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Background and Objectives: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. Material and Methods: This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. Results: There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. Conclusions: there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.
Assuntos
Dor Lombar , Humanos , Feminino , Projetos Piloto , Adulto , Dor Lombar/fisiopatologia , Pessoa de Meia-Idade , Limiar da Dor/fisiologia , Reto do Abdome/fisiopatologia , Medição da Dor/métodos , Diástase Muscular/fisiopatologia , Diástase Muscular/complicações , Pressão , Inquéritos e Questionários , Região Lombossacral/fisiopatologiaRESUMO
INTRODUCTION: The diastasis of the rectus abdominis muscles is common during pregnancy and post-partum. OBJECTIVE: To determine the prevalence of this pathology, methods of diagnosis, association with pelvic-perineal disorders and therapies that may be proposed. METHODS: Review of Pubmed, Medline, Embase and Cochrane literature using the following words and MeSH: diastasis, diastasis and pregnancy, diastasis of the rectus abdominis muscle, increase of the inter-recti distance. RESULTS: Among the 124 articles found, 61 were selected. Ultrasound seems to be the exam of choice both in terms of feasibility and reproducibility for the diagnosis of this pathology (intra-class correlation coefficients (ICC) high 0.81 to 0.94). The risk factors identified vary from one study to another: heavy load bearing (OR=2.18 (95 % CI 1.05 to 4.52) P=0.04), weight gain. Studies are discordant regarding the association between diastasis and low back pain (RR=1.39 (95 % CI 0.91-2.14), P=0.17), urinary incontinence (RR=0.86 (95 % CI 0.55-1.33) P>0.65) and prolapse (OR=2.25 (95 % CI 1.51-3.37) P<0.001), but the diastasis seems to play a role in the alteration of the quality of life for these patients. CONCLUSION: Knowledge about risk factors, consequences of diastasis and management is still limited today. It is therefore necessary to establish prospective studies on larger numbers in order to improve knowledge on the diastasis of the rectus abdominis muscles.
Assuntos
Diástase Muscular , Complicações na Gravidez , Reto do Abdome , Diástase Muscular/complicações , Diástase Muscular/diagnóstico , Diástase Muscular/epidemiologia , Diástase Muscular/terapia , Feminino , Humanos , Dor Lombar/etiologia , Dor Pélvica/etiologia , Períneo , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Fatores de RiscoRESUMO
BACKGROUND: Low back pain (LBP) is a common cause of disability worldwide; multiple causes and risk factors have been proposed in the genesis of back pain. Some studies reported an association between diastasis recti abdominis (DRA), a surrogate for decreased core strength muscle, and low back pain. We aimed to investigate the relationship between DRA and LBP through a systematic review. METHODS: A systematic review of the literature of clinical studies in English literature was conducted. PubMed, Cochrane, and Embase databases were used to conduct the search up to January 2022. The strategy included the following keywords: "Lower Back Pain" AND "Diastasis Recti" OR "Rectus abdominis" OR "abdominal wall" OR "paraspinal musculature". RESULTS: From 207 records initially found, 34 were suitable for full review. Thirteen studies were finally included in this review, with a total of 2,820 patients. Five studies found a positive association between DRA and LBP (5 of 13 = 38.5%) whereas 8 studies did not find any association between DRA and LBP (8 of 13 = 61.5%). CONCLUSIONS: Of the studies included in this systematic review, 61.5% did not find an association between DRA and LBP whereas a positive correlation was observed in 38.5% of studies included. Based on the quality of the studies included in our review, better studies are warranted to understand the association between DRA and LBP.
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Parede Abdominal , Diástase Muscular , Dor Lombar , Humanos , Reto do Abdome , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Diástase Muscular/complicações , Força MuscularRESUMO
INTRODUCTION: Urinary incontinence (UI) is a common pelvic floor dysfunction in pregnancy. The relationship between biomechanical changes and pregnancy-related UI has not been fully elucidated. OBJECTIVE: To investigate the association of various musculoskeletal and anthropometric changes in pregnancy that affect gestational UI. METHODS: The study was conducted with 275 pregnant women. Ninety-three, 110 and 72 women were in first, second and third trimesters, respectively. Incontinence Impact Questionnaire for UI, Urogenital Distress Inventory-Short Form and Incontinence Severity Index were applied. Lumbar lordosis measurement was performed by Baseline Bubble Inclinometer while diastasis recti abdominis (DRA) measurement was carried out by finger-width method. Manual muscle test for rectus abdominis and right and left external oblique abdominal muscles, and Benign joint hypermobility test with Beighton scoring method were also applied as musculoskeletal measurements. Tape measurement at the waist, umbilical and hip levels, caliper with bi-iliac and bi-trochanteric diameters were also recorded as anthropometric measurements. RESULTS: Significant associated factors for UI were: umbilical DRA (OR = 1.57; p = .012); rectus abdominis muscle strength (values of 3 and below, OR = 1.2; p = .014); umbilical environment (OR = 1.1; p = .029); bi-iliac diameter (OR = 1.1; p = .05;) and bi-trochanteric diameter (OR = 1.3; p = .05), respectively. CONCLUSION: Changing musculoskeletal and anthropometric characteristics of pregnant women should be taken into consideration in UI follow-up during pregnancy.
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Diástase Muscular , Doenças Musculares , Incontinência Urinária , Músculos Abdominais , Antropometria , Diástase Muscular/complicações , Feminino , Humanos , Gravidez , Reto do Abdome , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologiaRESUMO
OBJECTIVE: Explore the ultrasound characteristics of early postpartum Diastasis Recti Abdominis (DRA) and provide effective data support for its clinical diagnosis and treatment. METHOD: A total of 458 parturients who were diagnosed with DRA in the Chongqing Maternal and Child Health Hospital from December 2017 to September 2020 underwent postpartum ultrasound examinations. All of which were located at four points: 6 cm above the umbilicus (point 1), 3 cm above the umbilicus (point 2), umbilicus (point 3), and 3 cm below the umbilicus (point 4) to detect the interrectus distance (IRD) in the resting and sit-up state of the parturients postpartum and to study the differences in maternal age, weight, and ultrasound diagnosis of IRD at different stages after delivery. RESULTS: The IRD values of the four measurement points in the resting state of the parturient were significantly greater than the IRD values in the sit-up state. And in the resting state, the IRD value (4.31 ± 1.07 cm) of the point 3 region was the largest, and there were significant differences at different stages of the postpartum women. At the same time, the IRD values of points 3 and 4 have significant differences in parturient of different ages. In addition, the IRD values of the four measurement points of overweight women were higher than those of nonoverweight women. CONCLUSION: The umbilicus is the best ultrasound evaluation point for early postpartum DRA. The IRD value at this point in the resting state can be used as reference data for evaluating early postpartum DRA, which provides a useful reference for rapid postpartum recovery of parturients.
Assuntos
Diástase Muscular/complicações , Diástase Muscular/diagnóstico por imagem , Transtornos Puerperais/diagnóstico por imagem , Reto do Abdome/diagnóstico por imagem , Adulto , Biologia Computacional , Feminino , Humanos , Período Pós-Parto , Gravidez , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Adulto JovemRESUMO
Background: During pregnancy, women are at risk of developing persistent symptomatic diastasis recti abdominis (DRA), which may have a detrimental effect on their physical function and quality of life (QoL). The aim of this prospective cohort study was to determine the effect of surgical repair of DRA on abdominal trunk function, urinary incontinence and QoL in postpartum women with trunk instability symptoms resistant to training. Methods: Postpartum women with diagnosed DRA and training-resistant symptoms underwent double-row plication of the linea alba. Abdominal trunk function was evaluated as the primary endpoint using a multimodal examination tool, the Abdominal Trunk Function Protocol. Recurrence was assessed by CT, urinary incontinence was evaluated using the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and QoL was assessed with the Short Form 36 (SF-36®) questionnaire. All subjects were examined before and 1 year after surgery. Results: Sixty women were recruited. There was no DRA recurrence at the 1-year follow-up. Self-reported abdominal trunk function had improved in 98 per cent of patients, with a mean score improvement of 79·1 per cent. In the physiological tests monitored by a physiotherapist, 76 per cent performed better and endured exercise tests longer than before surgery. All SF-36® subscales improved significantly compared with preoperative scores and reached levels similar to, or higher than, the normative Swedish female population. For the UDI-6 and IIQ-7, 47 and 37 per cent respectively reported fewer symptoms at follow-up than before surgery, and 13 and 8 per cent respectively reported more symptoms. Conclusion: In this series of postpartum women presenting with DRA and symptoms of trunk instability resistant to training, surgical reconstruction resulted in a significant improvement in abdominal trunk function, urinary incontinence and QoL.
Antecedentes: Durante el embarazo, las mujeres tienen el riesgo de desarrollar una diástasis rectoabdominal persistente y sintomática (diastasis rectoabdominis, DRA) que puede tener un efecto perjudicial en su función física y en la calidad de vida (quality of life, QoL). El objetivo de este estudio de cohortes prospectivo fue determinar el efecto de reparación quirúrgica de la DRA en la función de la musculatura de la pared abdominal, la incontinencia urinaria y la QoL en mujeres con síntomas postparto de inestabilidad de la musculatura abdominal resistentes al entrenamiento. Métodos: Sesenta mujeres diagnosticadas en el postparto de DRA y con síntomas resistentes al entrenamiento se sometieron a una plicatura de doble capa de la línea alba. El objetivo primario fue evaluar la función de la musculatura de la pared abdominal mediante una herramienta de examen multimodal, el protocolo de la función de la pared abdominal (abdominal trunk function protocol, ATFP). La recidiva se evaluó mediante tomografía computarizada, la incontinencia urinaria utilizando los cuestionarios UDI6 y IIQ7 y la calidad de vida con el cuestionario SF36. Todas las participantes fueron examinadas antes de la cirugía y un año después de la misma. Resultados: Tras un año de seguimiento, no hubo recidiva de la DRA. Según informaron las pacientes, la función de la musculatura abdominal había mejorado en el 98,2% de los casos, con una mejoría en la puntuación media del 79,1%. En las pruebas fisiológicas controladas por un fisioterapeuta, el 76,0% presentó mejoría y aumentó la duración en las pruebas de resistencia en comparación con antes de la cirugía. Todas las subescalas del SF36 mejoraron significativamente en comparación con las puntuaciones preoperatorias y alcanzaron niveles similares o superiores a los de la población femenina sueca normal. Para el UDI6 y el IIQ7, el 46,7% y el 36,7% respectivamente, manifestaron menos síntomas en el seguimiento que antes de la cirugía, mientras que el 13,3% y el 8,3% respectivamente, reportaron más síntomas. Conclusión: En esta serie de mujeres que presentan DRA en el posparto y síntomas de inestabilidad de la musculatura abdominal resistente al entrenamiento, la reconstrucción quirúrgica produjo una mejora significativa en la función de la musculatura abdominal, la incontinencia urinaria y la calidad de vida.
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Diástase Muscular/cirurgia , Complicações na Gravidez/cirurgia , Qualidade de Vida , Reto do Abdome/cirurgia , Incontinência Urinária/cirurgia , Parede Abdominal/fisiopatologia , Parede Abdominal/cirurgia , Adulto , Diástase Muscular/complicações , Diástase Muscular/fisiopatologia , Diástase Muscular/psicologia , Feminino , Seguimentos , Humanos , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/psicologia , Estudos Prospectivos , Reto do Abdome/fisiopatologia , Autorrelato/estatística & dados numéricos , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/psicologiaRESUMO
BACKGROUND: Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. AIM: To describe a "new" technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. METHOD: SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. RESULTS: The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. CONCLUSION: The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.
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Diástase Muscular/cirurgia , Hérnia Ventral/cirurgia , Laparoscopia/métodos , Reto do Abdome/cirurgia , Tela Subcutânea/cirurgia , Adulto , Diástase Muscular/complicações , Feminino , Hérnia Ventral/complicações , Herniorrafia/métodos , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
INTRODUCTION: Rectus diastasis, when coexistent with umbilical hernia, can benefit from mesh-based repair of the midline. Laparoscopic correction of an umbilical hernia involves the placement of a mesh in the peritoneal cavity, but this comes with the risk of bowel complications. However, newly developed dual-sided composite meshes have helped to reduce this risk. MATERIALS AND SURGICAL TECHNIQUE: Four men and three women with umbilical hernia and rectus diastasis were treated with laparoscopic transabdominal preperitoneal repair. Composite mesh with a hydrophilic 3-D polyester textile on the parietal side and an absorbable collagen barrier on the peritoneal side were placed in the preperitoneal pocket after hernial sac reduction. Mean hernia size was 2.5 cm, and no recurrences were observed during the mean follow-up period of 9.2 months. DISCUSSION: The laparoscopic transabdominal preperitoneal approach for umbilical hernia and rectus diastasis may be a safe surgical option when trying to avoid potential complications related to intra-abdominal mesh positioning.
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Diástase Muscular/cirurgia , Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Reto do Abdome/cirurgia , Telas Cirúrgicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Diástase Muscular/complicações , Feminino , Seguimentos , Hérnia Umbilical/complicações , Herniorrafia/instrumentação , Humanos , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Peritônio/cirurgia , Resultado do TratamentoRESUMO
ABSTRACT Background: Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. Aim: To describe a "new" technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. Method: SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. Results: The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. Conclusion: The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.
RESUMO Racional: A diástase dos músculos retos abdominais (DMRA) é frequente e pode estar associada à presença de hérnias da parede abdominal. Para pacientes com excesso de pele, a dermolipectomia e plicatura da diástase é o procedimento mais comumente utilizado. Entretanto, há um grupo significativo de pacientes que não necessitam ressecção de pele ou não desejam grandes incisões. Objetivo: Descrever uma "nova" técnica (Subcutaneous Onlay Laparoscopic Approach - SCOLA) para a correção das hérnias ventrais combinada à plicatura da DMRA e relatar os resultados iniciais. Métodos: A técnica SCOLA de correção de hérnia ventral concomitante com a plicatura da DMRA por técnica endoscópica pré-aponeurótica foi aplicada em quarenta e oito pacientes. Resultados: O tempo operatório médio foi de 93,5 min. Não houve nenhuma complicação intra-operatória e nenhuma conversão. Seroma foi a complicação mais frequente (n=13, 27%). Apenas um (2%) apresentou infecção de ferida operatória. Após seguimento médio de oito meses (2-19) apenas um (2%) paciente apresentou recidiva da DMRA e um (2%) retração/fibrose do tecido subcutâneo. Quarenta e cinco (93,7%) relataram estarem satisfeitos com resultado. Conclusão: A técnica SCOLA é alternativa segura, reprodutível e efetiva para pacientes com hérnia da parede abdominal associada à DMRA.