Diastasis recti
Encyclopedia
Diastasis recti is a disorder defined as a separation of the rectus abdominis muscle
into right and left halves. 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.
Diastasis of this muscle occurs principally in two populations: newborns
and pregnant women
.
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. 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. 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).
or ventral hernia, which is rare and can be corrected with surgery.
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.
In extreme cases, diastasis recti is corrected during the cosmetic surgery procedure known as a tummy tuck 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. (Ref: 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 )
Rectus abdominis muscle
The rectus abdominis muscle, also known as the "six pack", is a paired muscle running vertically on each side of the anterior wall of the human abdomen . There are two parallel muscles, separated by a midline band of connective tissue called the linea alba...
into right and left halves. 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.
Diastasis of this muscle occurs principally in two populations: newborns
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
and pregnant women
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
.
- In the newborn, the rectus abdominis is not fully developed and may not be sealed together at midline. Diastasis recti is more common in prematurePremature birthIn humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...
and African AmericanAfrican AmericanAfrican Americans are citizens or residents of the United States who have at least partial ancestry from any of the native populations of Sub-Saharan Africa and are the direct descendants of enslaved Africans within the boundaries of the present United States...
newborns. - In pregnant or postpartumPostnatalPostnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...
women, the defect is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in multiparousParity (medicine)In biology, parity is a technical term that refers to the number of times a female has given birth to a fetus.It can lead to some ambiguity for events occurring between 20 and 24 weeks, and for multiple pregnancies.-Enumeration:...
women due to repeated episodes of stretching. When the defect occurs during pregnancy, the uterus can sometimes be seen bulging through the abdominal wall beneath the skin.
Presentation
A diastasis recti may appear as a ridge running down the midline of the abdomen, anywhere from the xiphoid processXiphoid process
The xiphoid process, or xiphisternum or metasternum, is a small cartilaginous process of the lower part of the sternum which is usually ossified in the adult human. By age 15 to 29, the xiphoid usually fuses to the body of the sternum with a fibrous joint. Unlike the synovial articulation of major...
to the umbilicus
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
. 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. The condition can be diagnosed by physical exam, and must be differentiated from an epigastric hernia
Epigastric hernia
An epigastric hernia is a type of hernia which may develop in the epigastrium . Epigastric hernias usually appear in adults....
or incisional hernia
Incisional hernia
An incisional hernia occurs in an area of weakness caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are termed ventral hernias. If it is not caused by an incision, then it is a...
, if the patient has had abdominal surgery. Hernias may be ruled out using ultrasound.
In infants, they typically result from a minor defect of the linea alba
Linea alba
The linea alba is a fibrous structure that runs down the midline of the abdomen in humans and other vertebrates. The name means white line and the linea alba is indeed white, being composed mostly of collagen connective tissue....
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
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
and xiphisternum (bottom of the breastbone).
Treatment
No treatment is necessary for women while they are still pregnant. In children, complications include development of an umbilicalUmbilical hernia
Congenital umbilical hernia is a congenital malformation, common in infants of African descent. Among adults, it is three times more common in women than in men; among children, the ratio is roughly equal...
or ventral hernia, which is rare and can be corrected with surgery.
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.
In extreme cases, diastasis recti is corrected during the cosmetic surgery procedure known as a tummy tuck 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. (Ref: 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 )