Functional outcomes were assessed with questionnaires regarding physical function, urinary incontinence and quality of life, as well as seven physical tests monitored by a physiotherapist. DRA was evaluated with ultrasonography as well as CT before surgery and at the 1-year follow-up, and no recurrences were seen 17. The study was conducted in Stockholm from 2015 to 2017. In a previous study, the effect of surgical repair of DRA, defined as greater than 30 mm at the widest distance, was examined in a cohort of 60 post-partum women with training-resistant core instability symptoms, with or without diagnosed concomitant ventral hernias. Studies have shown different surgical methods, open as well as laparoscopic repairs, to be successful regarding prevention of DRA recurrence and postoperative complications 16, 17, 28. Surgical reconstruction has been reported to recover abdominal core function in patients with training-resistant core dysfunction.
If core training fails, guidelines propose surgical repair in certain circumstances, such as a specified minimum of inter-recti distance (IRD) and a specified maximum BMI 21, 22. The optimal method and duration of core training are still under debate and the results from core training vary across studies 13, 23, 25–27. In general, the first-line treatment recommendation is core-stability training 13, 23, 24. Despite this, national guidelines stating recommendations of DRA management have been presented 21, 22. Multiple reviews have been published but consensus regarding best treatment is still lacking, due to conflicting results and insufficient follow-up time 18–20. The management of DRA has gained increasing attention during the last decade and studies have reported beneficial short-term results from surgical repair of DRA 15–17.
Risk factors for developing DRA include multiparity, advanced maternal age, caesarean section and collagen disposition 13, 14. The abdominal core, defined as the circumferential soft tissues of the diaphragm superiorly, the pelvic floor inferiorly and the abdominal wall and flank anterolaterally 12, is crucial for upholding the posture and abdominopelvic visceral function. DRA is one of several pathological components 5 of a generally stretched abdominal wall after pregnancy and can predispose for abdominal core dysfunctions such as back pain, abdominal core muscle weakness and poor posture 6–11. It is defined as a persisting widened and weakened linea alba caused by mechanical and hormonal changes during pregnancy and can present as a bulging or sagging of the abdominal midline. Diastasis recti abdominis (DRA) is a common condition after pregnancy, affecting approximately one-third of post-partum women 1–4.
0 kommentar(er)
