Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

Abstract

Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.

An Investigation of the Association between Transversus Abdominis Myofascial Structure and Activation with Age in Healthy Adults using Ultrasound Imaging

“…14 Abdominal fascial thickness values are reported in three other studies. 12,33,39 The thickness values reported in the present study are very similar to those reported in the reliability study published by Pirri et al 33 However, their thickness measurements were based only on one participant. It would have been interesting to know whether the similarity would have continued if the data had been collected on a larger sample.…”

“…It would have been interesting to know whether the similarity would have continued if the data had been collected on a larger sample. The current results cannot be compared to the two other studies 12,39 due to differences in methods. Neither study reported individual epimysial fascia thicknesses, but both reported the sum of all fascia thickness measurements.…”

The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study

“…In 2016, Ramin et al [ 51 ] published an extensive anatomical analysis of the so-called “fascial continuum” within the area of the pelvis and torso [ 51 ]. If, from a fascial point of view, the abdominal muscles are synergistically connected with the thoracolumbar fascia and the pelvic floor muscles [ 52 ], what effect may an incorrect posture have on their functional status and the formation of pelvic floor dysfunctions?…”

“…A 2015 literature review [ 51 ] on the anatomical, myofascial relationships between the pelvic floor, abdominal muscles, and back muscles formed an important theoretical basis for this project, referring to the multitude of fascial functions [ 52 ]. Based on the characteristic features of fasciae such as the transmission of force, the coordination of movements, stability, and proprioceptive communications throughout the body [ 52 ], it seems that any dysfunction along the myofascial chain may cause the overcompensation and dysfunction of other associated muscles [ 34 ]. In the case of PFMs, a persistent lack of muscle relaxation and/or heightened muscular activity may lead to involuntary muscle contraction, which in turn can lead to pelvic pain syndrome, involving taut bands and trigger points [ 60 ].…”

A Closer Look at the Cellular and Molecular Components of the Deep/Muscular Fasciae

“…Correlations have been found between body mass and fascia thickness (τ = 0.45–0.75, p < 0.05) as well as between flexibility and fascia thickness (τ = 0.38–0.42, p < 0.05). We reported in one of our previous works that the thickness of the rectus sheath was significantly thicker in women who had undergone a caesarean section with respect to those who had undergone a vaginal delivery and/or healthy nulliparous women [ 25 ].…”