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  • Diastasis recti abdominis (DRA)
  • Abdominal separation

  • 728.84 Diastasis of muscle

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

Description

  • 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

Essentials of Diagnosis

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

General Considerations

  • 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

Demographics

  • 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

Sign and Symptoms

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

Functional Implications

  • 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

Differential Diagnosis

  • Umbilical hernia
  • Ventral hernia

Laboratory Tests

Imaging

  • 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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