Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis

Published:October 05, 2022DOI:


      • Diastasis recti abdominis (DRA) is the separation of the rectus abdominis muscles in the midline at the linea alba.
      • It frequently occurs in women during the second and third trimesters of pregnancy and may persist to afflict in the postpartum period.
      • Increased inter-recti distance of women with DRA causes impaired postural stability in both static and dynamic conditions.
      • Alteration of inter-recti distance do not affect pelvic floor muscle functions and respiratory muscle strength in women with DRA.



      The main objective was to assess the relationship between inter-recti distance (IRD) and abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with Diastasis Recti Abdominis (DRA). Additionally, the secondary purpose of the study is to investigate the independent predictors of IRD in women with DRA.

      Study design

      Fifty-one women who were diagnosed with DRA participated to the study. IRD assessment with a caliper, abdominal muscle endurance test, Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), maximum inspiratory and expiratory pressure (MIP and MEP, respectively) tests, Clinical Test of Sensory Integration of Balance (m-CTSIB) under eyes open on a firm surface (EOFS), eyes closed on a firm surface (ECFS), eyes open on a foam surface (EOFoS), and eyes closed on a foam surface (ECFoS) conditions, and Limits of Stability (LOS) tests were performed for all subjects. Pearson or Spearman correlation analyses were used to determine the relationship between IRD and static abdominal flexion endurance test, PFDI-20, MIP and MEP, m-CTSIB, and LOS scores depending on the distribution properties of the data. Additionally, linear regression analysis was utilized for analyzing the independent predictors of IRD among the age, BMI, parity, time since last birth, birth weight, weight gains last pregnancy, and mode of delivery.


      IRD had correlations with Colorectal–Anal Distress score of PFDI-20 (r = -0.317, p = 0.03) and EOFS, ECFS, EOFoS, ECFoS and composite score of m-CTSIB (r = 0.356, p = 0.01; r = 0.337, p = 0.02, r = 0.279, p = 0.04; r = 0.265, p = 0.04; r = 0.413, p = 0.004, respectively) and LOS scores (r = 0.422, p = 0.003). Increased IRD did not influence abdominal muscle endurance and respiratory muscle strength in women with DRA (p < 0.05). Age, BMI, time since last birth, weight gains last pregnancy, and mode of delivery were not determined as the factors that influence IRD in women with DRA (p < 0.05).


      We concluded that increased IRD is associated with worse postural control, but better colorectal functions in women with DRA. Additionally, IRD does not show a clear association with abdominal muscle endurance, pelvic floor functions, and respiratory muscle strength. According to our results, postural stability assessments may perform in the physiotherapeutic management of women with DRA.


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      Hilal Denizoglu Kulli BS and MS in Physiotherapy and Rehabilitation at Istanbul University and Abant Izzet Baysal University, respectively. She completed her Ph.D. in Biomedical Engineering at Istanbul University- Cerrahpasa in 2018. She has worked in Bezmialem Vakif University, Division of Physiotherapy and Rehabilitation between 2013 to 2021. Currently, she has been an Assistant Professor in the Division of Physiotherapy and Rehabilitation at Istanbul Atlas University since 2021. Her research is focused on physiotherapy and rehabilitation, cardiopulmonary rehabilitation, and postural control.


      Hulya Nilgün Gurses BS in Physiotherapy and Rehabilitation and completed her Ph.D. in Physical Therapy and Rehabilitation at Hacettepe University in 1977. She has worked as an Assistant Professor between 1984 to 1988, then as a Professor between 1988 to 2008 in Cardiopulmonary Rehabilitation at Istanbul University, Institute of Cardiology. She had carried out Head of “The School of Health Sciences” and the “Division of Physiotherapy and Rehabilitation” at Istanbul Bilim University for four years. Currently, she has been Head of the “Division of Physiotherapy and Rehabilitation” and the “Department of Cardiopulmonary Physiotherapy and Rehabilitation” at Bezmialem Vakif University since 2012. Her research is focused on physiotherapy and rehabilitation, cardiopulmonary rehabilitation, respiratory muscle training and postural control.