Inter-rectus distance and its relation to pelvic floor function in primiparous women in the remote postpartum period: A cross-sectional study

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.