- Diastasis recti abdominis (DRA)
- Abdominal separation
- 728.84 Diastasis of muscle
- M62.00 Separation of muscle (nontraumatic), unspecified site
- 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
- Diagnosis usually made by clinical examination due to the superficial position of the rectus abdominis
- 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
- 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
- Separation of rectus abdominis at midline, resulting in protrusion and palpable gap between the borders
- Abdominal pain
- 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
Possible Contributing Causes
- 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
- Umbilical hernia
- Ventral hernia
- Ultrasonography accurate in measuring DRA
- CT and MRI utilized more frequently to diagnose hernia
- Repair of DRA considered cosmetic, often performed in conjunction with abdominoplasty (tummy tuck)
- To women’s health physical therapist for treatment of incontinence
- To physician or surgical referral if poor response to conservative treatment
- Lumbopelvic pain
- Urogynecologic dysfunction...
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