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Aim
The prevalence and definition of diastasis recti abdominis (DRA) is under debate. This retrospective cross-sectional study evaluated the interrectal distance and the prevalence of DRA in computed tomography (CT) in an asymptomatic population.
Materials and methods
Patients undergoing CT scans for suspected appendicitis or kidney stones from 01...
Citations
... However, there is not an established correlation of IRD measurements with patient's symptoms [24,27]. A cross-sectional CT study has shown presence of mild DR (based on IRD measurements) in 57% of an asymptomatic population undergoing CT for other reasons [28]. Nevertheless, IRD measurements are obtained to objectify the severity of DR to establish indication for surgery and for symptomatic patients with DR requiring surgical repair for reimbursement purposes as requested by some insurance companies, and our data suggest that Valsalva CT offers a better accuracy for determining the IRD [29]. ...
Purpose
To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver.
Methods
This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar’s test.
Results
The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias.
Conclusions
Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias.
... With regards to the lack of consensus about the risk factors for the development of DRA, higher age, increased body mass index, and parity have been proposed 4 . Spitznagle et al. 3 found that 65.13% of menopausal women had DRA. ...
Introduction: Recent studies have related the climacteric period with changes in connective tissue elasticity that may be related to diastasis recti abdominis. Mat Pilates is a method of exercise without impact that currently has more practitioners, due to its satisfactory results. However, there are no studies that evaluate the effectiveness of mat Pilates for women with diastasis recti abdominis. Objective: To evaluate the effectiveness of the mat Pilates program in climacteric women with diastasis recti abdominis. Methods: This randomized single-blinded clinical trial evaluated climacteric women with diastasis recti abdominis. The participants were randomized into the experimental group, which participated in 3 weekly sessions of mat Pilates for 12 weeks for a total of 36 sessions, and the control group (without exercises). The inter-rectus distance was measured with a digital caliper. The G*Power Version 3.1.9.2. software was used for the sample calculation, and the SPSS 20.0 program was used for statistical analysis. Results: The study comprised 21 women, including 10 in the control group and 11 in the experimental group, with mean ages of 54.3 ± 7.1 and 55.3 ± 6.0 years and body mass index values of 28.8 ± 5.5 kg/m2 and 29.9 ± 4.48 kg/m2, respectively. In the experimental group, reductions were observed in all the measures related to diastasis recti abdominis (p<0.05) in the supraumbilical, umbilical, and infra-umbilical regions. Conclusion: The mat Pilates method is effective for reducing diastasis recti abdominis in the climacteric period.
... It is assumed that DRA contributes to the development of back or pelvic pain [14][15][16][17][18]. However, there are indications that the aetiology is reversed: DRA does not cause back and pelvic pain; instead, low back or pelvic pain cause DRA. ...
Introduction: Diastasis rectus abdominis (DRA) is defined as an increased distance between the left and right muscle of the m. rectus abdominis. Pregnancy-related factors are assumed to be dominant factors in the occurrence of DRA. However DRA is not only found in peri-partum women but also in men and nulliparous women with back or pelvic pain. This study provides an inventory of the incidence of DRA in subjects with chronic back and pelvic pain. If DRA is common in both men and women then other factors besides pregnancy, like impaired motor control, should be explored as cause for DRA.
Material and Methods: This study was conducted with data from 849 back pain patients. Results from ultrasound assessment of the abdominal wall were combined with anamnestic data on age, gender, medical history and pregnancies (in women).
Results: There was no difference in Inter Rectus Distance cranial of the umbilicus (IRD above umbilicus) between men and women. Almost half of all women and men (45% and 43%, respectively) exhibit an increased IRD above umbilicus. The incidence of an increased IRD above umbilicus is twice as high in women below 30 years, compared to men below 30 years old. This difference is not observed for men and women above 30 years old.
Discussion: DRA occurs in women during pregnancy and increases with an increasing number of pregnancies. However, this condition does not affect significantly more women than men. Increased IRD above umbilicus already occurs in young men (mean age 30). Over 30 years of age, cranial of the umbilicus there is no difference in IRD between women and men. An alternative etiological mechanism is suggested.
... 30175). 9 In the medical literature, rectus diastasis that persists in women years after pregnancy remains poorly defined 10 and is consequently poorly understood by healthcare professionals. 11 To date, scholarly understanding has been drawn predominantly from quantitative research using dynamometers, functional assessment tools, and validated questionnaires such as patient-reported outcome measures (PROMs). ...
Background
Post-partum rectus diastasis, or the separation of the abdominal muscles after pregnancy, occurs in conjunction with physical symptoms and impaired quality of life. In Australia, health funding for surgery to treat diastasis was ceased in 2016, but reinstated in mid-2022, providing a unique context from which women’s experiences of this condition can be analysed.
Objectives
The objective is to examine the experiences of Australian women with post-partum rectus diastasis.
Design
This is an interview-style study with qualitative content analysis.
Methods
Women diagnosed with rectus diastasis were recruited to complete a baseline questionnaire (n = 45). Twenty-three responded to invitation for one-on-one interview via Zoom® between November 2021 and May 2022. Interviews were recorded, transcribed, and analysed using qualitative content analysis to identify key themes.
Results
Eighteen women had undergone caesarean section and eight had twins. Thirteen had private health insurance. Women were most often diagnosed by a physiotherapist (n = 10). Key themes identified included changed physical appearance and function; issues with self-esteem and intimacy; barriers to treatment; lack of recognition as a medical condition; and overall frustration. The impact of rectus diastasis extended beyond physical and psychological symptoms to affect women’s social functioning, child rearing, and return to work. There was a complex interaction between healthcare providers’ knowledge of rectus the removal of funding for surgical treatment, and limitations of conservative therapy, with women’s lived experiences and symptoms. The lack of an established medical definition also influenced the experiences of these women and their engagement with treatment.
Conclusion
This study contextualizes women’s experience of post-partum rectus diastasis with respect to the unique landscape of Australia’s healthcare economy and provides evidence of women’s absorption of health policy surrounding this condition. Our qualitative analysis provides critical knowledge for future quantitative studies, the results of which in combination could advance the definition of rectus diastasis and inform healthcare policy surrounding treatment.
... The prevalence of this pathological condition of the abdominal wall is very variable, ranging from 39% to 52% in post-pregnancy women. In addition to pregnancy, obesity is a major risk factor for the onset of this condition (10). ...
... The role of women's age as a risk factor of DRA is unclear. Age is reported a risk factor by Spitznagle, and most recently by Kaufmann (10,17). On the contrary, other authors have not confirmed this finding (8,18). ...
... Both obesity and pregnancy increase abdominal pressure and volume. Moreover, multiple pregnancies, as well as other factors such as lack of exercise, may contribute to cumulative mechanical stress to the connective tissue of the abdominal wall contributing to the development of a DRA (10,(17)(18)(19)(20). ...
Purpose
Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders.
Methods
In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3–5, >5 cm) were evaluated by a multinomial regression model.
Results
Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m² (range 16.0–40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity.
Conclusion
The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.
... Some studies have found that DRA is not associated with maternal age, 1,4,7 ethnicity, 4 height, 1,4 preconception weight, 1,4 gestational weight gain, 1,4 exercise habits, 7 or history of abdominal surgery. 4 However, other studies have reported that age, 2,8,9 cesarean section, 8 body mass index (BMI) before and after childbirth, 8,9 and parity 9 are significant risk factors for DRA. Furthermore, no specific indicators have been identified for the comprehensive evaluation of DRA. ...
... Some studies have found that DRA is not associated with maternal age, 1,4,7 ethnicity, 4 height, 1,4 preconception weight, 1,4 gestational weight gain, 1,4 exercise habits, 7 or history of abdominal surgery. 4 However, other studies have reported that age, 2,8,9 cesarean section, 8 body mass index (BMI) before and after childbirth, 8,9 and parity 9 are significant risk factors for DRA. Furthermore, no specific indicators have been identified for the comprehensive evaluation of DRA. ...
Purpose
Diastasis recti abdominis (DRA) is a condition in which the linea alba is stretched and widened, and the abdominal muscles are separated from each other. DRA typically occurs in pregnant and postpartum women. We aimed to determine the risk factors and patient-reported outcomes (PROs) of DRA in Chinese postpartum women.
Methods
This observational study was conducted in Hangzhou Hospital of Traditional Chinese Medicine, and involved 534 women who filled out the following risk-factor and PRO questionnaires: SF-MPQ-2, SF-ICIQ, LDQ, EPDS, MBIS, HerQles, and SF-36 (all Chinese versions). The inter-recti distance was measured by palpation. Statistical analyses were performed using SPSS v25.0 software and the Mann–Whitney U-test, chi-square test, binary logistic regression analysis (for risk factors of DRA), and the Kendall and Spearman tests (for correlation analysis).
Results
After childbirth, 78.1% (417/534) of the enrolled women had DRA. Abdominal surgery (P = 0.002), number of pregnancies (P = 0.035), parity (P = 0.012), number of births (P = 0.02), fetal birth weight (P = 0.014), and waist-to-hip ratio in the supine position (P = 0.045) significantly differed between the DRA and non-DRA groups. Caesarean delivery was an independent risk factor for DRA. The PROs were significantly worse in the DRA group than in the non-DRA group.
Conclusion
Caesarean delivery was an independent risk factor for DRA. Women with DRA are more likely to have limited physical activity or function after childbirth, lower self-confidence, and a decreased quality of life.
... Modern postprocessing techniques using CT scans, such as multiplanar reformation, three-dimensional (3D) visualization, and organ delineation, make it possible to study anatomy in vivo [12,13]. Several authors have described the Linea alba from a radiological point of view [1,[14][15][16]. It has been shown to be enlarged in obese people, during pregnancy and postpartum, at higher ages, and with diabetes mellitus [15,[17][18][19]. ...
... Most of the literature studying the Linea alba has been driven by the problem of defining diastasis recti [14,17,18,20,21]. The European Hernia Society recommendations define it as an inter-rectus distance (IRD) exceeding 2 cm that should be measured 3 cm above the umbilicus [22]. ...
... The European Hernia Society recommendations define it as an inter-rectus distance (IRD) exceeding 2 cm that should be measured 3 cm above the umbilicus [22]. With this definition, 35.6-57% of the population should be considered as presenting a diastasis recti [14,23]. Diastasis recti is often associated with umbilical, small midline, and groin hernia [23][24][25][26]. ...
Purpose
The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics.
Methods
Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients’ CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured.
Results
The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001–p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007).
Conclusion
This study provides an exhaustive 3D description of Linea alba’s anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.
... It can also lead to functional limitations in activities of daily living, such as lifting and carrying, and affect women's ability to return to their pre-pregnancy lifestyle [4]. In addition, the condition can have a negative impact on women's body image and self-esteem [5]. Physical therapy is the first-line treatment for postpartum diastasis recti. ...
... If the diastasis is greater than 15mm then it is sub dislocation and it is associated with pain, swelling, and deformity. (15) The other method is the use of dial calipers. Some tests including the curl-up test and leg lift test are also performed for manual assessment. ...
... The incidence of diastasis in the supra umbilical area was the same in primiparous and multiparous females but in the infra umbilical area, it was more evident in multiparity. (15) Demartini et al. conducted a descriptive study of transversal type on 88 women in the instant Puerperium. The result of this study was 61.36%. ...
Background: Diastasis recti is the divarication of rectus abdominal muscles due to the splitting of the mid-line collagen structure called the linea alba. It results in poor body biomechanics and alteration in the center of gravity of the body. It occurs mostly in multiparous females and in those who have poorly toned abdominal musculature. Physical activity and maternal care are significant to resolve this condition. Objective: The purpose of the study is to substantiate the prevalence of diastasis recti in a sample of immediate post-partum females attended by the Allied Hospital of Faisalabad. The aim is to create awareness of DRAM in clinical settings and the general population. Study design: This is a cross-sectional study that included 90 samples of females in the immediate postpartum period. Methodology: Specific assessment was done by finger-width method manually and confirmed the presence of DRAM. The umbilical region was the set point from which measurements were taken. Results and Conclusions: The separation was present and mostly affected the multiparous females. The study showed 63.3% prevalence and normal rectus abdominis is 36.7%. It also verified that 42.2% of females suffered from DRAM above the navel out of 63.3% and the rest are below the umbilicus. DRAM was prevalent to be in the majority of post-partum females. It was more present in the supra-umbilical region. Keywords: Pregnancy, rectus abdominis, multiparous, primiparous, physiotherapy.
... Diastasis of the rectus abdominis muscles (rectus diastasis, RD) is a physiological part of pregnancy and the immediate post-pregnancy period, caused by a hormonal thinning and relaxation of the linea alba and abdominal musculature to allow for the growing fetus [1]. The exact definition of diastasis between the rectus abdominis muscles is still debated [2][3][4][5][6] but has been found to be present in 100% of third-trimester pregnant women [1]. The condition regresses after delivery, but in a third of women, the condition has been described to persist after a year [7]. ...
Purpose
To evaluate our surgery for post-gestational rectus abdominis muscle diastasis using slowly absorbable monofilament suture and eight weeks of abdominal binder in terms of recurrence rate, complications, and effect on patients’ physical and cosmetic complaints.
Method
In a retrospective cohort study, all 44 patients operated between 2014 and 2020 were invited to a follow-up using ultrasound, clinical examination, and questionnaires regarding symptoms before and after surgery.
Results
89% of invited patients participated, with a median follow-up of 36 months. There was one recurrence caused by severe postoperative nausea and vomiting, which was the most common complication. Most procedures were safe, but two patients experienced Clavien–Dindo grade 3 complications. Patients reported feeling limited or taking precautions after surgery for a median of 8.5 months. Of all included patients, four responded that the operation did not alleviate their primary complaint. The remaining 35 patients (90%) experienced complete or partial alleviation of their primary complaints and would undergo the procedure again if needed.
Conclusion
Post-gestational diastasis recti can be associated with a large number of physical symptoms and functional complaints and can safely be operated using a single running plication of the anterior rectus fascia with a slowly absorbable suture, with fair cosmetic results, excellent effect on symptoms, few complications and high levels of patient satisfaction. Future research must determine which symptoms and findings should indicate surgery.
