Diastasis recti

Diastasis recti
Classification and external resources
ICD-10	M62.0
ICD-9	728.84

Diastasis recti (also known as abdominal separation) is a disorder defined as a separation of the rectus abdominis muscle into right and left halves.^[1] Normally, the two sides of the muscle are joined at the linea alba at the body midline. It is essentially a cosmetic condition, with no associated morbidity or mortality.^[2]

Diastasis of this muscle occurs principally in two populations: newborns and pregnant women.

• In the newborn, the rectus abdominis is not fully developed and may not be sealed together at midline. Diastasis recti is more common in premature and African American newborns.
• In pregnant or postpartum women, the defect is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in multiparous women due to repeated episodes of stretching. When the defect occurs during pregnancy, the uterus can sometimes be seen bulging through the abdominal wall beneath the skin.^[1]

Presentation

A diastasis recti may appear as a ridge running down the midline of the abdomen, anywhere from the xiphoid process to the umbilicus. It becomes more prominent with straining and may disappear when the abdominal muscles are relaxed. The medial borders of the right and left halves of the muscle may be palpated during contraction of the rectus abdominis.^[3] The condition can be diagnosed by physical exam, and must be differentiated from an epigastric hernia or incisional hernia, if the patient has had abdominal surgery.^[2] Hernias may be ruled out using ultrasound.

In infants, they typically result from a minor defect of the linea alba between the rectus abdominis muscles. This allows tissue from inside the abdomen to herniate anteriorly. On infants, this may manifest as an apparent 'bubble' under the skin of the belly between the umbilicus and xiphisternum (bottom of the breastbone).

Treatment

No treatment is necessary for women while they are still pregnant. In children, complications include development of an umbilical or ventral hernia, which is rare and can be corrected with surgery.^[1]

In adults, diastasis recti can in some cases be corrected and/or mitigated by physiotherapy. A study conducted at Columbia University Program in Physical Therapy established that the women utilizing the Tupler Technique exercises had a smaller diastasis than the control group who did not do these exercises.^[4]

In extreme cases, diastasis recti is corrected during the cosmetic surgery procedure known as a tummy tuck by creating a plication or folding of the linea alba and suturing together. This creates a tighter abdominal wall.

In adult females, a laparoscopic Venetian blind technique can be used for plication of the recti. (Ref: Laparoscopic repair of diastasis recti using the 'Venetian blinds' technique of plication with prosthetic reinforcement: a retrospective study Authors:C Palanivelu, M Rangarajan, P Jategaonkar, V Amar, K Gokul, B Srikanth; HERNIA June 2009 )

References

1. ^ ^{a b c} MedlinePlus Medical Encyclopedia: Diastasis Recti
2. ^ ^{a b} Norton, Jeffrey A. (2003). Essential practice of surgery: basic science and clinical evidence. Berlin: Springer. pp. 350. ISBN 0-387-95510-0. 
3. ^ University of Pennsylvania Health System Encyclopedia: Diastasis Recti
4. ^ Journal of Women's Health Physical Therapy Volume 29, No. 1, Spring, 2005