PREVALENCE OF PELVIC PAIN AND URINARY INCONTINENCE IN ASSOCIATION WITH DIASTASIS RECTI AFTER C-SECTION

Authors

  • Izza Ayub The University of Faisalabad, Pakistan. Author
  • Noor Habiba The University of Faisalabad, Pakistan. Author
  • Warda Imran The University of Faisalabad, Pakistan. Author
  • Arwa Nadeem The University of Faisalabad, Pakistan. Author
  • Sara Riaz The University of Faisalabad, Pakistan. Author
  • Areesha Ali The University of Faisalabad, Pakistan. Author
  • Rimsha Saleem The University of Faisalabad, Pakistan. Author

DOI:

https://doi.org/10.71000/75c1c548

Keywords:

Urinary incontinence, Pelvic pain, Cesarean Section, Diastasis Recti, Female, Pelvic Floor Disorders, Postpartum Period

Abstract

Background: Diastasis recti abdominis (DRA) is defined as a midline separation of the rectus abdominis muscles along the linea alba, commonly occurring during pregnancy and the postpartum period. It has been reported in 66–100% of women during the third trimester and persists in approximately 53% after childbirth. The condition is associated with altered core stability, pelvic floor dysfunction, and compromised quality of life. Identifying its relationship with pelvic pain and urinary incontinence in postpartum women is essential to guide rehabilitation and preventive strategies.

Objective: To determine the association of pelvic pain and urinary incontinence with diastasis recti abdominis among postpartum women following cesarean section.

Methods: A descriptive cross-sectional study was conducted on 100 postpartum women aged 20–35 years at Government General Hospital Faisalabad and District Head Quarters Hospital Faisalabad over four months. Participants were selected through simple random sampling, and written informed consent was obtained. Women with normal vaginal delivery, umbilical hernia, recurrent abdominal surgeries, post-menopausal status, or active pregnancy were excluded. Screening for DRA was performed using the finger-width method. The Pelvic Floor Distress Inventory Short Form-20 (PFDI-20) assessed pelvic pain, while the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) evaluated urinary incontinence. Data were analyzed using SPSS version 20, and chi-square test was applied to assess associations.

Results: The mean age of participants was 28.24 ± 4.16 years (range 20–36). The PFDI-20 showed that 28% of women experienced heaviness in the lower abdomen, 22% pressure in the lower abdomen, and 23% reported pain or discomfort in the pelvic region. Urinary incontinence was present in 36% of participants, with 27% classified as moderate and 9% as severe based on ICIQ-UI scores. Pelvic floor distress was mild in 72%, moderate in 9%, and severe in 19%. Chi-square analysis revealed a significant association between urinary incontinence and DRA (p ≤ 0.05), whereas no significant association was found between pelvic pain and DRA (p ≥ 0.05).

Conclusion: The study demonstrated a strong association between diastasis recti abdominis and urinary incontinence in postpartum women following cesarean delivery, while no significant link with pelvic pain was observed. These findings underscore the importance of early screening, preventive education, and postpartum rehabilitation to minimize pelvic floor complications and enhance quality of life.

Author Biographies

  • Izza Ayub, The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan.

  • Noor Habiba, The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan.

  • Warda Imran, The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan.

  • Arwa Nadeem, The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan.

  • Sara Riaz , The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan

  • Areesha Ali, The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan

  • Rimsha Saleem, The University of Faisalabad, Pakistan.

    Department of Rehabilitaion Sciences, The University of Faisalabad, Pakistan

References

Torosis M, Carey E, Christensen K, Kaufman MR, Kenton K, Kotarinos R, et al. A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction. Obstet Gynecol. 2024;143(4):595-602.

Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. Pelvic-floor function, dysfunction, and treatment. Eur J Obstet Gynecol Reprod Biol. 2021;265:143-9.

van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, Pelger RCM, Hagenaars-van Miert C, Laan ETM. Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sex Med Rev. 2022;10(2):209-30.

Bittelbrunn CC, de Fraga R, Martins C, Romano R, Massaneiro T, Mello GVP, et al. Pelvic floor physical therapy and mindfulness: approaches for chronic pelvic pain in women-a systematic review and meta-analysis. Arch Gynecol Obstet. 2023;307(3):663-72.

Prendergast SA, Mueller J. Pelvic Floor Physical Therapy and Female Sexual Dysfunction. Clin Obstet Gynecol. 2025;68(1):37-43.

Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health. 2023;23(1):2005.

Padoa A, McLean L, Morin M, Vandyken C. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med Rev. 2021;9(1):76-92.

González-Gutiérrez MD, López-Garrido Á, Cortés-Pérez I, Obrero-Gaitán E, León-Morillas F, Ibáñez-Vera AJ. Effects of Non-Invasive Radiofrequency Diathermy in Pelvic Floor Disorders: A Systematic Review. Medicina (Kaunas). 2022;58(3).

Del Forno S, Arena A, Pellizzone V, Lenzi J, Raimondo D, Cocchi L, et al. Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound Obstet Gynecol. 2021;57(5):726-32.

Çintesun E, Çintesun FNİ, Aydoğdu M, Bayramoğlu D, Çelik Ç. Effect of re-approximation of the rectus muscles on diastasis recti abdominis at cesarean section—a prospective cross-sectional study. Ginekologia Polska. 2021;92(2):132-6.

Harada BS, De Bortolli TT, Carnaz L, De Conti MHS, Hijaz A, Driusso P, et al. Diastasis recti abdominis and pelvic floor dysfunction in peri-and postmenopausal women: a cross-sectional study. Physiotherapy Theory and Practice. 2022;38(10):1538-44.

Fei H, Liu Y, Li M, He J, Liu L, Li J, et al. The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study. BMC Women's Health. 2021;21:1-8.

Braga A, Caccia G, Nasi I, Ruggeri G, Di Dedda MC, Lamberti G, et al. Diastasis recti abdominis after childbirth: Is it a predictor of stress urinary incontinence? Journal of gynecology obstetrics and human reproduction. 2020;49(10):101657.

Cavalli M, Aiolfi A, Bruni P, Manfredini L, Lombardo F, Bonfanti M, et al. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia. 2021;25(4):883-90.

van Wingerden J-P, Ronchetti I, Sneiders D, Lange JF, Kleinrensink G-J. Anterior and posterior rectus abdominis sheath stiffness in relation to diastasis recti: Abdominal wall training or not? Journal of Bodywork and Movement Therapies. 2020;24(1):147-53.

Saleh EA, Walton L, Said S, Raigangar V, Kim M. The association between Diastasis recti abdominis and pelvic floor dysfunction, sacroiliac joint dysfunction, and quality of life among postpartum women after Cesarean delivery. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2024;34(01):18-26.

Wang Q, Yu X, Chen G, Sun X, Wang J. Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. International Urogynecology Journal. 2020;31:277-83.

Hagovská M, Dudič R, Švihra J, Urdzík P. Relationships of diastasis recti abdominis with stress urinary incontinence and pelvic floor muscle dysfunction in postpartum women. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2024;301:222-6.

Yuan S, Wang H, Zhou J. Prevalence and risk factors of low back and pelvic pain in women with rectus abdominis diastasis: a multicenter retrospective cohort study. The Korean journal of pain. 2022;35(1):86-96.

Cardaillac C, Vieillefosse S, Oppenheimer A, Joueidi Y, Thubert T, Deffieux X. Diastasis of the rectus abdominis muscles in postpartum: concordance of patient and clinician evaluations, prevalence, associated pelvic floor symptoms and quality of life. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020;252:228-32.

Garnett G, Larson A. The Prevalence, Diagnosis, Education, and Treatment of Diastasis Recti Abdominis and Pelvic Floor Dysfunction among Post-Partum Women. Int J Womens Health Wellness. 2022;8(144):2474-1353.

Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Brazilian journal of physical therapy. 2021;25(6):664-75.

Downloads

Published

2025-09-24