Rectus abdominis diastasis
What is it? An anatomic term describing a condition in which the two rectus muscles are separated by an abnormal distance. Fairly consistently defined as more than 2cm.
The distance is usually measured above the umbilicus, at and below the umbilicus.
It is diagnosed by a simple physical exam.
Anatomy: The anterior abdominal wall consists of the abdominal rectus muscles separated by the linea alba, which is a fusion of the external and internal abdominal oblique muscles and the transverses abdominis aponeuroses.
Pregnancy and Postpartum: Pregnancy stretches the abdominal muscles, increasing the risk of diastasis. The amount of separation can increase, decrease or stay the same in the postpartum period.
One study showed, the prevalence of diastasis was 100 percent at 35wk GA and decreased to 39% at 6 months postpartum.
Prevention/treatment: exercise significantly reduced the risk of developing diastasis
Postpartum exercise programs can be used to help regain strength in the midline.
A randomized trial that looked at pregnant women assigned to a postpartum exercise protocol or no exercise in the immediate postpartum period saw that the intervention group had a greater decrease in the distance between the rectus muscles compared to the controls.
1. Draw in abdominal wall while on hands and knees
2. Draw in while prone (lying on stomach)
3. Half plank
4. Side plank
5. Oblique sit-ups
6. Straight sit ups
Another nonsurgical method for correction/improving diastasis is focused on allowing the damaged connective tissue to repair itself by offloading pressure by wearing an abdominal splint or binder-like device. It’s called the Tupler techniaque – usually 18 wk. Modified exercise is initiated at 6 weeks.
There is NO clear consensus on what the optimal treatment is.
It doesn’t represent a true hernia and thus, it does not necessarily require repair.
Weight management helps.
The decision for surgical repair depends on the clinical setting, degree of defect and symptoms. There are many approaches: abdominoplasty (tummy tuck), laparoscopic repair (minimally invasive), plication of the linea alba (stitches to approximate). I would not recommend surgical repair until you have completed your family (aka. You don’t plan on being pregnant again.) Of note, the recurrence rate can be as high as 40%.
your abdominal wall is stretched in pregnancy and everyone has some degree of diastasis
most will resolve spontaneously
first line treatment: exercise and weight management