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Condition/Disorder Synonyms

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  • Diastasis recti abdominis (DRA)

  • Abdominal separation

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ICD-9-CM Code

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  • 728.84 Diastasis of muscle

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ICD-10-CM Code

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  • M62.00 Separation of muscle (nontraumatic), unspecified site

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Preferred Practice Pattern

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Key Features

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Description

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  • Midline separation of rectus abdominis muscle at the linea albea

  • Usually greater than two fingertips in width

  • Rectus abdominis muscle originates from pubis, with insertion into xiphoid process and fifth to seventh costal cartilages

    • Acts to flex the vertebral column

    • Is separated by a midline band of connective tissue known as the linea alba

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination due to the superficial position of the rectus abdominis

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General Considerations

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  • Limited research, but significant relationship between DRA and pregnancy has been established

  • Incidence of DRA diminishes post-partum, but thinning of rectus abdominis and increased inter-recti distance may persist

  • DRA considered a cosmetic condition by most insurance carriers

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Demographics

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  • Usually occurs during pregnancy or delivery

  • Highest incidence of DRA in second and third trimesters

  • Most common location of diastasis at umbilicus, then superior to umbilicus; least common location is inferior to the umbilicus

  • Research indicates increased incidence of DRA in non-exercising pregnant women vs. pregnant women who exercise

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Clinical Findings

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Sign and Symptoms

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  • Separation of rectus abdominis at midline, resulting in protrusion and palpable gap between the borders

  • Abdominal pain

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Functional Implications

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  • Increased prevalence of DRA in patients with support-related pelvic floor dysfunction (urinary incontinence, fecal incontinence, pelvic organ prolapse)

  • Lumbopelvic pain related to diminished contribution of rectus abdominis or altered mechanics of spinal muscles

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Possible Contributing Causes

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  • Hormonal changes and uterine growth during pregnancy causing stretching of rectus abdominis

  • Postural changes during pregnancy, including anterior pelvic tilt and increased lumbar lordosis, changes angle of insertion and muscle's line of action

  • Pregnancy/multiple-birth pregnancy3

  • Large gestational size

  • Excess uterine fluid

  • Obesity or excessive weight gain during pregnancy

  • Previous DRA

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Differential Diagnosis

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  • Umbilical hernia

  • Ventral hernia

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Patient positioned in supine with hips and knees flexed to 90 degrees, and contracts rectus abdominis to flex trunk 2

  • Measurements should be taken at umbilicus and 4.5 cm superior and inferior to umbilicus

  • Palpable separation of ≥ 2.5 cm considered diastasis

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Imaging

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  • Ultrasonography accurate in measuring DRA

  • CT and MRI utilized more frequently to diagnose hernia

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