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van Wingerden JP, Ronchetti I, Kleinrensink GJ. Gender Equality in Diastasis Rectus Abdominis in Chronic Back Pain: A Model of M. Transversus Abdominis Motor Control Impairment. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12314. [PMID: 38751424 PMCID: PMC11094238 DOI: 10.3389/jaws.2024.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024]
Abstract
Introduction: Diastasis rectus abdominis (DRA) is defined as an increased distance between the left and right muscle of the m. rectus abdominis. Pregnancy-related factors are assumed to be dominant factors in the occurrence of DRA. However DRA is not only found in peri-partum women but also in men and nulliparous women with back or pelvic pain. This study provides an inventory of the incidence of DRA in subjects with chronic back and pelvic pain. If DRA is common in both men and women then other factors besides pregnancy, like impaired motor control, should be explored as cause for DRA. Material and Methods: This study was conducted with data from 849 back pain patients. Results from ultrasound assessment of the abdominal wall were combined with anamnestic data on age, gender, medical history and pregnancies (in women). Results: There was no difference in Inter Rectus Distance cranial of the umbilicus (IRD above umbilicus) between men and women. Almost half of all women and men (45% and 43%, respectively) exhibit an increased IRD above umbilicus. The incidence of an increased IRD above umbilicus is twice as high in women below 30 years, compared to men below 30 years old. This difference is not observed for men and women above 30 years old. Discussion: DRA occurs in women during pregnancy and increases with an increasing number of pregnancies. However, this condition does not affect significantly more women than men. Increased IRD above umbilicus already occurs in young men (mean age 30). Over 30 years of age, cranial of the umbilicus there is no difference in IRD between women and men. An alternative etiological mechanism is suggested.
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Affiliation(s)
| | | | - G-J. Kleinrensink
- Department of Neuroscience-Anatomy, Erasmus MC, Rotterdam, Netherlands
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Theodorsen NM, Moe-Nilssen R, Bø K, Haukenes I. Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy 2023; 121:13-20. [PMID: 37812848 DOI: 10.1016/j.physio.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/18/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). DESIGN Experimental longitudinal design. SETTING Physiotherapy clinic, primary health care. PARTICIPANTS Thirty-eight pregnant women with DRA ≥ 2.8 cm. INTERVENTIONS Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. MAIN OUTCOME MEASURES Change in IRD. RESULTS There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27-37 was a mean increase of 8 mm (95% CI: 6, 9). CONCLUSION Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Nina-Margrethe Theodorsen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway.
| | - Rolf Moe-Nilssen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
| | - Kari Bø
- Norwegian School of Sport Sciences, Department of Sports Medicine, Postboks 4014 Ullevål stadion, 0806 Oslo, Norway
| | - Inger Haukenes
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
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Du J, Ye J, Fei H, Li M, He J, Liu Y, Liu L, Ye Y, Li J, Hou L, Xu Y, Zhang H, Zhang C, Li T. Relationship Between Gestational Diabetes Mellitus and Postpartum Diastasis Recti Abdominis in Women in the First Year Postdelivery. Phys Ther 2023; 103:pzad102. [PMID: 37774365 PMCID: PMC10661657 DOI: 10.1093/ptj/pzad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 05/15/2023] [Accepted: 07/09/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Postpartum diastasis recti abdominis (DRA) influences women's appearance and health. Gestational diabetes mellitus (GDM) can affect the structure of the rectus abdominis muscles. However, the relationship between GDM and postpartum DRA is unknown. The objective of this study was to investigate the relationship between GDM and postpartum DRA. METHODS This retrospective cohort study included 241 women in the first year postdelivery. Women with GDM were matched with those without GDM using propensity score matching. They underwent an oral glucose tolerance test during pregnancy and a random blood glucose test before delivery. At follow-up, DRA was diagnosed by palpation, and interrectus distance was measured using ultrasound to evaluate the severity of DRA. The strength of the rectus abdominis was evaluated using the manual muscle testing method. RESULTS Among the 241 participants, 174 (72.2%) had postpartum DRA, and 46 women with GDM were matched with 46 women without GDM on the basis of propensity scores. Women with GDM had higher odds of experiencing postpartum DRA (adjusted odds ratio = 4.792; 95% CI = 1.672 to 13.736) and larger interrectus distance values at the upper part of the rectus abdominis than those without GDM. There was a weak and positive correlation between the fasting oral glucose tolerance test level and the interrectus distance values (0.267 ≤ r ≤ 0.367). CONCLUSION GDM was associated with postpartum DRA in women in the first year of delivery. Women with GDM had larger interrectus distance values at the upper part of the rectus abdominis than those without GDM. The fasting oral glucose tolerance test level showed a positive and weak correlation with the severity of postpartum DRA. IMPACT Women with GDM have higher odds of experiencing postpartum DRA than those without GDM. The upper part of the rectus abdominis deserves increased focus during and after rehabilitation. Controlling the fasting oral glucose tolerance test level may help reduce the severity of postpartum DRA.
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Affiliation(s)
- Jingran Du
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Juntong Ye
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Fei
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Mengxiong Li
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Juan He
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yun Liu
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lixiang Liu
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yangliu Ye
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Juanhua Li
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Hou
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yang Xu
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Haixia Zhang
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Changlin Zhang
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Tian Li
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Chen B, Zhao X, Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon 2023; 9:e20956. [PMID: 37867827 PMCID: PMC10589864 DOI: 10.1016/j.heliyon.2023.e20956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Diastasis recti abdominis (DRA) affects a significant number of postpartum women, while its treatments are still under debate. This study aimed to systematically evaluate the effectiveness of rehabilitation training programs for postpartum DRA treatment. Four databases were systematically searched to identify eligible studies published up to February 1, 2023. We followed the PRISMA for scoping reviews guideline in this study. The characteristics and the main findings of the included studies were extracted. Sixteen studies enrolling 1129 women during the ante- and/or postnatal period were included. The common rehabilitation training for DRA included physical exercise, non-exercise physical therapy, acupuncture, and electrotherapy. The presence of DRA could be diagnosed by ultrasound, caliper, or palpation, of which ultrasound had the best reliability. Besides, these assessments could also be used for evaluating the therapeutic efficacy after the rehabilitation training programs. Several studies concluded that patients with DRA could be effectively improved by specific interventions. But a few included studies revealed rehabilitation training might be not more effective than no interventions when treating DRA. For example, some investigators did not recommend physical exercise for DRA patients due to this intervention during pregnancy kept the linea alba less stressed by maintaining abdominal tone, strength, and control, and therefore might aggravate DRA. However, it should be noted that this evidence was derived from limited studies (16/60, 27 % papers) with small samples. To some extent, women with postpartum DRA can benefit from the specific rehabilitation regimen by alleviating postpartum inter-rectus distance. Further research is still warranted to propose strategies for improving postpartum DRA.
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Affiliation(s)
- Beibei Chen
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Xiumin Zhao
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang, China
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Liu X, Wang Q, Chen Y, Luo J, Wan Y. Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6-8 Weeks Postpartum. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:844-850. [PMID: 37093577 PMCID: PMC10521785 DOI: 10.1097/spv.0000000000001353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE In recent years, pelvic-abdominal dynamics has become a research topic in the field of pelvic floor dysfunction (PFD), and the relationship between diastasis of the rectus abdominis (DRA) and stress urinary incontinence (SUI) has been controversial. The study is helpful to further strengthen perinatal education, accurately identify the risk factors of SUI and DRA, and improve the quality of life of puerperae. OBJECTIVE This study aimed to investigate the association of SUI and DRA in women with PFD as measured by vaginal palpation or pelvic floor biofeedback machine testing. STUDY DESIGN A total of 301 patients diagnosed with female PFD who were 6-8 weeks postpartum at The Fifth People's Hospital of Zhuhai between May 2018 and April 2021 were enrolled. The prevalence rates and potential influencing factors of SUI and DRA were analyzed. RESULTS A total of 29.5% (89 of 301) of the patients were diagnosed with SUI, and 31.9% (96 of 301) were diagnosed with DRA. Binary logistic regression showed that a history of delivery ( P = 0.012; odds ratio [OR], 1.982) and vaginal delivery with perineal lacerations or episiotomy ( P = 0.016; OR, 2.187) were risk factors for SUI. High birth weight (weight>4.0 kg, P < 0.001; OR, 14.507) was a risk factor for DRA. CONCLUSIONS A history of delivery and vaginal delivery with perineal lacerations or episiotomy increased the risk of SUI, and high birth weight was an independent risk factor for DRA. Early intervention, including exercise therapy, manual therapy, and neuromuscular electrical stimulation, may be important for patients with PFD having these risk factors.
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Affiliation(s)
- Xiaohong Liu
- From the Department of Gynecology, Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou
- Department of Obstetrics and Gynecology, The Fifth People's Hospital of Zhuhai, Zhuhai, Guangdong Province, China
| | - Qin Wang
- Department of Obstetrics and Gynecology, The Fifth People's Hospital of Zhuhai, Zhuhai, Guangdong Province, China
| | - Yanling Chen
- Department of Obstetrics and Gynecology, The Fifth People's Hospital of Zhuhai, Zhuhai, Guangdong Province, China
| | - Jiamao Luo
- From the Department of Gynecology, Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou
| | - Yifeng Wan
- From the Department of Gynecology, Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou
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6
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Nervil GG, Paulsen JF, Kalstrup J, Deigaard S, Herbst I, Lambaa S, Hölmich L. Simple plication alleviates physical symptoms in patients with post-gestational rectus diastasis. Hernia 2023:10.1007/s10029-023-02814-y. [PMID: 37354279 PMCID: PMC10374809 DOI: 10.1007/s10029-023-02814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/25/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To evaluate our surgery for post-gestational rectus abdominis muscle diastasis using slowly absorbable monofilament suture and eight weeks of abdominal binder in terms of recurrence rate, complications, and effect on patients' physical and cosmetic complaints. METHOD In a retrospective cohort study, all 44 patients operated between 2014 and 2020 were invited to a follow-up using ultrasound, clinical examination, and questionnaires regarding symptoms before and after surgery. RESULTS 89% of invited patients participated, with a median follow-up of 36 months. There was one recurrence caused by severe postoperative nausea and vomiting, which was the most common complication. Most procedures were safe, but two patients experienced Clavien-Dindo grade 3 complications. Patients reported feeling limited or taking precautions after surgery for a median of 8.5 months. Of all included patients, four responded that the operation did not alleviate their primary complaint. The remaining 35 patients (90%) experienced complete or partial alleviation of their primary complaints and would undergo the procedure again if needed. CONCLUSION Post-gestational diastasis recti can be associated with a large number of physical symptoms and functional complaints and can safely be operated using a single running plication of the anterior rectus fascia with a slowly absorbable suture, with fair cosmetic results, excellent effect on symptoms, few complications and high levels of patient satisfaction. Future research must determine which symptoms and findings should indicate surgery.
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Affiliation(s)
- G G Nervil
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - J F Paulsen
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - J Kalstrup
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - S Deigaard
- Surgical Department, Herlev and Gentofte Hospital, Herlev, Denmark
| | - I Herbst
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - S Lambaa
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - L Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark.
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Opala-Berdzik A, Rudek-Zeprzałka M, Niesporek J, Cebula M, Baron J, Gruszczyńska K, Pascoal AG, Mota P, Chmielewska D. Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review. Insights Imaging 2023; 14:92. [PMID: 37202551 PMCID: PMC10195962 DOI: 10.1186/s13244-023-01443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Inter-recti distance (IRD) measurement using musculoskeletal USI has been used in physiotherapy research, in particular, to investigate pregnancy-related diastasis recti abdominis (DRA) and to seek its effective treatment methods. Severe and untreated diastasis may result in the formation of umbilical or epigastric hernias. OBJECTIVE This study aimed to systematically map physiotherapy-related research articles that included descriptions of IRD measurement procedures using USI to present their similarities and differences, and formulate recommendations on the procedure. DESIGN A scoping review was conducted according to PRISMA-ScR guidelines, including 49 of 511 publications from three major databases. Publications were selected and screened by two independent reviewers whose decisions were consulted with a third reviewer. The main synthesized data items were: the examinees' body position, breathing phase, measurement sites, and DRA screening methods. The final conclusions and recommendations were the result of a consensus between seven reviewers from four research centers. RESULTS Studies used 1-5 measurement sites that were differently determined. IRD was measured at the umbilicus (n = 3), at its superior (n = 16) and/or inferior border (n = 9), and at different levels: between 2 and 12 cm above the umbilicus, or a third of the distance and halfway between the umbilicus and xiphoid (n = 37); between 2 and 4.5 cm below the umbilicus or halfway between the umbilicus and pubis (n = 27). Different approaches were used to screen subjects for DRA. CONCLUSIONS The discrepancies between the measurement procedures prevent between-study comparisons. The DRA screening method should be standardized. IRD measurement protocol standardization has been proposed. CRITICAL RELEVANCE STATEMENT This scoping review indicates that the inter-recti distance measurement procedures using ultrasound imaging differ between studies, preventing between-study comparisons. Based on the results synthesis, the measurement protocol standardization has been proposed. KEY POINTS The inter-recti distance measurement procedures using USI differ between studies. Proposed standardization concerns body position, breathing phase, measurements number per location. Determination of measurement locations considering individual linea alba length is suggested. Recommended locations: umbilical top, ½ of umbilical top-xiphoid, ¼ of umbilical top-xiphoid/pubis distances. Diastasis recti abdominis diagnostic criteria are needed for proposed measurement locations.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Institute of Physiotherapy and Health Sciences, Department of Physiotherapy in Internal Diseases, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | | | - Justyna Niesporek
- Institute of Physiotherapy and Health Sciences, Department of Physiotherapy in Internal Diseases, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Maciej Cebula
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
- Individual Specialist Medical Practice Maciej Cebula, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Augusto Gil Pascoal
- Faculty of Human Kinetics, Interdisciplinary Centre of Human Performance (CIPER), Biomechanics and Functional Morphology Laboratory (LBMF), University of Lisbon, Lisbon, Portugal
| | - Patrícia Mota
- Faculty of Human Kinetics, Interdisciplinary Centre of Human Performance (CIPER), Biomechanics and Functional Morphology Laboratory (LBMF), University of Lisbon, Lisbon, Portugal
- H&TRC - Centro de Investigação em Saúde e Tecnologia, Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) - Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Daria Chmielewska
- Institute of Physiotherapy and Health Sciences, Electromyography and Pelvic Floor Muscles Assessment Laboratory, Department of Physical Medicine, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Aitken G, Gallego Eckstein J. A Novel Robotic Approach for the Repair of Abdominal Wall Hernias With Concomitant Diastasis Recti: Outcomes and Long-term Follow-up. Surg Laparosc Endosc Percutan Tech 2023; 33:137-140. [PMID: 36977313 DOI: 10.1097/sle.0000000000001155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/14/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Diastasis recti (DR) is defined as the separation of the rectus muscles as a result of the linea alba thinning and stretching. The purpose of this study was to evaluate the long-term outcomes of a new technique, robotic rectus abdominis medialization (rRAM), for DR repair with a concomitant ventral hernia. METHODS Patients who underwent rRAM for repair of DR and a concomitant ventral hernia were identified between January 2015 and December 2020. The results are from a single surgeon at a single institution. RESULTS A total of 40 patients were identified, 29 of which were female. The mean age was 43 years, the mean body mass index was 27 kg/m 2 , and the mean inter-rectus distance was 6 cm based on available preoperative imaging. The median postoperative length of stay was 1 day, and the median follow-up time was 1 month. Within 30 postoperative days, 3 patients were re-admitted and 5 developed complications, of which 1 required operative re-intervention for seroma. Beyond 30 days, 3 patients required operative re-intervention most commonly for persistent pain from suture material. On the basis of computed tomography scans performed at a mean of 30 months after the date of service, the mean postoperative inter-rectus distance was 1 cm; 1 patient had DR recurrence, and 1 patient developed a new incisional hernia without DR recurrence. There was no hernia recurrence. CONCLUSIONS rRAM is a safe and effective technique for DR repair with a concomitant ventral hernia. Further studies are needed to determine how outcomes from this robotic approach compare with those from different robotic, laparoscopic, and open techniques.
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Affiliation(s)
- Gabriela Aitken
- Department of Surgery, Memorial Healthcare System, Hollywood, FL
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Wang Y, Wang H. Systematic review and meta-analysis of the inter-recti distance on ultrasound measurement in nulliparas. J Plast Surg Hand Surg 2023; 57:22-28. [PMID: 35001809 DOI: 10.1080/2000656x.2021.2024555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective is to evaluate the inter-recti distance on ultrasound measurement at different locations in healthy nulliparas. Electronic databases were searched for studies describing the inter-recti distance measured by ultrasound in healthy nulliparas. We excluded studies without descriptions of the measurement position or the condition of the abdominal wall. A meta-analysis was performed to evaluate the inter-recti distance on ultrasound measurement. Seven eligible studies with 295 healthy nulliparas were included. The location of the inter-recti distance measurement by ultrasound was not uniform. The pooled data divided the measurement locations into three areas. The meta-analytic summary values of the umbilical inter-recti distance of the nulliparas was 8.77 mm (6.56-10.99 mm), the distance at the epigastric area was 7.22 mm (2.76-11.68 mm), and that at the infraumbilical area was 4.09 mm (1.55-6.64 mm). The maximal reported inter-recti distance in healthy nulliparous women is smaller than 10 mm on ultrasound measurement at all locations and the range in the umbilical area is larger than that in the epigastric, infraumbilical areas. The values for the inter-recti distance reported in this systematic review can be used as the reference of feasible and desirable distance of the rectus muscles after rectus fascia plication. The limitation was that the methodological quality of the assessment in most studies was unclear or low.
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Affiliation(s)
- Yue Wang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Huifang Wang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China.,Department of Ultrasound, Shenzhen Luohu People's Hospital, Third Affiliated Hospital of Shenzhen University, Shenzhen, China
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10
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Mandujano CC, Lima DL, Xia J, Sreeramoju P, Malcher F. An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10864. [PMID: 38314159 PMCID: PMC10831646 DOI: 10.3389/jaws.2022.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/31/2022] [Indexed: 02/06/2024]
Abstract
Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM). Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018-March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP). Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1 day (0-12), and the median follow-up was 103 days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7 years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2 min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5 days (10-523), with two reported hernia recurrences. Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM.
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Affiliation(s)
| | - Diego L. Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY, United States
| | - Jason Xia
- Department of Surgery, Montefiore Medical Center, Bronx, NY, United States
| | | | - Flavio Malcher
- Abdominal Wall Reconstruction Program, Department of Surgery, Montefiore Medical Center, Bronx, NY, United States
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11
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Bixo L, Sandblom G, Österberg J, Stackelberg O, Bewö K, Olsson A. Association Between Inter-Recti Distance and Impaired Abdominal Core Function in Post-Partum Women With Diastasis Recti Abdominis. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10909. [PMID: 38314149 PMCID: PMC10831648 DOI: 10.3389/jaws.2022.10909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 02/06/2024]
Abstract
Background and Aim: The definition and management of Diastasis Recti Abdominis (DRA) is under debate. This study aimed to understand the correlation between the post-partum inter-recti distance (IRD) and functional impairments associated with core instability, with the hypothesis that IRD could serve as a proxy for core instability symptoms and constitute a tool in decision-making for DRA treatment. Material and Methods: A cohort of post-partum women with abdominal core instability symptoms combined with DRA were studied. The size of IRD was measured with ultrasonography and cross-sectionally analysed against functional impairments registered with the self-report Disability Rating Index (DRI), which grades the ability to perform 12 different daily activities. Results: A total of 224 women were included in the study. In univariable analysis, IRD was associated with impairment of the activities running (p = 0.007), heavy work (p = 0.036) and exercise/sports (p = 0.047), but not with dressing, walking, sitting for long periods, standing bent over a sink, carrying a suitcase, making a bed, light manual labour or heavy lifting. No significant correlations were seen in the multivariable analysis when adjustments were made for BMI and parity. Conclusion: IRD and post-partum functional impairments had no significant correlation in multivariable analysis. The post-partum core instability condition is complex and probably associated with more factors than solely the IRD. The IRD alone does not seem to be a sufficient proxy for decision-making regarding optimal treatment. A more complete instrument to assess the post-partum abdominal core is warranted.
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Affiliation(s)
- L. Bixo
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - G. Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - J. Österberg
- Department of Surgery, Mora Hospital, Mora, Sweden
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - O. Stackelberg
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K. Bewö
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - A. Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Stockholm Hernia Center, Stockholm, Sweden
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Gluppe S, Ellström Engh M, Bø K. Primiparous women's knowledge of diastasis recti abdominis, concerns about abdominal appearance, treatments, and perceived abdominal muscle strength 6-8 months postpartum. A cross sectional comparison study. BMC Womens Health 2022; 22:428. [PMID: 36324105 PMCID: PMC9632123 DOI: 10.1186/s12905-022-02009-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diastasis recti abdominis (DRA) is a prevalent condition in the postpartum period. To date, there is scant knowledge on how DRA influences physical, mental, and emotional health. This study investigates primiparous women`s knowledge about DRA, concerns about abdominal appearance, and perceived abdominal muscle strength, comparing women with and without reported DRA. METHODS This was a cross-sectional comparison study. Data were collected by a web-based questionnaire, mainly through social media in Norway. To be included in the study women had to be primiparous 6-8 months postpartum. The questionnaire contained questions regarding women`s knowledge about DRA, perceived protrusion, received treatment, concerns with abdominal appearance and muscle strength. Abdominal body image was measured through the shape concern questions from The Eating Disorder Examination questionnaire (EDE-Q 6.0). Demographic and other descriptive variables are presented as means with standard deviations (SD) or as frequencies with percentages. Chi-square test of independence and independent sample t-tests were used to compare differences between women with and without abdominal protrusion for categorical and continuous variables, respectively. RESULTS Our sample consisted of 460 women. Knowledge about DRA was reported by 415/440 (94.3%) women. A total of 73.3% reported to have been worried during pregnancy about abdominal appearance postpartum. Mean degree of concern about present abdominal appearance was 5.5/10 (SD 2.4). Almost 80% experienced weaker abdominal muscles than pre-pregnancy. Ninety-six women (20.9%) reported a protrusion along the midline of their abdomen. Significantly more women with protrusion reported weaker abdominal muscles than women without protrusion. The most frequent treatment women with protrusion reported were exercises for the abdominal muscles (92.6%). Mean score on the EDE-Q, shape concern questions, was higher in women with reported protrusion (mean score: 2.37 (SD 1.6) than women without protrusion (mean score: 2.14 (SD 1.4), p = 0.175. CONCLUSION Primiparous women are concerned about abdominal appearance both during pregnancy and after birth. Those reporting abdominal protrusion are less satisfied with their abdominal appearance and they report weaker abdominal muscles than women without protrusion. This study may contribute to improved knowledge about women`s health concerns, and assessment of DRA should be part of routine follow-up of postpartum women.
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Affiliation(s)
- Sandra Gluppe
- grid.412285.80000 0000 8567 2092Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806 Oslo, Norway
| | - Marie Ellström Engh
- grid.411279.80000 0000 9637 455XDepartment of Obstetrics and Gynaecology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- grid.412285.80000 0000 8567 2092Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806 Oslo, Norway ,grid.411279.80000 0000 9637 455XDepartment of Obstetrics and Gynaecology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
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13
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Djivoh Y, De Jaeger D. Acute effect of Sit-up versus Curl-up on the interrecti distance: A cross-sectional study in parous women. Prog Urol 2022; 32:776-783. [DOI: 10.1016/j.purol.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
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14
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Relationship between Preoperative Abdominal Wall Strength and Bulging at the Abdominal Free Flap Donor Site for Breast Reconstruction. Plast Reconstr Surg 2022; 149:279e-286e. [PMID: 35077427 DOI: 10.1097/prs.0000000000008763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal bulging at the donor site of free abdominal flaps for breast reconstruction is a common postoperative complication. In addition to the thickness of abdominal muscles, the authors identified the rectus abdominis diastasis as an important factor that compromises abdominal wall strength. This study aimed to assess the relationship between preoperative abdominal wall strength and postoperative abdominal bulging. METHODS A total of 224 patients were enrolled in this study. Patient demographics, the rectus and lateral abdominis muscle thicknesses, and the rate of rectus abdominis diastasis were compared (with versus without bulging). Muscle thickness and rectus abdominis diastasis were investigated by preoperative computed tomography. RESULTS The group with bulging consisted of 32 patients (14.3 percent), whereas the group without bulging consisted of 192 patients. The group with bulging had a significantly higher gestational history rate. The thickness of the rectus abdominis muscle in the group with bulging was significantly thinner (median, 8.6 mm versus 10.5 mm; p < 0.001) and the rate of rectus abdominis diastasis was significantly higher (78.1 percent versus 32.3 percent; p < 0.001). There were no significant differences with respect to the thickness of the lateral abdominal muscle and the other factors (i.e., age, body mass index, history of laparotomy. and operative details). CONCLUSIONS Because the diagnosis of abdominal bulging was based on severity, the rate may be high compared to that reported from previous studies. Because the factor of gestational history correlated to thickness of the rectus abdominis muscle and rectus abdominis diastasis, this factor influenced the occurrence of abdominal bulging. Patients with a thin rectus abdominis muscle and rectus abdominis diastasis were at higher risk of abdominal bulging. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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15
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Keramidas E, Rodopoulou S, Gavala MI. A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study. Aesthetic Plast Surg 2022; 46:2323-2332. [PMID: 35043248 PMCID: PMC9592666 DOI: 10.1007/s00266-021-02739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
Background This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty. Materials and methods One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result. Results No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results. Conclusions In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02739-w.
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Affiliation(s)
- Evangelos Keramidas
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece.
| | - Stavroula Rodopoulou
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
| | - Maria-Ioanna Gavala
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
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16
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Babaitis R, Villegas FJ, Hoyos AE, Perez M, Mogollon IR. TULUA Male High-Definition Abdominoplasty. Plast Reconstr Surg 2022; 149:96-104. [PMID: 34936608 DOI: 10.1097/prs.0000000000008680] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominoplasty is a surgical technique for body contouring that has been shown to improve the patient's quality of life. It has become more common among male patients, so clear differences between procedures for men and women have to be stated. The authors present their experience with high-definition lipoabdominoplasty with transverse plication in men. METHODS Records of male patients undergoing transverse plication full abdominoplasty in addition to high-definition liposculpture were analyzed. A total of 24 consecutive cases were found between January of 2017 and June of 2019. Patient ages ranged from 24 to 60 years. Patients aged 18 years or younger were excluded. Body mass index ranged from 25 to 33 kg/m2. Photographic records were taken before and during follow-up at 2 days and 1, 3, 6, and 12 months after surgery. RESULTS Male TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) with high-definition lipoabdominoplasty was successfully achieved in 24 cases. No major complications were reported. Six minor complications were reported (25 percent). Rectus abdominis diastases are less common in men compared to women, as pregnancy is the most determining factor in its development. Fat distribution is also a key difference when performing lipoabdominoplasty for the male or the female patient. The authors recommend a transverse plication of the abdominal wall, instead of a vertical one, as flap viability is preserved and enhanced muscular definition can be accomplished. CONCLUSIONS Combining transverse plication with high-definition lipoabdominoplasty (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar plus high-definition lipoabdominoplasty) is a safe and reproducible technique for the male patient. It offers higher aesthetic results in line with modern beauty ideals. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Ricardo Babaitis
- From the Universidad de Buenos Aires; Universidad del Valle; and Total Definer Research Group
| | - Francisco J Villegas
- From the Universidad de Buenos Aires; Universidad del Valle; and Total Definer Research Group
| | - Alfredo E Hoyos
- From the Universidad de Buenos Aires; Universidad del Valle; and Total Definer Research Group
| | - Mauricio Perez
- From the Universidad de Buenos Aires; Universidad del Valle; and Total Definer Research Group
| | - Ivan R Mogollon
- From the Universidad de Buenos Aires; Universidad del Valle; and Total Definer Research Group
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17
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Zhou Z, Yan L, Li Y, Zhou J, Ma Y, Tong C. Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance. Surg Radiol Anat 2022; 44:1531-1543. [PMID: 36404360 PMCID: PMC9734211 DOI: 10.1007/s00276-022-03046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Many researchers have different views on the origin and anatomy of the preperitoneal fascia. The purpose of this study is to review studies on the anatomy related to the preperitoneal fascia and to investigate the origin, structure, and clinical significance of the preperitoneal fascia in conjunction with previous anatomical findings of the genitourinary fascia, using the embryogenesis of the genitourinary system as a guide. METHODS Publications on the preperitoneal and genitourinary fascia are reviewed, with emphasis on the anatomy of the preperitoneal fascia and its relationship to the embryonic development of the genitourinary organs. We also describe previous anatomical studies of the genitourinary fascia in the inguinal region through the fixation of formalin-fixed cadavers. RESULTS Published literature on the origin, structure, and distribution of the preperitoneal fascia is sometimes inconsistent. However, studies on the urogenital fascia provide more than sufficient evidence that the formation of the preperitoneal fascia is closely related to the embryonic development of the urogenital fascia and its tegument. Combined with previous anatomical studies of the genitourinary fascia in the inguinal region of formalin-fixed cadavers showed that there is a complete fascial system. This fascial system moves from the retroperitoneum to the anterior peritoneum as the preperitoneal fascia. CONCLUSIONS We can assume that the preperitoneal fascia (PPF) is continuous with the retroperitoneal renal fascia, ureter and its accessory vessels, lymphatic vessels, peritoneum of the bladder, internal spermatic fascia, and other peritoneal and pelvic urogenital organ surfaces, which means that the urogenital fascia (UGF) is a complete fascial system, which migrates into PPF in the preperitoneal space and the internal spermatic fascia in the inguinal canal.
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Affiliation(s)
- Zheqi Zhou
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China ,grid.440747.40000 0001 0473 0092Yan’an University, Yan’an, China
| | - Likun Yan
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Yi Li
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Jinsong Zhou
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Yanbing Ma
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Cong Tong
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
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18
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Yuan S, Wang H, Zhou J. Prevalence and risk factors of low back and pelvic pain in women with rectus abdominis diastasis: a multicenter retrospective cohort study. Korean J Pain 2022; 35:86-96. [PMID: 34966015 PMCID: PMC8728546 DOI: 10.3344/kjp.2022.35.1.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/11/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background To explore the association between low back pain (LBP) and pelvic pain (PP) and rectus abdominis diastasis (RAD) in postpartum women and identify the characteristics and risk factors. Methods Women diagnosed with RAD and a history of labor and delivery, between 2009 and 2018, were identified from six hospitals within the Partners Healthcare System. Univariate and multivariable binary logistic regression analyses were used to identify the risk factors associated with pain. Results Age at onset of RAD in the non-cesarean delivery group was earlier than those in cesarean delivery (CD) group (P = 0.017). Women who underwent CD demonstrated 4.5 times greater risk of RAD than those who had no CD exposure. The cumulative composition ratio of LBP at every age stage of the period from 8 years pre-first delivery to 8 years post-first delivery was significantly higher than the other five conditions (RAD, umbilical hernia, PP, depressive disorder [DD], and strain of muscle, fascia, and tendon [SMFT]) (P for trend < 0.001). Women with DD, SMFT, and PP were more likely to have LBP (odds ratio [OR] = 1.91, 95% confidence interval [CI] 1.06 to 3.47, P = 0.032; OR = 4.50, 95% CI 1.64 to 12.36, P = 0.003; OR = 2.14, 95% CI 1.17 to 3.89, P = 0.013; respectively). Conclusions In postpartum women with RAD, DD, SMFT, and PP were found to be risk factors contributing to the development of LBP. Race and LBP also played roles in the development of PP.
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Affiliation(s)
- Sue Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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19
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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 2021; 26:609-618. [PMID: 34609664 PMCID: PMC9012734 DOI: 10.1007/s10029-021-02493-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Aim The prevalence and definition of diastasis recti abdominis (DRA) is under debate. This retrospective cross-sectional study evaluated the interrectal distance and the prevalence of DRA in computed tomography (CT) in an asymptomatic population. Materials and methods Patients undergoing CT scans for suspected appendicitis or kidney stones from 01/2016 to 12/2018 were screened retrospectively to participate. A study population with equal distribution according to gender and age (18–90 years) was generated (n = 329 patients) and the interrectal distance was measured at six reference points. Results DRA (defined as > 2 cm at 3 cm above the umbilicus) was present in 57% of the population. The 80th percentile of the interrectal distance was 10 mm at the xiphoid (median 3 mm, 95% confidence interval (CI) 0–19 mm), 27 mm halfway from xiphoid to umbilicus (median 17 mm, 95% CI 0–39 mm), 34 mm at 3 cm above the umbilicus (median 22 mm, 95% CI 0–50 mm), 32 mm at the umbilicus (median 25 mm, 95% CI 0–45 mm), 25 mm at 2 cm below the umbilicus (median 14 mm, 95% CI 0–39 mm), and 4 mm halfway from umbilicus to pubic symphysis (median 0 mm, 95% CI 0–19 mm). In the multivariate analysis, higher age (p = 0.001), increased body mass index (p < 0.001), and parity (p < 0.037) were independent risk factors for DRA, while split xiphoid, tobacco abuse, and umbilical hernia were not. Conclusion The prevalence of DRA is much higher than commonly estimated (57%). The IRD 3 cm above the umbilicus may be considered normal up to 34 mm. To avoid over-treatment, the definition of DRA should be revised.
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Affiliation(s)
- R L Kaufmann
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - C S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - U A Dietz
- Department of General, Visceral and Plastic Surgery, Cantonal Hospital of Olten, Olten, Switzerland
| | - P A Clavien
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - R Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - S A Käser
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland. .,Department of General, Visceral, Thoracic and Vascular Surgery, Buergerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland. .,Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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20
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Olsson A, Kiwanuka O, Wilhelmsson S, Sandblom G, Stackelberg O. Surgical repair of diastasis recti abdominis provides long-term improvement of abdominal core function and quality of life: a 3-year follow-up. BJS Open 2021; 5:6369782. [PMID: 34518875 PMCID: PMC8438255 DOI: 10.1093/bjsopen/zrab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background Diastasis recti abdominis (DRA) is a condition affecting many post-partum women. The aim of this study was to evaluate long-term results of surgical repair of DRA in a cohort of post-partum women. Methods Sixty post-partum women with DRA and training-resistant core dysfunctions were included. Surgical repair was performed with suture plication of the linea alba. Abdominal core function was evaluated with the abdominal trunk function protocol (ATFP) including a self-report questionnaire and seven functional tests. Urinary incontinence and quality of life were evaluated with the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the SF-36 questionnaire. Follow-up was performed at 1 and 3 years after surgery. Results Response rate at the 3-year follow-up was 86.7 per cent for the disability rating index (DRI) questionnaire; and 71.7 per cent for the ATFP, UDI-6, IIQ-7 and SF-36 questionnaires. All DRI parameters were improved (P < 0.001) after 3 years of follow-up compared with preoperative values. The functional tests in the ATFP showed an improvement in core muscle strength and stability (P < 0.001), back muscle strength (P < 0.001) and abdominal muscle strength (P = 0.002) compared to preoperative values as well as an improvement of core muscle strength and stability compared with the 1-year follow-up values (P = 0.003). UDI-6 and IIQ-7 results were improved (P < 0.001 and P = 0.004) compared with preoperative values and showed consistent values compared with the 1-year follow-up (P = 0.09 and P = 1.0). Quality of life measured with SF-36 was improved compared with preoperative values and showed consistent values compared with the 1-year follow-up. Conclusion The functional improvement of surgical reconstruction of the DRA persisted for 3 years in this series of post-partum women with DRA.
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Affiliation(s)
- Anders Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Olivia Kiwanuka
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Sofia Wilhelmsson
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Otto Stackelberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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21
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Tuominen R, Jahkola T, Saisto T, Arokoski J, Vironen J. The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study. Hernia 2021; 26:599-608. [PMID: 34432175 PMCID: PMC9012726 DOI: 10.1007/s10029-021-02484-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
Purpose Post-pregnancy abdominal rectus diastasis (ARD) has raised attention in the field of surgery in recent years, but there is no consensus about when to consider surgery. Our aim was to find out what is the normal inter-rectus distance in fertile aged, female population in Finland and to examine whether there is a linea alba width that would predispose to diastasis-related problems after pregnancy. Methods For this prospective cohort study, women participating early pregnancy ultrasound in Helsinki University Hospital Department of Obstetrics and Gynecology during 1.1.2018–8.3.2019, were recruited. The width of linea alba was measured by ultrasound during the early pregnancy ultrasound. Symptoms were measured by questionnaire including Health-Related Quality of Life (RAND-36) and Oswestry Disability Index for back symptoms and disability. Results Linea alba width was measured in total of 933 women. The average inter-rectus distance (IRD) among nulliparous women was 1.81 ± 0.72 cm. After one previous pregnancy, the average linea alba width was 2.36 cm ± 0.83 cm and after more pregnancies 2.55 ± 1.09 cm. There was a positive correlation between previous pregnancies and the increased linea alba width (p = 0.00004). We did not perceive any threshold value of linea alba width that would predispose to back pain or movement control problems in this cohort, in which severe diastasis (over 5 cm) was rare. Conclusion Mean inter-rectus distance in parous population exceeds stated normative values. Moderate ARD (3.0–5.0 cm) alone does not seem to explain low back pain or functional disability in population level. Severe post-pregnancy diastasis (over 5.0 cm) is rare.
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Affiliation(s)
- R Tuominen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, PL 266, 00029 HUS, Helsinki, Finland.
| | - T Jahkola
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, PL 266, 00029 HUS, Helsinki, Finland
| | - T Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Vironen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy. J Am Acad Orthop Surg 2021; 29:e805-e814. [PMID: 34043597 DOI: 10.5435/jaaos-d-21-00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 02/01/2023] Open
Abstract
There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.
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Köckerling F, Lorenz R, Stechemesser B, Conze J, Kuthe A, Reinpold W, Niebuhr H, Lammers B, Zarras K, Fortelny R, Mayer F, Hoffmann H, Kukleta JF, Weyhe D. Comparison of outcomes in rectus abdominis diastasis repair-which data do we need in a hernia registry? Hernia 2021; 25:891-903. [PMID: 34319466 DOI: 10.1007/s10029-021-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rectus abdominis diastasis (RAD) ± concomitant hernia is a complex hernia entity of growing significance in everyday clinical practice. Due to a multitude of described surgical techniques, a so far missing universally accepted classification and hardly existing comparative studies, there are no clear recommendations in guidelines. Therefore, "RAD ± concomitant hernia" will be documented as a separate hernia entity in the Herniamed Registry in the future. For this purpose, an appropriate case report form will be developed on the basis of the existing literature. METHODS A systematic search of the available literature was performed in March 2021 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library. 93 publications were identified as relevant for this topic. RESULTS In total 45 different surgical techniques for the repair of RAD ± concomitant hernia were identified in the surgical literature. RAD ± concomitant hernia is predominantly repaired by plastic but also by general surgeons. Classification of RAD ± concomitant hernia is based on a proposal of the German Hernia Society and the International Endohernia Society. Surgical techniques are summarized as groups subject to certain aspects: Techniques with abdominoplasty, open techniques, mini-less-open and endoscopic sublay techniques, mini-less-open and endoscopic subcutaneous/preaponeurotic techniques and laparoscopic techniques. Additional data impacting the outcome are also recorded as is the case for other hernia entities. Despite the complexity of this topic, documentation of RAD ± concomitant hernia has not proved to be any more cumbersome than for any of the other hernia entities when using this classification. CONCLUSION Using the case report form described here, the complex hernia entity RAD ± concomitant hernia can be recorded in a registry for proper analysis of comparative treatment options.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - J Conze
- UM Hernia Center, Arabellastr. 17, 81925, München, Germany
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - W Reinpold
- Hernia Center Hamburg, Helios Mariahilf Klinik, Stader Str. 203C, 21075, Hamburg, Germany
| | - H Niebuhr
- Hanse Hernia Center, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Lammers
- Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - R Fortelny
- Medical Faculty Austria, Private Hospital Confraternitaet, Sigmund Freud Private University Vienna, 1080, Vienna, Austria
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J F Kukleta
- Klinik Im Park Zurich (Hirslanden Group), Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany
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Depledge J, McNair P, Ellis R. Exercises, Tubigrip and taping: can they reduce rectus abdominis diastasis measured three weeks post-partum? Musculoskelet Sci Pract 2021; 53:102381. [PMID: 33910111 DOI: 10.1016/j.msksp.2021.102381] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rectus abdominis diastasis is regarded as a risk factor for abdominal muscle dysfunction and reduced quality of life postpartum. It is thought that specific exercises and additional physical support might reduce the diastasis, with a need to establish efficacy in doing so. OBJECTIVES Determine the effect of four abdominal exercises as well as Tubigrip or taping in reducing rectus abdominis diastases three weeks postpartum. DESIGN Cross-sectional repeated measures comparison. METHODS 32 women undertook a single session of ultrasound imaging. Ultrasound measurements of inter-rectus distance were taken at rest and during: 1) crook lying abdominal "drawing in" exercise; 2) crook lying trunk curl-up; 3) early Sahrmann level leg raise; 4) McGill side lying plank. The curl-up and abdominal "drawing in" exercises were assessed under two further conditions: a) wearing Tubigrip, b) taping across the diastasis. Data analyses involved repeated measures ANOVA. RESULTS At rest the mean inter-rectus distance above and below the umbilicus was 3.5 cm (SD:1.1) and 2.6 cm (SD:1.2) respectively. A significant decrease (19%, p < 0.05) was observed at both measurement points during the curl-up exercise. No other exercises elicited a significant difference compared to resting. At rest, wearing Tubigrip reduced the inter-rectus distance (7%, p < 0.05). During exercise, there was no additional change in the inter-rectus distance (p > 0.05) with supports. CONCLUSION The curl-up exercise was most effective in reducing inter-rectus distance. As no exercises invoked an increase in the rectus diastasis, they could not be regarded as potentially detrimental. Tubigrip and taping did not add to the effects of these exercises.
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Affiliation(s)
- Jill Depledge
- Community Rehabilitation Team, Auckland District Health Board, Auckland, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Alcahuz-Griñan M, Nieto-Gil P, Perez-Soriano P, Gijon-Nogueron G. Morphological and Postural Changes in the Foot during Pregnancy and Puerperium: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052423. [PMID: 33801299 PMCID: PMC7967558 DOI: 10.3390/ijerph18052423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9-13 of gestation, weeks 32-35 of gestation and weeks 4-6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium.
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Affiliation(s)
- Monserrat Alcahuz-Griñan
- Department of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.A.-G.); (P.N.-G.)
| | - Pilar Nieto-Gil
- Department of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.A.-G.); (P.N.-G.)
| | - Pedro Perez-Soriano
- Research Group in Sport Biomechanics, Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain;
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
- Correspondence:
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Qu E, Wu J, Zhang M, Wu L, Zhang T, Xu J, Zhang X. The ultrasound diagnostic criteria for diastasis recti and its correlation with pelvic floor dysfunction in early postpartum women. Quant Imaging Med Surg 2021; 11:706-713. [PMID: 33532270 DOI: 10.21037/qims-20-596] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background There has been a long-standing controversy about diastasis recti diagnostic criteria and its relation to pelvic floor dysfunction (PFD). This study aimed to establish ultrasound diagnostic criteria for diastasis recti and investigate the correlation between it and PFD in early postpartum females. Methods The inter-rectus distance (IRD) was measured at 3 locations in 116 healthy nulliparous females and 108 postpartum females. At the same time, they remained relaxed and then maintained a head-lift posture. The measurement for the 90th percentile was used to define the normal IRD in the nulliparous group. Afterward, the 108 postpartum females underwent an ultrasonographic examination of pelvic floor function. The correlations of these values with the IRD were then examined. Results We established the following ultrasonographic diagnostic criteria for diastasis recti: an IRD of >2 mm at 3 cm below the umbilicus, >20 mm at the umbilicus, and >14 mm at 3 cm above the umbilicus. The IRD was positively correlated with body mass index (BMI) in the nulliparous group (r=0.286, P<0.01) and with age in the postpartum group (r=0.230, P<0.05). The IRD was not relative to either the PFD ultrasound results or the clinical symptoms. Conclusions We established a set of ultrasonographic diagnostic criteria for diastasis recti at 3 locations along the umbilicus. There is no clear correlation between diastasis recti and PFD in early postpartum females.
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Affiliation(s)
- Enze Qu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiawei Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Man Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lili Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Xu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Da Cuña-Carrera I, Soto-González M, Alonso-Calvete A, González-González Y, Lantarón-Caeiro EM. Immediate effects of different types of abdominal exercises on the inter-rectus distance. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-203161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND: The effects of abdominal exercises on the inter-rectus distance are unclear. OBJECTIVE: To compare the inter-rectus distance at rest and during different abdominal exercises: abdominal crunch, abdominal crunch with transversus abdominis pre-activation and hypopressive exercise. METHODS: A transversal experimental study was carried out in 98 healthy adults without diastasis recti abdominis were recruited. Measurements were assessed using ultrasound imaging, and two points were evaluated: just above the umbilicus (U point) and halfway between the U point and the xiphoid (UX point). The inter-rectus distance was measured at rest and during the abdominal exercises. RESULTS: The abdominal crunch with transversus abdominis pre-activation increases the inter-rectus distance in comparison with rest and with abdominal crunch in the U point. CONCLUSION: These results increase the knowledge about the behaviour of the linea alba and inter-rectus distance during abdominal exercises, with practical applications in the rehabilitation of the abdominal wall and low back.
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Van Kerckhoven L, Nevens T, Van De Winkel N, Miserez M, Vranckx JJ, Segers K. Treatment of rectus diastasis: should the midline always be reinforced with mesh? A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:1870-1880. [PMID: 33612425 DOI: 10.1016/j.bjps.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Two main trends are described for the treatment of diastasis recti: plication versus midline mesh reinforcement. Indications for these procedures have not been clearly described. This study reviewed the outcomes in the treatment of rectus diastasis with plication versus mesh by the assessment of durability, complications, and patient-reported outcomes. MATERIALS AND METHODS A systematic review of literature on the treatment of diastasis recti was performed searching through PubMed, Embase, Web of Science, and Cochrane databases. This resulted in 53 eligible articles and predefined inclusion criteria led to the selection of 24 articles. Primary outcomes included recurrence and perioperative complications and secondary outcomes were defined as patient satisfaction, chronic pain, and quality of life. RESULTS A total of 931 patients were surgically treated for rectus divarication (age range: 18 - 70 years). The most frequently noted comorbidity was obesity and 10.6 percent were smokers. Recurrence was reported in 5 percent of the patients. The most frequent complication was seroma (7 percent), followed by abdominal hypoesthesia (6 percent), and surgical site infection (2 percent). Chronic pain was reported in 4 percent of the patients. Satisfaction was assessed subjectively in the majority of patients and was generally rated as high. Follow-up period ranged from 3 weeks to 20 years. CONCLUSIONS Durability, safety, and high patient satisfaction support surgical correction of rectus diastasis and could not favor a treatment method. Inter-rectus distance could not be identified as the indicator for technique, which emphasizes that other factors might add to the entity of abdominal wall protrusion more than previously thought.
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Affiliation(s)
- Liza Van Kerckhoven
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Thomas Nevens
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nele Van De Winkel
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Jeroen Vranckx
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katarina Segers
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
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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; 32:2367-2375. [PMID: 33416967 DOI: 10.1007/s00192-020-04619-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A functional interaction exists between the pelvic floor and the abdominal wall. The study was aimed at investigating the clinical and morphological relationships between diastasis rectus abdominus (DRA) and pelvic floor trauma in primiparous women. METHODS Eighteen women suffering from DRA and 18 women without DRA (non-DRA group), all primiparous with pelvic floor trauma, were enrolled in the study. Ultrasound was performed on the 36 women examining the inter-rectus distance, pelvic floor morphology, abdominal muscle force (MMT), Static Abdominal Flexion Endurance Test (SFET), and Dynamic Abdominal Flexion Endurance Test (DFET), abdominal circumference, visual analog scale, and responses to the Oswestry Low Back Pain Questionnaire and the Pelvic Floor Distress Inventory questionnaire (PFDI). RESULTS A significant increase in the urinary symptoms portion of the in PFDI-20 questionnaire was found in the DRA group (non-DRA = 12.5 ± 22.8, DRA = 26.8 ± 18.2, p = 0.01). A significant reduction in abdominal force and endurance was observed in the DRA2-3 group compared with the DRA0-1 group (0.025 < p < 0.04). DFET (average repetitions) in the DRA0-1 group measured 13.4 ± 11.8 and 6.46 ± 4.59 in the DRA2-3 group (p = 0.025). SFET was 20.48 ± 14.46 s in the DRA0-1 group and 10.62 ± 10.6 s in the DRA2-3 group (p = 0.031). MMT was 4 in the DRA0-1 group and 3 in the DRA2-3 group (p = 0.04). CONCLUSIONS Diastasis rectus abdominus does not correlate with morphological changes in the pelvic floor, but does correlate with higher scores in the urinary symptoms portion of the PFDI-20. Women suffering from DRA do not endure more pain or greater lumbar disability than non-DRA women. In extended DRA, the abdominal muscles are significantly compromised and weaker.
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Affiliation(s)
- Vered H Eisenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lee Sela
- Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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A Comprehensive, Evidence-Based Literature Review of the Surgical Treatment of Rectus Diastasis. Plast Reconstr Surg 2020; 146:1151-1164. [PMID: 33136963 DOI: 10.1097/prs.0000000000007252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy. RESULTS Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability. CONCLUSIONS Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.
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31
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Pregnancy after abdominoplasty with mesh placement: A case report. JPRAS Open 2020; 26:8-11. [PMID: 32995457 PMCID: PMC7501402 DOI: 10.1016/j.jpra.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/21/2020] [Indexed: 11/21/2022] Open
Abstract
A 32-year-old Caucasian female, who had an abdominoplasty with sublay mesh placement for rectus abdominis diastasis becamepregnant one year later. The gestation was uneventful and the baby was born healthy after 40 weeks of pregnancy. During and after the pregnancy the patient's abdomen had been evaluated intensively and there was no recurrence of rectus abdominis diastasis. In this particular case the tissues of the abdominal wall elongated as the foetus grew larger, except for the site where the rectus diastasis has been corrected. The experience with this particular case does not assure that all patients will have the same uneventful outcomes as described. Nonetheless, it shows that pregnancy after abdominoplasty with mesh placing for rectus abdominis diastasis can be safe for both mother and child. However, each patient must be informed about the risks of pregnancy in this particular situation and professional follow-up is mandatory when pregnancy does occur. This is, as far as we know, the first case report of an uneventful pregnancy after rectus abdominis diastasis repair with the placement of a sublay mesh and abdominoplasty.
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Carlstedt A, Bringman S, Egberth M, Emanuelsson P, Olsson A, Petersson U, Pålstedt J, Sandblom G, Sjödahl R, Stark B, Strigård K, Tall J, Theodorsson E. Management of Diastasis of the Rectus Abdominis Muscles: Recommendations for Swedish National Guidelines. Scand J Surg 2020; 110:452-459. [PMID: 32988320 PMCID: PMC8551433 DOI: 10.1177/1457496920961000] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. Methods: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. Results: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient’s symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. Discussion: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
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Affiliation(s)
- A Carlstedt
- Department of Surgery, Karlstad Central Hospital, Karlstad, Sweden
| | - S Bringman
- Department of Surgery, Södertälje Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Egberth
- Department of Surgery, Mora hospital, Mora, Sweden
| | - P Emanuelsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - A Olsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinic of Surgery, Capio CFTK, Stockholm, Sweden
| | - U Petersson
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - J Pålstedt
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - R Sjödahl
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - B Stark
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - J Tall
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - E Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Abdominal wall and pelvic hernias: classic and unusual hernias and their mimics. Clin Imaging 2020; 64:57-66. [DOI: 10.1016/j.clinimag.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
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Correction of Diastasis Rectus Abdominis with Tacking the Rectus Sheath and Resection of Excess Skin for Cosmesis. Case Rep Med 2020; 2020:7635801. [PMID: 32607106 PMCID: PMC7315276 DOI: 10.1155/2020/7635801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction We report a case of diastasis rectus abdominis (DRA), in which the improvement of the appearance was obtained by performing extra skin resection. Case Report. A 30-year-old woman presented persistent abdominal bulging after her second delivery. She was diagnosed as DRA by computed tomography. We underwent a surgery that tacking the anterior layer of the rectus sheath and resecting excess skin. Results There has been no clinical evidence of recurrence, and the patient satisfies her abdominal appearance. Conclusion Because DRA is not a true hernia, surgery for DRA should be performed in understanding how patients want to improve their aesthetic appearance.
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Coratti F, Barbato G, Maggioni C, Manetti A, Cianchi F. Laparoscopic diastasis recti repair and umbilicus reconstruction - a video vignette. Colorectal Dis 2020; 22:725-726. [PMID: 31955482 DOI: 10.1111/codi.14971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 02/08/2023]
Affiliation(s)
| | - G Barbato
- Università degli Studi di Firenze, Firenze, Italy
| | - C Maggioni
- Università degli Studi di Firenze, Firenze, Italy
| | | | - F Cianchi
- Università degli Studi di Firenze, Firenze, Italy
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Draghi F, Cocco G, Richelmi FM, Schiavone C. Abdominal wall sonography: a pictorial review. J Ultrasound 2020; 23:265-278. [PMID: 32125676 DOI: 10.1007/s40477-020-00435-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis fascia, preperitoneal fat, and the parietal peritoneum), has many functions: containment, support and protection for the intraperitoneal contents, and involvement in movement and breathing. While hernias are often encountered and well reviewed in the literature, the other abdominal wall pathologies are less commonly described. In this pictorial review, we briefly discuss the normal anatomy of the anterior abdominal wall, describe the normal ultrasonographic anatomy, and present a wide range of pathologic abnormalities beyond hernias. Sonography emerges as the diagnostic imaging of first choice for assessing abdominal wall disorders, thus representing a valuable tool for ensuring appropriate management and limiting functional impairment.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Filippo Maria Richelmi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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Abuín-Porras V, de la Cueva-Reguera M, Benavides-Morales P, Ávila-Pérez R, de la Cruz-Torres B, Pareja-Galeano H, Blanco-Morales M, Romero-Morales C. Comparison of the Abdominal Wall Muscle Thickness in Female Rugby Players Versus Non-Athletic Women: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 56:E8. [PMID: 31881780 PMCID: PMC7022579 DOI: 10.3390/medicina56010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.
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Affiliation(s)
- Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
| | - Mónica de la Cueva-Reguera
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
| | - Pedro Benavides-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
| | - Rocío Ávila-Pérez
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
| | | | - Helios Pareja-Galeano
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
| | - María Blanco-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (M.d.l.C.-R.); (P.B.-M.); (R.Á.-P.); (H.P.-G.); (M.B.-M.); (C.R.-M.)
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Diastasis of rectus abdominis muscles: patterns of anatomical variation as demonstrated by ultrasound. Pol J Radiol 2019; 84:e542-e548. [PMID: 32082453 PMCID: PMC7016498 DOI: 10.5114/pjr.2019.91303] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose The aim of our study was to categorise the anatomical variations of rectus abdominis muscle diastasis (diastasis recti) by using ultrasound (US). Material and methods In a one-year period 92 women were evaluated with US because of suspected diastasis of rectus muscles. Patients were examined in a supine position, with head extended, upper limbs aligned to the trunk, and knees flexed. US was performed with high-frequency, broad-band transducers. Trapezoid field-of-view and extended field-of-view were employed to measure diastasis exceeding 5 cm. Diastasis was defined as a margin-to-margin distance > 20 mm at rest and classified according to the following anatomical patterns: open only above the navel, open only below the navel, open at the navel level, open completely but wider above the navel, and open completely but wider below the navel. Results Diastasis was found in 82 patients (30-61 years old, mean age 35 years). The width was 21-97 mm, mean 39 mm. The prevalence and severity of the anatomical patterns was as follows: open only above the navel in 48 patients (21-88 mm, mean 40 mm), open only below the navel in one patient (33 mm), open at the navel level in seven patients (23-39 mm, mean 34 mm), open completely but wider above the navel in 24 patients (21-97 mm, mean 41 mm), open completely but wider below the navel in two patients (21-29 mm, mean 25 mm). Conclusions The above-navel patterns of recti muscle diastasis are the most common. Even when open completely, diastasis is usually wider above the navel. Knowledge of the anatomical type of rectus muscle diastasis could be of value to the patient (exercises to do and to avoid) and to the surgeon (abdominoplasty planning).
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Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract 2019; 37:1018-1033. [PMID: 31642725 DOI: 10.1080/09593985.2019.1675207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To explore the feasibility of two physiotherapy interventions for the management of diastasis recti abdominis (DrA): abdominal binding and targeting trunk exercises.Methods: A pilot randomized controlled trial (RCT) design was used to compare the effectiveness of exercise therapy and/or abdominal binding to no intervention on thirty-two primiparous women who presented with DrA in the early post-partum period. Feasibility was determined based on study recruitment, compliance, and attrition rates as well as through computation of treatment effect sizes associated with each intervention compared to no intervention. Outcomes included inter-rectus distance measured using ultrasound, body image, pain, urogynecological symptoms, and function measured using questionnaires, and trunk flexion strength and endurance measured using clinical tests.Results: The recruitment rate was 3 participants/month. Intervention adherence rates were >50% and the attrition rate was 16%. After 6 months, positive effects (Cohen's d (d) = 0.2-0.5) on body image were observed in both the abdominal binding alone and combination therapy groups. A positive effect on trunk flexion strength (d = 0.7) was observed in the combination therapy group.Conclusion: The effect sizes suggest that physiotherapy interventions can positively impact body image and trunk flexion strength. While a clinical trial investigating these interventions is feasible, further preliminary investigation is recommended.
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Affiliation(s)
- Nadia Keshwani
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Laparoscopic Repair of Diastasis Recti: A Case Report and Literature Review. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:127-130. [PMID: 35599692 PMCID: PMC8980151 DOI: 10.7602/jmis.2019.22.3.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/08/2022]
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Olsson A, Kiwanuka O, Wilhelmsson S, Sandblom G, Stackelberg O. Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life. BJS Open 2019; 3:750-758. [PMID: 31832581 PMCID: PMC6887686 DOI: 10.1002/bjs5.50213] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- A Olsson
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset Stockholm Sweden.,Department of Surgery, Södersjukhuset Karolinska University Hospital Stockholm Sweden
| | - O Kiwanuka
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset Stockholm Sweden.,Department of Surgery, Södersjukhuset Karolinska University Hospital Stockholm Sweden
| | - S Wilhelmsson
- Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function Karolinska University Hospital Stockholm Sweden
| | - G Sandblom
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset Stockholm Sweden.,Department of Surgery, Södersjukhuset Karolinska University Hospital Stockholm Sweden
| | - O Stackelberg
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset Stockholm Sweden.,Unit of Cardiovascular and Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden.,Department of Surgery, Södersjukhuset Karolinska University Hospital Stockholm Sweden
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Joueidi Y, Vieillefosse S, Cardaillac C, Mortier A, Oppenheimer A, Deffieux X, Thubert T. Impact du diastasis des muscles droits de l’abdomen sur les symptômes pelvi-périnéaux : revue de la littérature. Prog Urol 2019; 29:544-559. [DOI: 10.1016/j.purol.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Sneiders D, Yurtkap Y, Kroese LF, Kleinrensink GJ, Lange JF, Gillion JF. Risk Factors for Incarceration in Patients with Primary Abdominal Wall and Incisional Hernias: A Prospective Study in 4472 Patients. World J Surg 2019; 43:1906-1913. [PMID: 30980102 DOI: 10.1007/s00268-019-04989-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Incarceration of primary and incisional hernias often results in emergency surgery. The objective of this study was to evaluate the relation of defect size and location with incarceration. Secondary objectives comprised identification of additional patient factors associated with an incarcerated hernia. METHODS A registry-based prospective study was performed of all consecutive patients undergoing hernia surgery between September 2011 and February 2016. Multivariate logistic regression was performed to identify risk factors for incarceration. RESULTS In total, 83 (3.5%) of 2352 primary hernias and 79 (3.7%) of 2120 incisional hernias had a non-reducible incarceration. For primary hernias, a defect width of 3-4 cm compared to defects of 0-1 cm was significantly associated with an incarcerated hernia (OR 2.85, 95% CI 1.57-5.18, p = 0.0006). For incisional hernias, a defect width of 3-4 cm compared to defects of 0-2 cm was significantly associated with an incarceration (OR 2.14, 95% CI 1.07-4.31, p = 0.0324). For primary hernias, defects in the peri- and infra-umbilical region portrayed a significantly increased odds for incarceration as compared to supra-umbilical defects (OR 1.98, 95% CI 1.02-3.85, p = 0.043). Additionally, in primary hernias age, BMI, and constipation were associated with incarceration. In incisional hernias age, BMI, female sex, diabetes mellitus and ASA classification were associated with incarceration. CONCLUSION For primary and incisional hernias, mainly defects of 3-4 cm were associated with incarceration. For primary hernias, mainly defects located in the peri- and infra-umbilical region were associated with incarceration. Based on patient and hernia characteristics, patients with increased odds for incarceration may be selected and these patients may benefit from elective surgical treatment.
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Affiliation(s)
- Dimitri Sneiders
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. .,, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Yagmur Yurtkap
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leonard F Kroese
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience and Anatomy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
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Werner LA, Dayan M. Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor. CURRENT WOMENS HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666180222152952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.
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Affiliation(s)
- Laura Anne Werner
- Shelbourne Physiotherapy 100B-3200 Shelbourne V8P 5G8, Victoria, BC, Canada
| | - Marcy Dayan
- Dayan Physiotherapy and Pelvic Floor Clinic 909-750 W Broadway V5Z 1H8 Vancouver, BC, Canada
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Tuominen R, Vironen J, Jahkola T. Case series of a novel open plication supported by mesh (PSUM) - technique for symptomatic abdominal rectus diastasis repair with or without concomitant midline hernia: Early results and a review of the literature. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_25_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hills NF, Graham RB, McLean L. Comparison of Trunk Muscle Function Between Women With and Without Diastasis Recti Abdominis at 1 Year Postpartum. Phys Ther 2018; 98:891-901. [PMID: 30011041 DOI: 10.1093/ptj/pzy083] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/14/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND A separation of the abdominal muscles at the linea alba, known as diastasis recti abdominis (DRA), can occur after childbirth. However, the impact of DRA on abdominal muscle function is not clear. OBJECTIVE The objective was to determine if differences exist in trunk muscle function and self-reported pain and low back dysfunction between women with and without DRA at 12 to 14 months postpartum and if differences that emerge from the data are associated with the magnitude of the interrectus distance (IRD). DESIGN This study was a prospective, observational, case-control study. METHODS Women with (IRD ≥ 2.2 cm; n = 18) and without DRA (IRD < 2.2 cm; n = 22) participated. Maximal trunk flexion, extension, and rotation torque-generating capacity (Newton-meters), the Sit-Up test (0 to 3 points), and the Sitting-Rising Test (0 to 10 points), and trunk flexion, extension, and lateral flexion endurance (seconds) were measured. Pain and disability were assessed using numerical pain rating scales (0 to 100) and the Roland Morris Low Back Pain Questionnaire (0 to 24 points). Women were compared using independent t tests and Mann-Whitney U Tests. Pearson product-moment and Spearman rank correlation coefficients were used to determine associations; a = .05 was used for all tests. RESULTS Women with DRA demonstrated significantly lower trunk muscle rotation torque and scored lower on the sit-up test than those without DRA. IRD was negatively correlated with both trunk rotation torque (rho = -0.367) and sit-up test score (rho = -0.514). LIMITATIONS The results of this study should not be generalized to women who present with moderate-to-severe IRDs or to multiparous women. CONCLUSION The presence of DRA in primiparous women at 1 year postpartum is associated with trunk rotation strength and ability to perform a sit-up.
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Affiliation(s)
- Nicole F Hills
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Ryan B Graham
- School of Human Kinetics, University of Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
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Butler DP, Plonczak AM, Reissis D, Henry FP, Hunter JE, Wood SH, Jallali N. Factors that predict deep inferior epigastric perforator flap donor site hernia and bulge. J Plast Surg Hand Surg 2018; 52:338-342. [DOI: 10.1080/2000656x.2018.1498790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Daniel P. Butler
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
| | - Agata M. Plonczak
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
| | - Dimitris Reissis
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
| | - Francis P. Henry
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
| | - Judith E. Hunter
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
| | - Simon H. Wood
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
| | - Navid Jallali
- Department of Plastic and Reconstructive Surgery, Imperial College Hospital NHS Trust, London, UK
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Abstract
Diastasis recti is a relatively common condition in which there is a midline abdominal bulge that can affect a variety of individuals. The etiology and diagnosis is well understood and optimal management depends on the degree of severity. Patients at high risk for diastasis recti include multiparous women, obese patients, and those with multiple previous operations. Diagnosis includes clinical examination and assessment of symptoms. Physical characteristics include a midline abdominal bulge without a fascial defect. Classification systems are based on the degree of separation between the paired midline rectus and myofascial deformity. Optimal management varies and includes simple plication of the midline defect, extensive plication of the anterior abdominal wall, and sometimes the use of resorbable or nonresorbable mesh.
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Lawson S, Sacks A. Pelvic Floor Physical Therapy and Women's Health Promotion. J Midwifery Womens Health 2018; 63:410-417. [PMID: 29778086 DOI: 10.1111/jmwh.12736] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/27/2022]
Abstract
Pelvic floor dysfunction is defined as abnormal function of the pelvic floor and includes conditions that can have significant adverse impacts on a woman's quality of life, including urinary incontinence (stress, urge, and mixed), fecal incontinence, pelvic organ prolapse, sexual dysfunction, diastasis recti abdominis, pelvic girdle pain, and chronic pain syndromes. Women's health care providers can screen for, identify, and treat pelvic floor dysfunction. This article examines the case of a woman with multiple pelvic-floor-related problems and presents the evidence for the use of pelvic floor physical therapy (PFPT) for pregnancy-related pelvic floor dysfunction. PFPT is an evidence-based, low-risk, and minimally invasive intervention, and women's health care providers can counsel women about the role that PFPT may play in the prevention, treatment, and/or management of pelvic floor dysfunction.
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