Diastasi dei muscoli retti : analisi del fenomeno e ruolo dell'ostetrica nella prevenzione, diagnosi e trattamento

Introduction Rectus abdominis diastasis (RAD) is a pathology that arises mainly after pregnancy, and it has been reported by 30% of women, within 12 months of having given birth. Even if it is mistakenly considered by many to be harmless and only aesthetic pathology, the consequences that the diastasis causes are significant clinical problems such as postural changes, urinary incontinence, fecal incontinence, pelvic pain, disorders of digestion and the formation of one or more umbilical hernias. For these reasons the training of health professionals is essential in such a way as to provide all women with adequate information during pregnancy, to be able to put in place some precautions to prevent the onset of this pathology. Purposes The first goal of this study is to investigate women’s knowledge of exercises and preventive measures to be implemented both during pregnancy and in post-partum. At the same time we want to find the role of the midwife in the prevention, information and treatment of this pathology. The second goal is to evaluate, in the women analized, the presence or absence of conditions that are identified by the literature as risk factors for the development of diastasis and related symptoms. The third goal is to find out how women have become aware of this pathology, who diagnosed it and what treatment was recommended to them. Materials and methods Sampling was not probabilistic, thanks to the identification of two blogs: “Diastasi Italia official group” and “Diastasi donna ODV”, to which women who suffer from RAD are registered and who reported problems the first or subsequent pregnancies. After that a questionnaire was presented to the women of both blogs, to be completed freely online thanks to a link linked to “Google moduli”. Data collection took place between April and May 2018. Results The study sample was conducted on 382 Italian women between ages 21 and 57. From the collected data it emerged that 98% of the women have, in their case history, at least one of the risk factors named in the literature, and only 2% don’t present them, and these 2% include only women with mild RAD (2-4 cm). All the women in the study have one or more symptoms related to the RAD. It emerged that 78% of the women discovered the existence of this pathology through personal information, only 22% were informed by a health professional, and among these only 15% were informed by a midwife. Also only 40% were diagnosed by helath professionals, 56% found out by self-diagnosis. Only 3% have performed prevention exercises, and among these, noone have been recommended by a midwife and only 0,5% of the study partecipants were explained the importance of having a balanced diet to avoid excessive weight gain in pregnancy, considered a risk factor in the develpment of RAD. Finally, as regards the women’s knowledge of the role of the midwife, only 37% claimed to know that this health professional deals with rehabilitation of the pelvic floor, prevention of diastasis and proposes exercises to improve the condition, and only 10% claimed to know that the midwife deals with treatment of scar after surgery. Conclusions Therefore there is a link between this study and the literature regarding the presence of risk factors and symptoms related to RAD. The results show how poorly informed women are about this pathology during pregnancy, and how often health professionals are poorly trained to spot the signs and symptoms of RAD, and, therefore, are unable to prevent, diagnose and to propose an appropriate treatment. Finally, the women’s knowledge about the role of the midwife in the rehabilitation of the pelvic floor, prevention of diastasis, exercises aimed at improving it and in the treatment of scar after surgery, proved to be very limited.