Morkved S, Frawley H, Sherbum M. Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourol Urodyn 2009;28(5):368-37. doi: 10.1002/nau.20700

Thompson J, O’Sullivan P. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: A crosssectional study and review. Int Urogynecol J Pelvic Floor Dysfunct 2003;14(2):84-8. doi: 10.1007/s00192-003-1036-5

Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52(6):377. doi: 10.1136/jech.52.6.377

Kamper SJ. Randomization: linking evidence to practice. J Orthop Sports Phys Ther 2018;48(9):730-1. doi: 10.2519/jospt.2018.0704

Itens P, Revis R, Uma P. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol Serv Saúde 2015;24(2):335–42. doi: 10.5123/S1679-49742015000200017

Braga A, Caccia G, Nasi I, Ruggeri G, Di Dedda MC, Lamberti G, et al. Diastasis recti abdominis after childbirth: is it a predictor of stress urinary incontinence? J Gynecol Obstet Hum Reprod 2019;49(10). doi: 10.1016/j.jogoh.2019.101657

Fei H, Liu Y,Li M, He J, Liu L, Li J, et al. The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study. BMC Women’s Health 2021;21:68. doi: 10.1186/s12905-021-01194-8

Sperstad JB, Tennfjord MK, Hilde G, Engh ME, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 2016;50:1092-96. doi: 10.1136/bjsports-2016-096065

Cardaillac C, Vieillefosse S, Oppenheimer A, Joueidi Y, Thubert T, Deffieux X. Diastasis of the rectus abdominis muscles in postpartum: Concordance of patient and clinician evaluations, prevalence, associated pelvic floor symptoms and quality of life. Eur J Obstet Gynecol Reprod Biol 2020;228-32. doi: 10.1016/j.ejogrb.2020.06.038

Harada BS, De Bortolli TT, Carnaz L, De Conti MH, Hijaz A, Driusso P, et al. Diastasis recti abdominis and pelvic floor dysfunction in peri- and postmenopausal women: a cross-sectional study. Physiother Theory Pract 2020;1-7. doi: 10.1080/09593985.2020.1849476

Volkan T, Cagdas C, Esengul T, Umit K. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol [Internet] 2011[cited 2022 Aug 30];82(11):817-21. Available from: https://journals.viamedica.pl/ginekologia_polska/article/view/46265/33053

Wang Q, Yu X, Chen G, Sun X, Wang J. Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Int Urogynecol J 2020;31:277-83. doi: 10.1007/s00192-019-04005-9

Bø K, Hilde G, Tennfjord MK, Sperstad JB, Engh ME. Pelvic floor muscle function, pelvic floor dysfunction, and diastasis recti abdominis: prospective cohort study. Neurourol Urodyn 2016;36(3):716-21. doi: 10.1002/nau.23005

Eisenberg VH, Sela L, Weisman A, Masharawi Y. The relationship between diastasis rectus abdominus, pelvic floor trauma and function in primiparous women postpartum. Int Urogynecol J 2021;32:2367–75. doi: 10.1007/s00192-020-04619-4

Gluppe S, Engh ME, Bø K. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominais. Physiotherapy 2021;111:55-65. doi: 10.1016/j.physio.2021.01.008

Van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther 2016;(21):41-53. doi: 10.1016/j.math.2015.09.013

Mota P, Pascoal AG, Sancho F, Carita AI, Bø K. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther 2013;18(4):294-8. doi: 10.1016/j.math.2012.10.013

Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Women Health Phys Therap 2012;36(3):131-42. doi: 10.1097/JWH.0b013e318276f35f

Fede C, Pirri C, Fan C, Albertin G, Porzionato A, Macchi V, et al. Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production. PLoS One 2019;14(9). doi: 10.1371/journal.pone.0223195

Fan C, Guidolin D, Ragazzo S, Fede C, Pirri C, Gaudreault N, et al. Effects of cesarean section and vaginal delivery on abdominal muscles and fasciae. Medicina 2020;56(6):260. doi: 10.3390/medicina56060260

Gitta S, Magyar Z, Tardi P, Füge I, Járomi M, Pongrác C et al. Prevalence, potential risk factors and sequelae of diastasis resti abdominis. Orvosi Hetilap 2017;158(12):454-60. doi: 10.1556/650.2017.30703

Published

2022-10-12