The association between Diastasis recti abdominis and pelvic floor dysfunction, sacroiliac joint dysfunction, and quality of life among postpartum women after Cesarean delivery

Abstract

Purpose The goal of this study is to see if there's a predictive relationship between diastasis rectus abdominis and pelvic floor dysfunction, sacroiliac joint dysfunction, and postpartum women's health-related quality of life.

Method This cross-sectional, correlative study focused on 32 postpartum mothers aged 18 to 45 years old. Real Ultrasound Sonographic Imaging (RUSI) was used to determine DRA. The Pelvic Floor Disability Index was used to assess pelvic floor dysfunction (PFDI). The Active Straight Leg Raise Test (ASLR), the Long Dorsal Sacral Ligament Test (LDL), and the Posterior Pelvic Provocation Test (P4) were also investigated. The Short Form-12 (SF-12) Survey was used to assess health-related quality of life (HRQoL).

Results A negative correlation between DRA and postpartum period was recorded (ρ=0.0001). The following categories showed a significant positive correlation between DRA and Pelvic floor dysfunction: Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) corelated positively with DRA (ρ =0.01); Colorectal-Anal Distress Inventory-8 (CRAD-8) (ρ =0.02); Urinary Distress Inventory-6 (UDI-6) (ρ =0.00). There was no correlation between DRA and sacroiliac joint dysfunction (ρ =0.8).

Conclusion DRA was discovered to be a strong predictor of pelvic floor dysfunction, such as prolapse, colorectal-anal dysfunction, and urine distress. There was no evidence of a link between DRA and sacroiliac joint dysfunction or HRQoL.

Zusammenfassung

Fragestellung Ziel der vorliegenden Studie ist es zu untersuchen, ob eine prädiktive Beziehung zwischen Rektusdiastase und Beckenbodendysfunktion, iliosakraler Dysfunktion und der gesundheitsbezogenen Lebensqualität von Frauen in der postpartalen Phase besteht.

Methode In die korrelative Querschnittsstudie wurden 32 Frauen im Alter von 18 bis 45 Jahren in der postpartalen Phase aufgenommen. Das Vorliegen einer Rektusdiastase wurde mittels RUSI (Real Ultrasound Sonographic Imaging) bestimmt. Mithilfe des PFDI (Pelvic Floor Disability Index) wurde das Vorliegen einer Dysfunktion des Beckenbodens ermittelt. Weiterhin wurden der funktionelle Beckentest ASLR (Active Straight Leg Raise Test), der LDL (Long Dorsal Sacral Ligament Test) und der P4-Provokationstest (Posterior Pelvic Provocation Test) durchgeführt. Für die Ermittlung der gesundheitsbezogenen Lebensqualität (HRQoL) wurde der SF-12-Fragebogen (Short Form 12) verwendet.

Ergebnisse Es fand sich eine negative Korrelation zwischen Rektusdiastase und postpartaler Phase (ρ=0,0001). Die folgenden Kategorien zeigten eine signifikante positive Korrelation zwischen Rektusdiastase und Beckenbodendysfunktion: POPDI-6 (Pelvic Organ Prolapse Distress Inventory-6) zeigte eine positive Korrelation mit einer Rektusdiastase (ρ=0.01); CRAD-8 (Colorectal-Anal Distress Inventory-8) (ρ=0.02); UDI-6 (Urinary Distress Inventory-6) (ρ=0.00). Hingegen fand sich keine Korrelation zwischen Rektusdiastase und sakroiliakaler Dysfunktion (ρ=0.8).

Schlussfolgerung Die Rektusdiastase zeigte sich als starker Prädiktor einer Beckenbodendysfunktion, wie beispielsweise Prolaps, kolorektal-anale Dysfunktion und Harnwegsbeschwerden. Es fand sich kein Hinweis auf eine Beziehung zwischen Rektusdiastase und sakroiliakaler Dysfunktion oder gesundheitsbezogener Lebensqualität.

Key words

Diastasis Recti Abdominis - Pelvic Organ Prolapse - pelvic floor dysfunction - Colorectal-Anal Distress - Urinary Distress - Real Ultrasound Sonographic Imaging

Schlüsselwörter

Rektusdiastase - Genitalprolaps - Beckenbodendysfunktion - kolorektal-anale Beschwerden - Harnwegsbeschwerden - RUSI Ultraschall

• References

• 1 Mota P, Pascoal AG, Vaz C. et al. Diastasis Recti During Pregnancy and Postpartum. Cham: Springer International Publishing; 2018.
• 2 Mota P, Pascoal AG, Carita AI. et al. Normal width of the inter-recti distance in pregnant and postpartum primiparous women 2018; 35: 34-37
• 3 Dalal K, Kaur A, Mitra M.. Correlation between Diastasis Rectus Abdominis and Lumbopelvic Pain and Dysfunction 2014; 8: 210-214
• 4 Bø K, Hilde G, Tennfjord MK. et al. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study 2017; 36: 716-721
• 5 Sperstad JB, Tennfjord MK, Hilde G. et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain 2016; 50: 1092-1096
• 6 Ostgaard HC, Roos-Hansson E, Zetherström G.. Regression of Back and Posterior Pelvic Pain After Pregnancy 1996; 21: 2777-2780
• 7 Lee D, Hodges PW.. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study 2016; 46: 580-589
• 8 Vleeming A, Albert HB, Östgaard HC. et al. European guidelines for the diagnosis and treatment of pelvic girdle pain 2008; 17: 794-819
• 9 Vercellini P.. Chronic pelvic pain. John Wiley & Sons; 2011
• 10 Gillard S, Ryan CG, Stokes M. et al. Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women 2017; 34: 1-7
• 11 BROADHURST NA, BOND MJ.. Pain provocation tests for the assessment of sacroiliac joint dysfunction 1998; 11: 341-345
• 12 Laslett M.. Pain provocation sacroiliac joint tests: Reliability and prevalence 1997; 287-295
• 13 Laslett M, Williams M.. The reliability of selected pain provocation tests for sacroiliac joint pathology 1994; 19: 1243-1249
• 14 De Vries HJ, Vieeming A, Ronchetti I. et al. Pelvic girdle pain: the sensitivity and specificity of the Long Dorsal Sacroiliac Ligament test 2007; 488-491
• 15 Laslett M, Aprill CN, McDonald B. et al. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests 2005; 10: 207-218
• 16 Freburger JK, Riddle DL.. Using published evidence to guide the examination of the sacroiliac joint region 2001; 81: 1135-1143
• 17 O’Sullivan PB, Beales DJ, Beetham JA. et al. Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test 2002; 27: E1-E8
• 18 Bruno PA, Millar DP, Goertzen DA.. Inter-rater agreement, sensitivity, and specificity of the prone hip extension test and active straight leg raise test 2014; 22: 23
• 19 Zuchelo LTS, Bezerra IMP, Da Silva ATM. et al. Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: a systematic review 2018; 10: 409-424
• 20 Van der Woude DAA, Pijnenborg JMA, de Vries J.. Health status and quality of life in postpartum women: a systematic review of associated factors 2014; 185: 45-52
• 21 Carlstedt A, Bringman S, Egberth M. et al. Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines 2021; 110: 452-459
• 22 Spitznagle TM, Leong FC, Van Dillen LR.. Prevalence of diastasis recti abdominis in a urogynecological patient population 2007; 18: 321-328
• 23 Vergeldt TFM, Weemhoff M. Hout J in’t et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review 2015; 26: 1559-1573
• 24 Gilleard WL, Brown JMM.. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period 1996; 76: 750-762
• 25 Kamel DM, Yousif AM.. Neuromuscular Electrical Stimulation and Strength Recovery of Postnatal Diastasis Recti Abdominis Muscles 2017; 41: 465-474
• 26 Yang M, Yue W, Han X. et al. Postpartum care indications and methodological quality: a systematic review of guidelines 2021; 1-15
• 27 Wang Q, Yu X, Chen G. et al. Does diastasis recti abdominis weaken pelvic floor function?. A cross-sectional study 2019; 31: 277-283
• 28 Tuominen R, Jahkola T, Saisto T. et al. The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study 2021; 26: 599-608
• 29 Vergeldt TFM, Weemhoff M. Hout J in’t et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review 2015; 26: 1559-1573
• 30 Benjamin DR, van de Water ATM, Peiris CL.. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review 2013; 100: 1-8
• 31 Mens JM, Pool-Goudzwaard A.. Contraction of the transverse abdominal muscle in pelvic girdle pain is enhanced by pain provocation during the task 2017; 32: 78-83
• 32 Turan V, Colluoglu C, Turkyilmaz E. et al. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey 2011; 82: 817-821 Im Internet https://www.ncbi.nlm.nih.gov/pubmed/22384613
• 33 Braga A, Caccia G, Nasi I. et al. Diastasis recti abdominis after childbirth: Is it a predictor of stress urinary incontinence? 2020; 49: 101657
• 34 Parker MA, Millar LA, Dugan SA.. Diastasis Rectus Abdominis and Lumbo-Pelvic Pain and Dysfunction-Are They Related? 2009; 33: 15-22
• 35 Mota P, Pascoal AG, Sancho F. et al. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women 2012; 42: 940-946
• 36 Mota P, Pascoal AG, Sancho F. et al. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements 2013; 18: 294-298