During pregnancy your abdominal muscles shift to accommodate your growing baby. After delivery and during your postpartum period your abdominal muscles can remain widened and weakened. DRAM can be observed by a bulging or sagging abdominal midline and can predispose a postpartum individual to back pain and abdominal core muscle weakness.
The current consensus on first line treatment is core stability training. (Hodges, L 2016). If this fails in certain cases surgical repair can be recommended. Raney 1990 reports that a separation greater than 5cm may benefit from surgical repair. Currently most are completed for aesthetic reasons as reported by Carlstedt, A et al 2020.
A study conducted by Olsson, A et al 2021 completed a 3-year review of surgical outcomes in post-partum women. A group of 60 women with DRAM and training resistant core dysfunction were followed. Measures investigated were:
- Abdominal function (functional test and questionnaire)
- Urinary Incontinence ((questionnaire)
- Urogenital distress (questionnaire)
Key Facts about Surgical Outcomes
- 0-40% reoccurrence rate after surgery (Carlstedt, A et al 2020)
- Post operative complications: seroma, wound infection, chronic pain, sensory loss
- Patient satisfaction was higher in the surgical group compared to exercise group (Emanuelsson et al)
- Very limited evidence to support the benefit of surgery for DRAM.
- Small evidence to show at 1 year follow up improvements were seen in abdominal core function, decrease urinary incontinence and improved quality of life. (Olsson et al 2019).
- After 3 years the researchers found improvements in abdominal strength compared to preoperative levels.
Recommendations from Research
- Patients should undergo a core training program for 6 months before considering surgical DRAM correction.
- An inter recti distance (width between muscles) of 5cm or more may be considered for surgery (Ranney 1990)
In current research multiple authors state that more research is required to develop guidelines for surgical intervention for DRAM. Currently there is only a small amount of evidence suggesting that surgery can have some good outcomes regarding strength and quality of life. Your health is always your decision and the more information you have available to you the better. Bump Fitness physiotherapists are currently trained and follow the recommended guidelines for DRAM rehabilitation. We provide postpartum women with an individualized abdominal exercise program to address any abdominal weakness resulting from pregnancy. If you have any questions or concerns always reach out to your GP or women’s health physiotherapist to discuss what may work best for you.
References
- Lee D, Hodges PW. J Orthop Sports Phys Ther 2016;46:580–589 Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study – PubMed (nih.gov)
- Ranney B: S D J Med 1990;43(10):5–8. Diastasis recti and umbilical hernia causes, recognition and repair – PubMed (nih.gov)
- Olsson A, Kiwanuka O, Wilhelmsson S, Sandblom G, Stackelberg O. BJS Open 2019;3:750–758. Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life – PubMed (nih.gov)
- Carlstedt A, Bringman S, Egberth M, et al. Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines. Scandinavian Journal of Surgery. 2021;110(3):452-459. doi:1177/1457496920961000 https://journals.sagepub.com/doi/full/10.1177/1457496920961000