Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Diastasis recti abdominis (DRA)Abdominal separation ++ 728.84 Diastasis of muscle ++ M62.00 Separation of muscle (nontraumatic), unspecified site ++ 4C: Impaired muscle performance14E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation +++ Description ++ Midline separation of rectus abdominis muscle at the linea albeaUsually greater than two fingertips in widthRectus abdominis muscle originates from pubis, with insertion into xiphoid process and fifth to seventh costal cartilagesActs to flex the vertebral columnIs 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 establishedIncidence of DRA diminishes post-partum, but thinning of rectus abdominis and increased inter-recti distance may persistDRA considered a cosmetic condition by most insurance carriers +++ Demographics ++ Usually occurs during pregnancy or deliveryHighest incidence of DRA in second and third trimestersMost common location of diastasis at umbilicus, then superior to umbilicus; least common location is inferior to the umbilicusResearch 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 bordersAbdominal 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 abdominisPostural changes during pregnancy, including anterior pelvic tilt and increased lumbar lordosis, changes angle of insertion and muscle’s line of actionPregnancy/multiple-birth pregnancy3Large gestational sizeExcess uterine fluidObesity or excessive weight gain during pregnancyPrevious DRA +++ Differential Diagnosis ++ Umbilical herniaVentral hernia +++ Laboratory Tests ++ Patient positioned in supine with hips and knees flexed to 90 degrees, and contracts rectus abdominis to flex trunk2Measurements should be taken at umbilicus and 4.5 cm superior and inferior to umbilicusPalpable separation of ≥ 2.5 cm considered diastasis +++ Imaging ++ Ultrasonography accurate in measuring DRACT 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 incontinenceTo physician or surgical referral if poor response ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth