KETIDAKNYAMANAN PASCA PERSALINAN: ANALISIS KONSEPTUAL DAMPAK DIASTASIS RECTUS ABDOMINIS (DRA) TERHADAP IBU POSTPARTUM
Isi Artikel Utama
Abstrak
Diastasis rectus abdominis (DRA) in postpartum mothers has a high prevalence, with 85% experiencing this condition, leading to various complaints. However, clinical management remains limited due to the lack of consensus on symptom boundaries and clinical impacts. This study aims to analyze the concept of discomfort due to DRA in postpartum mothers using Walker and Avant’s approach. A descriptive method with concept analysis was applied. Literature search using international electronic databases with a global scope including Scopus, ScienceDirect, MEDLINE, EBSCO, ProQuest, and SAGE, using keywords such as "diastasis rectus abdominis," "interrectus abdominis," "postpartum," and "impact." Inclusion criteria were open-access, including literature review, and full-text articles published from 2018 to 2024. Articles that did not address antecedents, attributes, or consequences of discomfort were excluded. A total of 28 out of 88 identified articles were analyzed, covering various fields such as obstetrics, gynecology, surgery, physiotherapy, radiology, nursing, and public health. The study concludes that discomfort due to DRA consists of primary and secondary symptoms. Primary symptoms include a distended abdomen, abdominal pain, kinesiophobia, impaired self-concept, disturbed social interaction, and reduced quality of life. Secondary discomfort includes hunched posture, back and pelvic pain, spinal and pelvic instability, pelvic floor disorders, and gastrointestinal issues. This categorization of discomfort is expected to establish clearer symptom boundaries. Defining these symptoms can help develop standardized clinical practice guidelines, ensuring more effective diagnosis and treatment for postpartum mothers with DRA.
Rincian Artikel
Referensi
H. Chen, Y. Lin, Y. Cai, and J. Liao, "Evaluation of rectus abdominis muscle using high-frequency ultrasound and shear wave elastography to construct a risk prediction model for postpartum low back pain," Academic Radiology, Article 2024, doi: 10.1016/j.acra.2024.10.041.
N. Keshwani, S. Mathur, and L. McLean, "Relationship Between Interrectus Distance and Symptom Severity in Women With Diastasis Recti Abdominis in the Early Postpartum Period," (in eng), Phys Ther, vol. 98, no. 3, pp. 182-190, Mar 1 2018, doi: 10.1093/ptj/pzx117.
C. Cardaillac, S. Vieillefosse, A. Oppenheimer, Y. Joueidi, T. Thubert, and X. Deffieux, "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 and Gynecology and Reproductive Biology, Article vol. 252, pp. 228-232, 2020, doi: 10.1016/j.ejogrb.2020.06.038.
S. Lin et al., "Prevalence and risk factors of diastasis recti abdominis in the long-term postpartum: a cross-sectional study," Scientific Reports, Article vol. 14, no. 1, 2024, Art no. 25640, doi: 10.1038/s41598-024-76974-x.
R. Zulfiani, "Analisiss Faktor Risiko Kejadian Diastasis Recti Abdominis pada Ibu Post Partum di RSIA Asy-syifa Sangatta," Universitas Hasanuddin, 2021.
M. Balasch-Bernat, S. Pérez-Alenda, J. J. Carrasco, B. Valls-Donderis, L. Dueñas, and L. Fuentes-Aparicio, "Differences in inter-rectus distance and abdominopelvic function between nulliparous, primiparous and multiparous women," International Journal of Environmental Research and Public Health, Article vol. 18, no. 23, 2021, Art no. 12396, doi: 10.3390/ijerph182312396.
M. Eriksson Crommert, K. Petrov Fieril, and C. Gustavsson, "Women’s experiences of living with increased inter-recti distance after childbirth: an interview study," BMC Women's Health, Article vol. 20, no. 1, 2020, Art no. 260, doi: 10.1186/s12905-020-01123-1.
V. Marander, M. Råheim, I. Haukenes, and N. M. Theodorsen, "Mothers’ experiences living with diastasis recti abdominis – an interview study," BMC Women's Health, Article vol. 24, no. 1, 2024, Art no. 292, doi: 10.1186/s12905-024-03131-x.
H. Fitriani, S. Setyowati, Y. Afiyanti, R. A. Koestoer, and H. Arifin, "Traditional treatment for diastasis rectus abdominis in postpartum mothers: A phenomenological study," British Journal of Midwifery, Article vol. 32, no. 9, pp. 474-482, 2024, doi: 10.12968/bjom.2024.0043.
S. E. Fitzpatrick, K. Foley, T. Crittenden, D. Watson, and N. R. Dean, "Australian women’s experiences of post-partum rectus diastasis: A qualitative study," Women's Health, Article vol. 20, 2024, doi: 10.1177/17455057241233123.
C. Gustavsson and M. Eriksson-Crommert, "Physiotherapists' and midwives' views of increased inter recti abdominis distance and its management in women after childbirth," BMC Women's Health, Review vol. 20, no. 1, 2020, Art no. 37, doi: 10.1186/s12905-020-00907-9.
M. Eriksson Crommert, K. Petrov Fieril, and C. Gustavsson, "Women’s experiences of living with increased inter-recti distance after childbirth: an interview study," BMC women's health, vol. 20, no. 1, pp. 1-10, 2020.
L. A. Nasution and Y. Afiyanti, "Self-care among breast cancer survivors: A concept analysis," Jurnal Keperawatan Padjadjaran, vol. 12, no. 2, pp. 208-219, 2024.
L. O. Walker and K. C. Avant, Strategies for theory construction in nursing. Pearson/Prentice Hall Upper Saddle River, NJ, 2005.
A. Abdelaziz, H. Ramirez, T. Blusewicz, and M. Karram, "A Randomized Controlled Trial to Evaluate the Effect of Abdominal Electrical Muscle Stimulation on Abdominal Wall Restoration in Postpartum Women," Journal of Clinical Gynecology and Obstetrics, vol. 10, no. 3, pp. 59-66, 2021.
L. Álvarez-Barrio, V. Rodríguez-Pérez, C. Calvo-Lobo, R. Leirós-Rodríguez, E. Alba-Pérez, and A. F. López-Rodríguez, "Immediate Effects of Whole-Body versus Local Dynamic Electrostimulation of the Abdominal Muscles in Healthy People Assessed by Ultrasound: A Randomized Controlled Trial," Biology, Article vol. 12, no. 3, 2023, Art no. 454, doi: 10.3390/biology12030454.
E. Awad, A. Mobark, A. A. Zidan, H. A. Hamada, and T. Shousha, "Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: A randomized controlled trial," Journal of Human Sport and Exercise, Article vol. 16, no. Proc2, pp. 395-403, 2021, doi: 10.14198/jhse.2021.16.Proc2.24.
M. Asadi, M. Noroozi, and M. Alavi, "Identifying women’s needs to adjust to postpartum changes: a qualitative study in Iran," BMC Pregnancy and Childbirth, vol. 22, no. 1, p. 115, 2022.
D. R. Benjamin et al., "Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women – A systematic review and meta-analysis," Physiotherapy, vol. 119, pp. 54-71, 2023/06/01/ 2023, doi: https://doi.org/10.1016/j.physio.2023.02.002.
L. L. Blankensteijn, M. Hockx, M. Mullender, M.-B. Bouman, and W. B. W. H. Melenhorst, "Clinical significance of diastasis recti: Literature review and awareness amongst health care professionals," Journal of Plastic, Reconstructive & Aesthetic Surgery, vol. 84, pp. 439-446, 2023/09/01/ 2023, doi: https://doi.org/10.1016/j.bjps.2023.06.005.
D. Gruszczyńska, A. Dąbek, and W. Rekowski, "Diastasis recti abdominis - what may cause it in postpartum women?," Advances in Rehabilitation, vol. 35, 2021.
S. Marcos, S. M. Elkosery, H. Hassan, and M. M. Yosri, "Prevalence of diastasis recti abdominis in postmenopausal women with stress urinary incontinence: An observational study," Egyptian Journal of Physical Therapy, 2024.
A. Carlstedt et al., "Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines," Scandinavian Journal of Surgery, Review vol. 110, no. 3, pp. 452-459, 2021, doi: 10.1177/1457496920961000.
M. Cavalli et al., "Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation," Hernia, Review vol. 25, no. 4, pp. 883-890, 2021, doi: 10.1007/s10029-021-02468-8.
A. Corvino et al., "Diastasis of rectus abdominis muscles: patterns of anatomical variation as demonstrated by ultrasound," Polish journal of radiology, vol. 84, pp. 542-548, 2019.
H. Denizoglu Kulli and H. N. Gurses, "Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis," (in eng), Eur J Obstet Gynecol Reprod Biol, vol. 279, pp. 40-44, Dec 2022, doi: 10.1016/j.ejogrb.2022.10.001.
J. Depledge, P. McNair, and R. Ellis, "The effect of Tubigrip and a rigid belt on rectus abdominus diastasis immediately postpartum: A randomised clinical trial," Musculoskeletal Science and Practice, Article vol. 63, 2023, Art no. 102712, doi: 10.1016/j.msksp.2022.102712.
L. Fuentes Aparicio, M. Rejano-Campo, G. M. Donnelly, and V. Vicente-Campos, "Self-reported symptoms in women with diastasis rectus abdominis: A systematic review," (in eng), J Gynecol Obstet Hum Reprod, vol. 50, no. 7, p. 101995, Sep 2021, doi: 10.1016/j.jogoh.2020.101995.
S. Gluppe, M. Ellström Engh, and B. Kari, "Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis," Physiotherapy (United Kingdom), Article vol. 111, pp. 57-65, 2021, doi: 10.1016/j.physio.2021.01.008.
M. Hagovska, R. Dudic, V. Dudicova, J. Svihra, and P. Urdzik, "Prevalence of diastasis m. rectus abdominis and pelvic floor muscle dysfunction in postpartum women," Bratislava Medical Journal, Article vol. 125, no. 1, pp. 12-16, 2024, doi: 10.4149/BLL_2024_003.
P. Hernández-Granados et al., "European Hernia Society guidelines on management of rectus diastasis," British Journal of Surgery, Article vol. 108, no. 10, pp. 1189-1191, 2021, doi: 10.1093/bjs/znab128.
N. F. Hills, R. B. Graham, and L. McLean, "Comparison of trunk muscle function between women with and without diastasis recti abdominis at 1 year postpartum," Physical Therapy, Article vol. 98, no. 10, pp. 891-901, 2018, doi: 10.1093/PTJ/PZY083.
G. Sokunbi et al., "Is Diastasis Recti Abdominis Associated With Low Back Pain? A Systematic Review," (in eng), World Neurosurg, vol. 174, pp. 119-125, Jun 2023, doi: 10.1016/j.wneu.2023.03.014.
B. L. Rodgers, C. S. Jacelon, and K. A. Knafl, "Concept analysis and the advance of nursing knowledge: state of the science," Journal of Nursing Scholarship, vol. 50, no. 4, pp. 451-459, 2018.
D. R. Benjamin, H. C. Frawley, N. Shields, A. T. M. van de Water, and N. F. Taylor, "Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review," Physiotherapy (United Kingdom), Review vol. 105, no. 1, pp. 24-34, 2019, doi: 10.1016/j.physio.2018.07.002.
J. Sondakh and I. Yuliani, "Implementasi “Uterus Bag” Terhadap Penurunan Fundus Uteri Postpartum pada Persalinan Normal di Praktek Mandiri Bidan Kabupaten Malang," Media Publikasi Promosi Kesehatan Indonesia (MPPKI), vol. 5, pp. 1585-1589, 10/11 2022, doi: 10.56338/mppki.v5i12.2790.
N. Keshwani, S. Mathur, and L. McLean, "The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial," (in eng), Physiother Theory Pract, vol. 37, no. 9, pp. 1018-1033, Sep 2021, doi: 10.1080/09593985.2019.1675207.
A. R. Deussen, P. Ashwood, R. Martis, F. Stewart, and L. E. Grzeskowiak, "Relief of pain due to uterine cramping/involution after birth," (in eng), The Cochrane database of systematic reviews, vol. 10, no. 10, p. Cd004908, Oct 20 2020, doi: 10.1002/14651858.CD004908.pub3.
L. Wu et al., "Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: Prevalence, risk factors and its impact on life," (in eng), J Clin Nurs, vol. 30, no. 3-4, pp. 518-527, Feb 2021, doi: 10.1111/jocn.15568.
P. Ghadiri Harati, S. M. Hosseini, A. Javaheri, and F. Dehghan Manshadi, "Prevalence, Risk Factors, and Consequences of Diastasis of Rectus Abdominis in Women: A Narrative," The Scientific Journal of Rehabilitation Medicine, vol. 11, no. 3, pp. 346-355.
Y. Jobanputtra, S. Patil, and Y. R. Jobanputtra, "Immediate Effect of Kinesio Taping on Lumbopelvic Stability in Postpartum Women With Diastasis Recti: A Review," Cureus, vol. 15, no. 1, 2023.
S. A. Gautam, A. S. Lachyan, S. P. C. Sharma, S. Khan, S. V. P. Gupta, and P. S. Kulkarni, "A study to assess the effectiveness of Kegel exercise and prone position on afterpains and involution of uterus among post-natal mothers: A review article," World Journal of Biology Pharmacy and Health Sciences, vol. 9, no. 3, pp. 001-005, 2022.
R. A. Pohan, "The Effect of Postpartum Exercises on Uterine Involution in Postpartum Mothers in Sei Serindan Village, Sei Kepayang Barat District, Asahan Regency," International Journal of Public Health Excellence (IJPHE), vol. 3, no. 1, pp. 101-107, 2023.
P. Liang, M. Liang, S. Shi, Y. Liu, and R. Xiong, "Rehabilitation programme including EMG-biofeedback- assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial," (in eng), Physiotherapy, vol. 117, pp. 16-21, Dec 2022, doi: 10.1016/j.physio.2022.05.001.
Y. Liu et al., "Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: A randomized controlled clinical trial," (in eng), Frontiers in public health, vol. 10, p. 1003361, 2022, doi: 10.3389/fpubh.2022.1003361.
D. M. Nekar, H. Y. Kang, J. W. Lee, S. Y. Oh, S. M. Jung, and J. H. Yu, "Investigating the Biological Impact of a Hot Circle EMS Massage Belt on Abdominal Muscle Exercises in Healthy Women," African Journal of Biological Sciences (South Africa), Article vol. 6, no. 2, pp. 132-142, 2024, doi: 10.33472/AFJBS.6.2.2024.132-142.
S. Suparno, M. Estiani, and A. Aisyah, "Pelatihan Mengenalkan Diastasis Rektus Abdominis pada Tenaga Kesehatan di Desa Talang Jawa UPTD Puskesmas Tanjung Agung," Indonesia Berdaya, vol. 3, no. 2, pp. 287-302, 2022.
F. Özyurt, C. C. Aksoy, and M. Özkaya, "Examining spinal mobility, aerobic capacity and functional movement in patients with non-specific chronic low back pain: a case-control study," International Journal of Therapy And Rehabilitation, vol. 31, no. 10, pp. 1-12, 2024.
J.-P. van Wingerden, I. Ronchetti, D. Sneiders, J. F. Lange, and G.-J. Kleinrensink, "Anterior and posterior rectus abdominis sheath stiffness in relation to diastasis recti: Abdominal wall training or not?," Journal of Bodywork and Movement Therapies, vol. 24, no. 1, pp. 147-153, 2020/01/01/ 2020, doi: https://doi.org/10.1016/j.jbmt.2019.10.015.
A. Skoura et al., "Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice," International Urogynecology Journal, Review 2024, doi: 10.1007/s00192-024-05727-1.