Effect of core muscle motor control training on postpartum diastasis recti abdominis / 中国康复理论与实践

ObjectiveTo explore the clinical effect of core muscle motor control training on postpartum diastasis recti abdominis. MethodsFrom January, 2021 to January, 2022, 30 outpatients with postpartum diastasis recti abdominis were randomly divided into control group (n = 15) and experimental group (n = 15). Manipulative therapy and breathing training were performed simultaneously in both groups. Besides, the control group received conventional core strength training, and the experimental group received core muscle motor control training, for four weeks. Their distance of diastasis recti abdominis, abdominal circumference and waist circumference were compared before and after treatment. ResultsAfter treatment, the distance of diastasis recti abdominis, abdominal circumference and waist circumference reduced in both groups (Z = 3.408, t > 5.927, P < 0.05). The reduction value of diastasis recti abdominis distance was more in the experimental group than in the control group (t = 2.328, P < 0.05). ConclusionCore muscle motor control training can effectively relieve postpartum diastasis recti abdominis, and the effect is better than conventional core strength training.

Study on the status and influencing factors of rectus abdominis muscle separation in postpartum women / 中国综合临床

Objective:To analyze the current situation and influencing factors of rectus abdominis muscle separation in postpartum women.Methods:The clinical data of 3 368 postpartum women who underwent postpartum physical examination in Shenzhen Longgang maternal and child health hospital from June to October 2020 were retrospectively analyzed. The general data, rectus abdominis separation and pelvic organ prolapse were collected for cross-sectional investigation.Results:The incidence of rectus abdominis separation in postpartum women was 60.7% (2 045/3 368). <30 years old, ≥30 years old (56.8% (856/1 507) and 63.9% (1 189/1 861), χ2=17.54)). The increase of body mass during pregnancy was <16 kg, ≥16 kg (59.1% (1 351/2 285) and 64.1% (694/1 083), χ2=7.57)). Spontaneous labor and cesarean section (55.7% (1 262/2 266) and 71.7% (790/1 102), χ2=77.87)). Pregnancy 1, 2, ≥3 times (53.9% (645/1 196), 62.1% (702/1 131) and 67.1% (698/1 041), χ2=41.48). Production for 1, 2, ≥3 times (53.9% (877/1 628), 67.0% (1 016/1 517) and 68.2% (151/223), χ2=62.09)). History of macrosomia (68.7% (160/233) and 60.1% (1 885/3 135), χ2=6.64)). Prolapse of anterior vaginal wall (75.2% (1 559/2 072) and 37.5% (486/1 296), χ2=476.15), there were significant differences in the incidence of rectus abdominis separation (all P<0.05). Logistic regression analysis showed that ≥ 3 times pregnancies ( OR=1.572,95% CI=1.270-1.945),cesarean section ( OR=2.440,95% CI=2.050-2.905),macrosomia ( OR=1.660,95% CI=1.213-2.273), anterior vaginal prolapse( OR=7.324,95% CI=6.083-8.819) were risk factors of diastasis recti abdominis (all P<0.05). Conclusions:The incidence of rectus abdominis separation in postpartum women is high. Three or more pregnancies, cesarean section, history of macrosomia and prolapse of anterior vaginal wall play an important role in the occurrence of rectus abdominis separation.

Analysis on the level of knowledge, attitude and practice of rehabilitationfor postpartum diastasis recti abdominisinpuerperaeand the influencing factors of behavior / 中国实用护理杂志

Objective:To explore the current level of knowledge, attitude and practice of rehabilitation for postpartum diastasis recti abdominis inpuerperae, and analysis the influencing factors of behavior, in order to provide a reference frame for nursing staff to formulate effective health education programs.Methods:From November 2020 to April 2021, a self-designed questionnaire was used to investigate 522 puerperae from 4 tertiary hospitals in Guangdong province, Jiangsu province and Zhejiang province, to explore their level of knowledge, attitude and behavior of rehabilitation for postpartum diastasis recti abdominis. Mann-Whitney Utest or Kruskal-Wallis Htest was used for univariate analysis, Binary Logistic regression analysis was used to analysis the influencing factors of rehabilitative behavior.Results:The median score of knowledgedimension, attitude dimension and behavior dimension of rehabilitation for postpartum diastaisis recti abdominis in puerperae respectively were 47.0 (36.0, 55.0), 26.0 (24.0, 31.0), 15.0 (10.0, 18.0) points. The results show that the main factors influencing of rehabilitation behaviorfor postpartum diastaisis recti abdominis in puerperae were knowledge ( χ2 = 87.78, P<0.05), attitude ( χ2 = 4.77, P<0.05), number of deliveries ( χ2 = 3.94, P<0.05) and family personal monthly income ( χ2 = 4.88, P<0.05). Conclusions:At present, puerperae have a positive attitude towards rehabilitation for postpartum diastasis recti abdominis, but the level of knowledge and practice of rehabilitation for postpartum diastasis recti abdominisneed to be improved.Nursing staff should focus on puerperae with incomplete knowledge, negative attitude, multiple deliveries and low family personal monthly income.

Effects of Pelvic Floor Neuromuscular Electrical Stimulation and Sling Exercise Training on Diastasis Recti Abdominis after Parturition / 中国康复理论与实践

Objective:To observe the effect of pelvic floor neuromuscular electrical stimulation (NMES) and sling exercise training (SET) on diastasis recti abdominis after parturition. Methods:From September to December, 2019, 90 patients with rectus abdominis separation > 2 cm and pelvic floor muscle strength above grade III were randomly divided into three groups, accepting simple pelvic floor NMES (group A), pelvic floor NMES and SET (group B), and simple SET (group C), respectively, for four weeks. The separation distance of rectus abdominis was measured before treatment, two weeks and four weeks after treatment, and four weeks follow-up. Results:The separation distance of rectus abdominis decreased in each group after treatment (F > 8.327, P < 0.01); and it was the least in group B (F > 8.327, P < 0.01), while the multiple comparison results showed that there was no significant difference between group A and group C (P > 0.05). Conclusion:Both pelvic floor NMES and SET can similarly relieve the diastasis recti abdominis after parturition, and it is more effective in combination.

Laparoscopic Repair of Diastasis Recti: A Case Report and Literature Review

Diastasis recti is a state with separated aponeurosis between two recti caused by weakening of the intercrossing fibers in the linea alba and it causes abdominal protrusion. Common causes comprised of increased intraabdominal pressure, or congenital weakening of myoaponeurotic layer. We describe a patient who underwent laparoscopic repair of diastasis recti. A 30-year-old woman was referred to our outpatient department for an abdominal mass that had appeared 1 year earlier. Physical examination revealed an abdominal wall defect along the midline and computed tomography showed thinning and stretching of the linea alba. The patient underwent laparoscopic repair for diastasis recti. The stretched linea alba was approximated using interrupted sutures from the epigastrium to the suprapubic area. A dual mesh was applied below the peritoneum to prevent recurrence. The patient was discharged without complications, and was followed up for 1 year without recurrence. Laparoscopic repair could be a considerable is a treatment modality for diastasis recti.

Clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti / 中华消化外科杂志

Objective To investigate the clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti.Methods The retrospective cross-sectional study was conducted.The clinical data of 14 patients with postpartum diastasis recti who were admitted to Ruijin Hospital of Shanghai Jiaotong University School of Medicine between June 2016 and June 2018 were collected.Patients underwent laparoscopic-assisted linea alba reconstruction.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,diastasis recti and umbilical hernia recurrence up to September 2018.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (P25,P75).Results (1) Intra-and post-operative situations:14 patients underwent successful laparoscopic-assisted linea alba reconstruction and 8 complicated with umbilical hernia area of (6± 3) cm2 were sutured and closed.The mesh area,operation time,visual analogue score for pain at the first day after operation,time of postoperative drainage-tube removal and duration of postoperative hospital stay were respectively (214±26) cm2,(74 ± 14) minutes,3.7 ± 0.6,(3.3 ± 0.7) days and (4.1 ± 1.2) days.No patient required administration of analgesics and had postoperative complication.(2) Follow-up:14 patients were followed up for 17 months (5 months,21 months).During the follow-up,1 patient returned visit at postoperative day 10 due to surgical incision drainage and cured after dressing change.The other patients had no complications,without diastasis recti and umbilical hernia recurrence.Conclusion Laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti is safe and effective.

Collagen I and III in women with diastasis recti

OBJECTIVES: Interest in elucidating the etiology of hernias has encouraged countless studies of musculoaponeurotic structures in individuals with and without hernias. Studies of hernia patients have firmly demonstrated a correlation between hernias and collagen alterations in their fascia. Diastasis recti is an increased width of the abdominal midline that is exclusively composed of interlacing aponeurotic expansions of the anterolateral abdominal muscles. The condition is common among women undergoing abdominoplasty, and many factors, not only mechanical, play a role. The goal of this study is to evaluate and compare collagen type I and III levels in the midline fascia of women with and without diastasis recti to report their possible influence on this condition. METHODS: This is a case-control study nested within a surgical cohort of 18 women with diastasis recti and 18 women without the condition (cases and controls, respectively). Fascia from the midline of the abdominal wall was collected and analyzed through immunohistochemistry using polyclonal antibodies to collagen type I and III. RESULTS: Both type I and type III collagen were less abundant in women with diastasis recti than in those without the condition, and the difference was statistically significant (p<0.001). CONCLUSION: Low collagen type I and type III levels in the midline of the abdominal wall may play a key role in the development of diastasis recti.

Neuromuscular Electrical Stimulation and Strength Recovery of Postnatal Diastasis Recti Abdominis Muscles

OBJECTIVE: To assess the effect of neuromuscular electrical stimulation (NMES) on the recovery of abdominal muscle strength in postnatal women with diastasis of recti abdominis muscles (DRAM). METHODS: Sixty women, 2 months postnatal, participated in this study. They were divided randomly into two equal groups. Group A received NMES in addition to abdominal exercises; group B received only abdominal exercises. The intervention in both groups was for three times per week for 8 weeks. The outcome measures were body mass index (BMI), waist/hip ratio, inter recti distance (IRD), and abdominal muscle strength in terms of peak torque, maximum repetition total work, and average power. RESULTS: Both groups showed highly significant (p<0.05) improvement in all outcomes. Further, intergroup comparisons showed significant improvement (p<0.05) in all parameters in favor of group A, except for the BMI. CONCLUSION: NMES helps reduce DRAM in postnatal women; if combined with abdominal exercises, it can augment the effects.