Diastasis recti

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Diastasis recti
Classification and external resources
Hernie ligne blanche.JPG
Diastasis recti in an infant
ICD-10M62.0
ICD-9728.84
MedlinePlus001602
 
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Diastasis recti
Classification and external resources
Hernie ligne blanche.JPG
Diastasis recti in an infant
ICD-10M62.0
ICD-9728.84
MedlinePlus001602

Diastasis recti (also known as abdominal separation) is a disorder defined as a separation of the rectus abdominis muscle into right and left halves.[1] Normally, the two sides of the muscle are joined at the linea alba at the body midline. It is essentially a cosmetic condition, with no associated morbidity or mortality.[2]

The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba which connects the two regions.[3]

Diastasis of this muscle occurs principally in two populations: newborns and pregnant women.

Presentation[edit]

A diastasis recti may appear as a ridge running down the midline of the abdomen, anywhere from the xiphoid process to the umbilicus. It becomes more prominent with straining and may disappear when the abdominal muscles are relaxed. The medial borders of the right and left halves of the muscle may be palpated during contraction of the rectus abdominis.[5] The condition can be diagnosed by physical exam, and must be differentiated from an epigastric hernia or incisional hernia, if the patient has had abdominal surgery.[2] Hernias may be ruled out using ultrasound.

In infants, they typically result from a minor defect of the linea alba between the rectus abdominis muscles. This allows tissue from inside the abdomen to herniate anteriorly. On infants, this may manifest as an apparent 'bubble' under the skin of the belly between the umbilicus and xiphisternum (bottom of the breastbone).

Examination is performed with the subject lying on their back, knees bent at 90° with feet flat, head slightly lifted placing chin on chest. With muscles tense, examiners then place fingers in the ridge that is presented. Measurement of the width of separation is determined by the number of fingertips that can fit within the space between the left and right rectus abdominis muscles. Separation consisting of a width of 2 fingertips (approximately 1 1/2 centimeters) or more is the determining factor for diagnosing diastasis recti.[6]

Treatment[edit]

No treatment is necessary for women while they are still pregnant. In children, complications include development of an umbilical or ventral hernia, which is rare and can be corrected with surgery.[1]

Alerting a medical professional is important when an infant displays signs of vomiting, redness or pain in the abdominal area.[1]

Typically the separation of the abdominal muscles will lessen within the first year after childbirth, however it is possible to remain after this time. The weakening of these abdominal muscles may also make it difficult to lift objects, and cause lower back pain.[4] Additional complications can manifest in weakened pelvic alignment, poor posture which can result in chronic back pain.[6]

Physiotherapy[edit]

A study conducted at Touro College in 1988 was conducted to determine if exercises could reduce the amount of separation in the rectus abdominis muscles. The study further explored which specific exercises resulted in a more favorable effect. After a six week trial, results were shown that exercising greatly reduced the amount of the distasis.[6]

In adults, diastasis recti can in some cases be corrected and/or mitigated by physiotherapy. A study conducted at Columbia University Program in Physical Therapy established that the women utilizing the Tupler Technique exercises had a smaller diastasis than the control group who did not do these exercises.[7]

Exercises[edit]

The following exercises have been shown to reduce the distasis recti separation[8]

It is also noted that incorrect exercises, including crunches can actually increase the distasis recti separation[citation needed]). All corrective exercises should be in the form of pulling in of the abdominal muscles rather than a pushing of them outwards. Consultation of a professional physiotherapist is recommended for correct exercise routines.[8]

In addition to the above exercises, the Touro College study concluded the "quadruped" position yielded the most effective results.[6] A quadruped position is defined as "a human whose body weight is supported by both arms as well as both legs".[9] In this position, the subject would start with a flat back, then slowly tilt the head down, and arch the back, contracting the abdominal muscles towards the spine, holding this position for 5 seconds, then releasing back to starting position. Complete 2 sets of 10 repetitions.[6]

Surgical[edit]

In extreme cases, diastasis recti is corrected during the cosmetic surgery procedure known as an abdominoplasty by creating a plication or folding of the linea alba and suturing together. This creates a tighter abdominal wall.

In adult females, a laparoscopic Venetian blind technique can be used for plication of the recti.[10]

References[edit]

  1. ^ a b c d MedlinePlus Medical Encyclopedia: Diastasis Recti
  2. ^ a b Norton, Jeffrey A. (2003). Essential practice of surgery: basic science and clinical evidence. Berlin: Springer. p. 350. ISBN 0-387-95510-0. 
  3. ^ Hsia, Merry; Sue Jones (2000). "Natural resolution of rectus abdominis diastasis. Two single case studies". Australian journal of physiotherapy 46 (4): 301–307. 
  4. ^ a b Harms, M.D., Roger W. "Why do abdominal muscles sometimes separate during pregnancy?". Why do abdominal muscles sometimes separate during pregnancy?. 
  5. ^ University of Pennsylvania Health System Encyclopedia: Diastasis Recti
  6. ^ a b c d e f Engelhardt, Laura (1988). "Comparison of two abdominal exercises on the reduction of the diastasis recti abdominis of postpartum women". ProQuest Dissertations and Theses. UMI Dissertations Publishing. Retrieved 10 June 2013. 
  7. ^ Journal of Women's Health Physical Therapy Volume 29, No. 1, Spring, 2005
  8. ^ a b c d e f g h Liao, Sharon (February 2012). "15 minutes and you're done: crunch-free abs". Real Simple (Time Inc.) 13 (2). ISSN 1528-1701. 
  9. ^ Saunders (2007). "Definition of quadruped". Dorland's Medical Dictionary for Health Consumers. Elsevier, Inc. Retrieved 11 June 2013. 
  10. ^ Laparoscopic repair of diastasis recti using the 'Venetian blinds' technique of plication with prosthetic reinforcement: a retrospective study Authors:C Palanivelu, M Rangarajan, P Jategaonkar, V Amar, K Gokul, B Srikanth; HERNIA June 2009