Postpartum diastasis recti abdominis (DRA), characterized by increased inter-rectus distance (IRD), is common and linked to functional impairments, but its association with pelvic floor dysfunction (PFD) remains uncertain. This study investigated whether IRD correlates with pelvic floor muscle (PFM) function and examined the association between DRA and PFD in primiparous women during the remote postpartum period. This cross-sectional study included primiparous women 45 days to 12 months postpartum. The IRD and PFM function were assessed using standardized ultrasound protocols, with additional clinical, anthropometric, and questionnaire data collected in face-to-face interviews. PFD and sexual function were evaluated using the QMAP-Br and FSFI-6 instruments, respectively. Among 51 primiparous women, DRA was most prevalent at the umbilical level (31.4 percent), weak PFM function was observed in 60.8 percent, and sexual dysfunction in 62.8 percent. No significant correlations were found between IRD and PFM function. Weak correlations were identified between IRD (supraumbilical and umbilical levels) and PFD, and between IRD and sexual function. Greater IRD at the umbilical and infraumbilical levels was associated with a lower likelihood of absent/weak PFM function, and DRA at the infraumbilical level was strongly associated with sexual dysfunction. Current findings suggest that IRD is not associated with PFM function and shows only weak correlations with PDF. These results support the multifactorial nature of postpartum PFM function, indicating that IRD alone does not explain these outcomes.

PURPOSE: Rectus Abdominis Diastasis (RAD) is a prevalent postpartum condition, yet consensus regarding the efficacy of conservative management remains limited. This meta-analysis evaluates the effectiveness of structured exercise programs in reducing Inter-Recti Distance (IRD) and improving functional outcomes in postpartum women compared to no-treatment or standard care. METHODS: A systematic search was conducted for Randomized Controlled Trials (RCTs) published before August 2025. The primary outcome was IRD reduction; the secondary outcome was physical disability assessed via the Oswestry Disability Index (ODI). Methodological quality and certainty of evidence were evaluated using Revised Cochrane Risk-of-Bias (RoB 2) and GRADE criteria. RESULTS: Nine RCTs (450 participants) were included for IRD analysis, demonstrating a significant reduction in the exercise group (MD: -8.05 mm; 95% CI: -10.43, -5.68; p < 0.05). Subgroup analyses showed that interventions initiated < 3 months postpartum achieved greater reduction (MD: -10.2 mm; 95% CI: -14.94, -5.46) than delayed starts. Crucially, while no significant difference was found between specific types of training (p = 0.32), a consistent advantage was observed for structured exercise over no intervention or standard care. Regarding functional outcomes, meta-analysis of 3 comparisons from 2 RCTs (n = 115) using the ODI score showed no significant difference between groups (MD: 0.82 higher score; 95% CI: -2.75, 4.38; p = 0.75; I20%). CONCLUSIONS: Structured exercise programs significantly reduce IRD in women with RAD. However, this anatomical improvement does not translate into superior functional recovery, as measured by the ODI score, within the observed periods. Further standardized research is warranted to establish optimal clinical protocols and the need for RAD-specific functional scales in future research.

INTRODUCTION: This systematic review and meta-analysis seeks to evaluate the effectiveness of abdominal and pelvic floor muscle (PFM) exercise programs in the treatment of postpartum diastasis recti abdominis (DRA). Specifically, we aim to update the current evidence by reassessing the impact of exercise-based interventions on inter-recti distance (IRD). METHODS: A comprehensive online search was conducted using MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, and LILACS, from inception until January 2025 without any filter applied. Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. To maintain rigor and mitigate bias in the analysis and results, a search for studies was conducted using the same search strategy employed in the previous study. The primary outcome was change in IRD or presence of DRA. Study quality was assessed using the Rob 2 approach. Meta-analyses were performed using R software (version 4.4.2), with pooled effects expressed as mean differences (MD) and 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I2 statistic. RESULTS: A total of 93 records were screened, of which 11 studies met the inclusion criteria. Four additional studies were retrieved from the prior systematic review, yielding a total of 15 studies and 803 participants. Among these, three studies provided sufficient homogeneity to be included in the meta-analysis. The pooled analysis demonstrated no statistically significant difference in IRD between participants undergoing transversus abdominis (TrA) focused exercise and those receiving minimal or no intervention (MD -0.06 cm; 95% CI -1.19 to 1.08; p = 0.92). Considerable heterogeneity was observed, likely reflecting differences in intervention protocols, participant characteristics, and outcome assessment methods. CONCLUSION: This updated systematic review and meta-analysis found no evidence to support the effectiveness of exercise-based interventions as a standalone treatment for reducing IRD in postpartum women. Although exercise may provide functional or symptomatic benefits, its impact on anatomical correction appears limited. These findings highlight the need for well-designed randomized controlled trials and suggest that, in selected cases, alternative or adjunctive therapeutic strategies, including surgical approaches, may be required to achieve meaningful anatomical restoration. STUDY REGISTRATION: This systematic review was registered in the PROSPERO database CRD420251276159.

Background: Diastasis recti abdominis (DRA) is a common condition in postpartum period and may affect abdominal function and trunk stability. Rehabilitation programs often include exercises targeting deep abdominal muscles such as the transversus abdominis. Instructional strategies derived from motor learning research, including the use of external focus, may influence how these exercises are performed. Objectives: To investigate changes in transversus abdominis muscle thickness during the execution of rehabilitation exercises performed with external focus instructions in women with DRA. Methods: A cross-sectional study with a within-subject quasi-experimental component was conducted in women with postpartum DRA. Ultrasound imaging was used to measure transversus abdominis thickness at rest and during the execution of therapeutic exercises performed under therapist guidance using external focus instructions. Results: Participants demonstrated increases in transversus abdominis thickness during exercise execution compared with resting conditions, suggesting effective abdominal muscle contraction during the tasks performed. Conclusions: Exercises performed with external focus instructions were associated with increases in transversus abdominis thickness during exercise execution in women with DRA. While these findings suggest that such instructional strategies may facilitate muscle recruitment during rehabilitation exercises, further controlled studies are required to compare different instructional approaches and to investigate potential motor learning effects.

BACKGROUND: Optimal management of diastasis recti in patients undergoing ventral hernia repair remains uncertain, particularly regarding mesh plane selection. We compared wound morbidity and functional outcomes across mesh locations using a multi-institutional registry. METHODS: Retrospective cohort study using the Abdominal Core Health Quality Collaborative (ACHQC) registry (2015–2025). Eligible patients underwent elective ventral hernia repair with mesh and associated diastasis recti repair, with complete 30-day follow-up. The primary outcome was 30-day surgical site occurrence (SSO). Secondary outcomes included surgical site infection, readmission, reoperation, and patient-reported outcomes (HerQLes and PROMIS Pain Interference). RESULTS: Among 1,209 patients (mean age 55.0 ± 13.6 years, 49.7% female, mean BMI 31.4 ± 6.2 kg/m[2]), mesh location was retromuscular in 74.3%, intraperitoneal in 11.9%, preperitoneal in 9.3%, and onlay in 4.5%. The overall 30-day SSO rate was 7.8% and varied by mesh plane (p = 0.007): onlay 16.7%, retromuscular 8.4%, intraperitoneal 4.9%, and preperitoneal 2.7%. After multivariable adjustment, onlay placement had fivefold higher odds of SSO compared with retromuscular repair (OR 5.25, 95% CI 1.82–15.16, p = 0.002). Baseline HerQLes was the strongest predictor of postoperative HerQLes (β = 0.39; p < 0.001), but preperitoneal repair was associated with higher adjusted 30-day HerQLes compared with retromuscular repair. Baseline PROMIS predicted postoperative pain, while mesh location was not independently associated with 1-year pain. Onlay repair was performed in patients with lower BMI than retromuscular repair (25.9 vs. 32.0 kg/m[2]). CONCLUSIONS: Preperitoneal repair demonstrated the most favorable short-term wound profile, whereas onlay mesh placement was associated with higher early wound morbidity despite use in lower–body mass index patients. Baseline functional status was the primary determinant of postoperative quality of life and pain, highlighting the need for prospective studies to define optimal mesh positioning in diastasis recti repair.