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

Chenglei Fan, Diego Guidolin, Serena Ragazzo, Caterina Fede, Carmelo Pirri, Nathaly Gaudreault, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, Carla Stecco, Chenglei Fan, Diego Guidolin, Serena Ragazzo, Caterina Fede, Carmelo Pirri, Nathaly Gaudreault, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, Carla Stecco

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.

Keywords: abdominal muscles; caesarean section; fascia; pain; ultrasound; vaginal delivery.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A): LA: linea alba; (B): RA: rectus abdominal muscle; (C): AL: axillary line; A-RS: anterior fascia of rectus sheath; P-RS: posterior fascia of rectus sheath; LCT: loose connective tissue between sublayers of P-RS: EO: external oblique muscle; FEO: anterior fascia of external oblique muscle; IO: internal oblique muscle; TrA: transversus abdominis muscle; FTrA: posterior fascia of transversus abdominis muscle; FEO/IO: fasciae between external oblique and internal oblique muscle; FIO/TRA: fasciae between internal oblique and transversus abdominal muscle; TAM: total abdominal muscles = EO + IO + TrA; APF: abdominal perimuscular fasciae = FEO + FEO/IO + FIO/TrA + FTrA.
Figure 2
Figure 2
Results of the CS pain questionnaire. SP: scar pain; ABP: abdominal pain; LBP: low back pain; PVP: pelvic pain.

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