Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study

Abstract

Aims: Compare vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength, and endurance in women with and without diastasis recti abdominis at gestational week 21 and at 6 weeks, 6 months, and 12 months postpartum. Furthermore, to compare prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) in the two groups at the same assessment points.

Methods: This is a prospective cohort study following 300 nulliparous pregnant women giving birth at a public university hospital. VRP, PFM strength, and endurance were measured with vaginal manometry. ICIQ-UI-SF questionnaire and POP-Q were used to assess UI and POP. Diastasis recti abdominis was diagnosed with palpation of ≥2 fingerbreadths 4.5 cm above, at, or 4.5 cm below the umbilicus.

Results: At gestational week 21 women with diastasis recti abdominis had statistically significant greater VRP (mean difference 3.06 cm H₂ O [95%CI: 0.70; 5.42]), PFM strength (mean difference 5.09 cm H₂ O [95%CI: 0.76; 9.42]) and PFM muscle endurance (mean difference 47.08 cm H₂ O sec [95%CI: 15.18; 78.99]) than women with no diastasis. There were no statistically significant differences between women with and without diastasis in any PFM variables at 6 weeks, 6 months, and 12 months postpartum. No significant difference was found in prevalence of UI in women with and without diastasis at any assessment points. Six weeks postpartum 15.9% of women without diastasis had POP versus 4.1% in the group with diastasis (P = 0.001).

Conclusions: Women with diastasis were not more likely to have weaker PFM or more UI or POP. Neurourol. Urodynam. 36:716-721, 2017. © 2016 Wiley Periodicals, Inc.

Keywords: diastasis recti abdominis; pelvic floor muscles; pelvic organ prolapse; postpartum; pregnancy; urinary incontinence.