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Sartori A, Tfaily A, Botteri E, Andreuccetti J, Lauro E, Caliskan G, Verlato G, Di Leo A. Rectus muscle diastasis in Italian women: determinants of disease severity, and associated disorders. Front Surg 2024; 11:1360207. [PMID: 38529469 PMCID: PMC10961386 DOI: 10.3389/fsurg.2024.1360207] [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: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders. Methods In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model. Results Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m2 (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity. Conclusion The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.
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Affiliation(s)
- Alberto Sartori
- U.O. Chirurgia Generale e d'Urgenza, Ospedale Montebelluna, Montebelluna, Italy
| | - Ahmad Tfaily
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia, Montichiari, Italy
| | | | - Enrico Lauro
- U.O. Chirurgia Generale, Ospedale Civile Santa Maria del Carmine, Rovereto, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Alberto Di Leo
- U.O. Chirurgia Generale e Mininvasiva, Ospedale San Camillo, Trento, Italy
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Guo XH, Wang H, Chen SJ, Xie YJ, Liu RR. Multidimensional Ultrasound Evaluation of Diastasis Recti Abdominis During Different Gestational Periods. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:525-533. [PMID: 38050787 DOI: 10.1002/jum.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The purpose of this study is to explore the application value of two-dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of diastasis recti abdominis (DRA) during different gestational periods. METHODS A cohort of 202 gravidas that were examined in our hospital between June 2021 and September 2022 were selected for the purpose of the study, which included 26 cases with <14 weeks of pregnancy, 36 cases in the 14th-27th week of pregnancy, 36 cases in the 28th-34th week of pregnancy, 32 cases in the 35th-38th week of pregnancy, 45 cases at 42 days postpartum, and 27 cases at 3 months postpartum. The inter-rectus distance (IRD) and the thickness in each gestational period were measured, and Young's modulus of the rectus abdominis at different gestational periods was measured using SWE by two sonographers. The differences in IRD, thickness, and elasticity characteristics during different periods, and the correlation between rectus abdominis elasticity and IRD, thickness, body mass index (BMI), neonatal weight, and delivery mode were analyzed and compared. The consistency of SWE parameters obtained by different sonographers was also compared. RESULTS There were significant differences in IRD, thickness, and Young's modulus during different gestational periods (P = .000, P < .001, P < .001). Early postpartum IRD and Young's modulus did not restore to the level of early pregnancy (P < .001, P < .001), while the thickness of rectus abdominis was not significantly different from that of early pregnancy (P = .211). The Young's modulus of rectus abdominis was negatively correlated with the IRD (r = .515), positively correlated with the thickness of rectus abdominis (r = .408), and weakly negatively correlated with maternal BMI (r = -.296). There was no significant correlation with neonatal weight or delivery mode (P = .147, .648). The Bland-Altman plot showed that the two sonographers had good consistency in evaluating the elasticity of rectus abdominis by SWE. CONCLUSION The multidimensional evaluation of DRA by ultrasound is feasible and IRD and Young's modulus can be used to evaluate the postpartum recovery of DRA. The combination of the two can objectively reflect the severity of DRA morphology and function.
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Affiliation(s)
- Xiao-Han Guo
- Department of Ultrasonic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Hua Wang
- Department of Ultrasonic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Sheng-Jiang Chen
- Department of Ultrasonic, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Yu-Juan Xie
- Department of Ultrasonic, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Rui-Rui Liu
- Department of Ultrasonic, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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Ugurlu C, Gok H, Sahin A, Bayar B, Olcucuoglu E, Kulacoglu H. Prevalence of rectus diastasis is higher in patients with inguinal hernia. Hernia 2023:10.1007/s10029-023-02820-0. [PMID: 37335520 DOI: 10.1007/s10029-023-02820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. MATERIAL AND METHODS Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. RESULTS A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. CONCLUSIONS The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.
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Affiliation(s)
- C Ugurlu
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, 60030, Tokat, Turkey.
| | - H Gok
- Department of General Surgery, Hernia Istanbul Comprehensive Hernia Center, Istanbul, Turkey
| | - A Sahin
- Department of General Surgery, University of Health Science, Konya City Hospital, Konya, Turkey
| | - B Bayar
- Department of General Surgery, Mus State Hospital, Mus, Turkey
| | - E Olcucuoglu
- Department of General Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - H Kulacoglu
- Department of General Surgery, Ankara Hernia Center, Ankara, Turkey
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Olsson A, Woxnerud K, Kiwanuka O, Sandblom G, Stackelberg O. The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery. BJS Open 2023; 7:7025466. [PMID: 36734959 PMCID: PMC9897176 DOI: 10.1093/bjsopen/zrac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. METHODS A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. RESULTS Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. CONCLUSIONS Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.
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Affiliation(s)
- A Olsson
- Correspondence to: Anders Olsson, PhD, Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden (e-mail: )
| | - K Woxnerud
- Stockholm Hernia Center, Stockholm, Sweden,Women's Health Department, Hela Kvinnans Klinik, Stockholm, Sweden
| | - O Kiwanuka
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden,Unit of Nutritional Epidemiology, Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Ramírez-Jiménez M, Alburquerque-Sendín F, Garrido-Castro JL, Rodrigues-de-Souza D. Effects of hypopressive exercises on post-partum abdominal diastasis, trunk circumference, and mechanical properties of abdominopelvic tissues: a case series. Physiother Theory Pract 2023; 39:49-60. [PMID: 34779692 DOI: 10.1080/09593985.2021.2004630] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Abdominal diastasis (AD) is highly prevalent at post-partum. Although several conservative approaches have been proposed, an effective and protocolized treatment is lacking for this condition. OBJECTIVE To identify modifications of inter-rectus abdominis distance (IRAD), trunk circumferences and mechanical properties of the AD, transversus abdominis and the pelvic floor (PF) muscles, after the application of hypopressive exercises (HE) and at a two-month follow-up in postpartum AD. METHODS Twelve volunteers with post-partum AD followed a four-week (three times a week) tailored program of HE. The main outcome was the IRAD, assessed at four specific supraumbilical points (3, 6, 9, and 12 cm). Abdominal circumference and respiratory expansion were measured at three different locations (axillar, xiphoid, and umbilical), and the mechanical properties of abdomino-pelvic tissues were also assessed using tonometry (MyotonPRO). Four evaluations were performed for all outcomes: at baseline, post-intervention, at a 1-month follow-up, and at a 2-month follow-up. RESULTS The IRAD of participants was reduced (p < .05), furthermore, some participants displayed no AD after the intervention period. In addition, the abdominal circumference increased, mainly at follow-up, whereas the thoracic respiratory expansion decreased a median of 2 cm. The tension and stiffness of the LA decreased, when assessed at 3 and 6 cm supraumbilical. Finally, the tension and elasticity of TA/IO and of the PF, and also the elasticity of the PF decreased after the intervention period. No complaints were identified in relation to the HE program or assessments. CONCLUSION A program of HE showed positive results for the reduction of post-partum AD. Different study designs should be performed to better explain the effects of HE for AD.
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Affiliation(s)
- Miriam Ramírez-Jiménez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Juan Luis Garrido-Castro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, Córdoba, Spain
| | - Daiana Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
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Kvist M, Henriksen NA, Burcharth J, Nielsen YW, Jensen TK. Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study. Hernia 2022; 27:353-361. [PMID: 36422726 DOI: 10.1007/s10029-022-02719-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy. METHODS A single-center, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis. RESULTS A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls; p = < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71-5.47; p = < 0.001). No other suspected risk factors showed a significant association with burst abdomen. CONCLUSION Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.
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Affiliation(s)
- M Kvist
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
| | - N A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - J Burcharth
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Y W Nielsen
- Department of Radiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - T K Jensen
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
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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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PUELLES Á, GONZÁLEZ J, PIZARRO A, GALLEGUILLOS F, TORRES C, FABREGA A. Ultrasound analysis of morphological changes in the abdominal wall in postpartum women with diastasis recti: a cross-sectional study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ponomarenko OV, Sergeeva LN, Khristenko TA. METHODS FOR QUANTITATIVE ASSESSMENT OF COLLAGEN ACCUMULATION PROCESSES IN DAMAGED TRAUMATIC INTEGUMENTARY TISSUES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1331-1336. [PMID: 35758454 DOI: 10.36740/wlek202205219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To study the level of expression of type I, III collagen under conditions of traumatic damage to integumentary tissues and to develop quantitative criteria for collagen formation processes for choosing the volume of reconstruction of a wound defect. PATIENTS AND METHODS Materials and methods: Studies were performed for 62 victims. Clinical group 1 (n = 16) - patients with wound surface sizes of the body surface area, group 2 (n = 32) consisted of patients who received integumentary tissue defects due to or together with damage osteoarticular apparatus of the limb, group 3 (n = 14) - patients with combined trauma. RESULTS Results: In the skin samples of patients of groups 1 and 2 of the affected groups, a statistically significant difference was established between the indicators of the relative accumulation area of type I, type III collagen (W = 675, p = 0.01 and W = 697, p = 0.03, respectively). In patients of groups 2 and 3, when analyzing relationships, a direct moderate strength was observed between the areas of collagen deposition of type I, type III (rs = 0.52 and 0.54). Collagen deposition coefficient (Кd) was used as a quantitative criterion for assessing the prognosis of the results of restoration of integumentary tissues according to the proposed scale, which made it possible to obtain postoperative complications in only 3.2 % of cases. CONCLUSION Conclusions: A positive treatment result taking into account the quantitative criterion (Kd) was obtained in 96.8 % of the examined patients.
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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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11
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Management of the post-pregnancy abdomen: the plastic surgical perspective. Hernia 2021; 25:929-938. [PMID: 34342744 DOI: 10.1007/s10029-021-02478-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
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12
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Nienhuijs SW, Berkvens EHM, de Vries Reilingh TS, Mommers EHH, Bouvy ND, Wegdam J. The male rectus diastasis: a different concept? Hernia 2021; 25:951-956. [PMID: 34297251 DOI: 10.1007/s10029-021-02467-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE More interest in the treatment of rectus diastasis has been evoked lately. Following the postpartum females from a great distance, the middle-aged males living with obesity are the second most common group of rectus diastasis patients. Although gender differences are considered frequently in regard to cosmetic appearance and symptoms, it is less obvious in classifications and subsequent treatment strategies. Is a unisex approach of rectus diastasis still applicable? The lack of a firm answer warrants this review of the current literature. METHODS An explorative free-text multi-database bibliographic search (Pubmed/CENTRAL/EMBASE/PEDro/Scholar) was performed with the focus on the rectus diastasis in males. Anticipating the limited references, the design was a non-systematic review. All studies, regardless of study type, language or time period, describing etiology, symptoms, classification and/or treatment options were eligible for inclusion. From the articles retrieved out of this search, additional references were identified by a manual search among the cited references. RESULTS The multi-database search resulted in a total of 7633 records. Based on the title and abstract 95 records were full text assessed for eligibility. Eleven studies were identified as relevant, six by cross-reference and another four by hand-search were added to provide an insight in gender-specific aspects in rectus diastase. Hereditary causes are differences in collagen-like composition of types and concomitant abdominal aneurysm as well as gender differences in the linea alba architecture. Acquired etiology is distributed into both absolute pressure by visceral obesity and relative pressure caused by weight lifting or improper exercises. Furthermore, the impact of muscle thickness and age are considered as influencers of biomechanics. Gender differences can also play a role in symptoms of body image and core stability. It is known that there are anatomical differences between male and female persons; more transverse fibers are found in infra-umbilical region in women. In classifications the awareness of male rectus diastasis is limited, treatment outcome studies are scarce on males. CONCLUSION An overview of male-specific aspects of rectus diastasis is provided, underlining that key aspects surrounding rectus diastasis in males differ from females. Although males are the minority of rectus diastasis patients, we recommend that the male rectus diastasis as a concept should be specifically acknowledged in classifications systems and study outcome reporting to evaluate this subgroup more accurately in the future.
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Affiliation(s)
- S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands.
| | - E H M Berkvens
- Department of Physiotherapy, Elkerliek Hospital Helmond, Helmond, The Netherlands
| | | | - E H H Mommers
- Department of Radiology, Maastricht University Hospital, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - J Wegdam
- Department of Surgery, Elkerliek Hospital Helmond, Helmond, The Netherlands
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Harada BS, De Bortolli TT, Carnaz L, De Conti MHS, Hijaz A, Driusso P, Marini G. Diastasis recti abdominis and pelvic floor dysfunction in peri- and postmenopausal women: a cross-sectional study. Physiother Theory Pract 2020; 38:1538-1544. [PMID: 33283590 DOI: 10.1080/09593985.2020.1849476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Diastasis recti abdominis (DRA) and pelvic floor dysfunction (PFD) occurs commonly with aging; however, little is known about what leads to these changes.Objective: We aimed to investigate and compare the presence or absence of DRA and PFD in peri- and postmenopausal women.Methods: This cross-sectional study involved 150 participants who answered questions on their sociodemographic and clinical profiles related to urinary and fecal incontinence and pelvic organ prolapse. Diastasis recti abdominis was diagnosed with a digital caliper.Results: Supra-umbilical diastasis occurred in 37.3% of cases, and 78.6% of participants with DRA had PFD. No significant differences existed between participants with and without DRA in terms of background and clinical variables. However, participants with DRA were 2.6 times more likely to have PFD than participants without DRA. Furthermore, the presence of DRA was significantly shown to be a risk factor for PFD on binary logistic regression analyses (p = .01, OR = 3.2).Conclusions: This cross-sectional study suggests that DRA is a predictive factor of PFD in women aged over 50 years.
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Affiliation(s)
- Beatriz Souza Harada
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Thainá Tolosa De Bortolli
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Letícia Carnaz
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Marta Helena Souza De Conti
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Adoniz Hijaz
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Patricia Driusso
- Department of Physical Therapy, Federal University of Sao Carlos, São Carlos, São Paulo State, Brazil
| | - Gabriela Marini
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
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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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