Diastasis recti

• Diastasis recti abdominis (DRA)
• Abdominal separation

• 728.84 Diastasis of muscle

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

• 4C: Impaired muscle performance1
• 4E: 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 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

• Patient positioned in supine with hips and knees flexed to 90 degrees, and contracts rectus abdominis to flex trunk2
• Measurements should be taken at umbilicus and 4.5 cm superior and inferior to umbilicus
• Palpable separation of ≥ 2.5 cm considered diastasis

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 ...