Rectus abdominis diastasis

Abstract

Because of the lack of agreement on when rectus diastasis (RD) is pathologic, the aim was to investigate indications for surgical repair. This study presents classifications of RD, current knowledge on the relation to pregnancy, and conservative and surgical management. A systematic search in Pubmed, Embase, Cochrane, and Cinahl revealed 437 studies. Inclusion criteria were applied according to the above mentioned subjects of interest. In total 28 studies were included, representing 3725 patients, 11 of these by assessing reference lists of included studies. Only one RCT was found; most studies were case-series lacking statistical analysis. RD was common in post-partum women. Antepartum activity level may have a protective effect on RD and exercise may improve post-partum symptoms of RD. Repair was done during abdominoplasty or laparoscopically. The patient-satisfaction was high and long-term recurrence was reported by one study, while five reported no recurrence. Overall major complications were few, while minor complications were primarily seroma and wound complications. RD is by itself not a true hernia and, therefore, not associated with the risk of strangulation. Repair is mostly done due to cosmetic reasons. The condition does not necessarily require repair, and conservative management may be an alternative. If done, the protrusion of the abdomen, rather than the diastasis itself should influence the decision of repair. It is recommended that future studies use the established classifications (e.g. Beer, Rath, or Nahas) when reporting RD and long-term outcome of treatment. Comparison of surgical techniques and studies that address and compare conservative management with surgery are needed.

Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain

“…Criteria and cut off point for the diagnosis of DRA vary in the literature (Bursch 1987;Boissonnault and Blaschak 1988;Ranney 1990;Gilleard and Brown 1996;Rath et al 1996;Candido et al 2005;Spitznagle et al 2007;Beer et al 2009;Akram and Matzen 2014), and to date there is no international consensus on the measurement location. In a cadaver study , Rath et al (1996) defined a widening of the IRD more than 10 mm above the umbilicus, 27 mm at the level of the umbilicus and 9 mm below the umbilicus, as pathological DRA.…”

Does abdominal diastasis influence lumbar pain during gestation?

“…Abdominal muscles are major stabilizers so the weaker these muscles, the more severe will be the joint instability and consequently more severe low back pain 5,6 . During gestation, recti abdomini muscles borders separa-te to allow fetal growth 2,[7][8][9] . This is called rectus abdomini muscles diastasis (RAMD) and is associated to stretching and weakening of such muscles 2,[7][8][9] .…”

“…During gestation, recti abdomini muscles borders separa-te to allow fetal growth 2,[7][8][9] . This is called rectus abdomini muscles diastasis (RAMD) and is associated to stretching and weakening of such muscles 2,[7][8][9] . Some authors consider excessive or pathological a gap larger than 3 cm 7,8 .…”

“…This is called rectus abdomini muscles diastasis (RAMD) and is associated to stretching and weakening of such muscles 2,[7][8][9] . Some authors consider excessive or pathological a gap larger than 3 cm 7,8 . However, literature is controversial with regard to RAMD reference value, that is, when to consider it pathological and whether the classification should be used only during the puerperal period or also during gestation 8 .…”

“…Some authors consider excessive or pathological a gap larger than 3 cm 7,8 . However, literature is controversial with regard to RAMD reference value, that is, when to consider it pathological and whether the classification should be used only during the puerperal period or also during gestation 8 . Pathological RAMD increases risks for developing future abdominal hernia and impairs the return of such muscles to their pre-gestational anatomic position 2,8,9 .…”