Diastasis recti

Dr. med. Mira Seidel is a freelance writer for the medical team.

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In a diastasis rectus (out of alignment, midline break), the straight abdominal muscles diverge. This causes abdominal wall hernias. The cause is an abdominal wall weakness, which is often caused by pregnancy or being overweight. Therapy consists in strengthening the abdominal muscles, in some cases surgery is required. Read more about the symptoms, diagnosis and therapy of diastasis recti here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M62

Diastasis recti: description

The doctor describes the expansion of the so-called linea alba, a vertical suture of connective tissue on the abdomen, as diastasis rectus. As a result, the right and left straight abdominal muscles deviate to the side and a noticeable gap remains. The linea alba is usually one to two centimeters wide and is formed by the interweaving of connective tissue structures of the straight abdominal muscles, which cover the surface of the front abdomen. The diastasis rectus is not a real fracture, even if it resembles a fracture when standing or when there is increased pressure in the abdominal cavity due to the protrusion.

The diastasis recti is usually most pronounced in the area of ​​the navel and is between one to ten centimeters long. Sometimes it extends from the costal arch to the pubic bone.

Diastasis recti is much more common in women than in men: the stresses and strains of pregnancy overstretch the straight abdominal muscles and cause them to deviate (out of alignment). If the abdominal muscles are weak, the muscle strands can even spread apart by more than a hand's breadth. As a result, this affects the holding, supporting and carrying function of the muscles. In this case, despite weight loss, an unsightly bulge remains on the anterior abdominal wall after pregnancy.

In men, diastasis recti is usually limited to the area above the navel.

Abdominal muscles build-up

Under the skin of the abdominal wall lies the more or less pronounced layer of fat, which is separated from the muscles by a connective tissue structure (fascia). The abdominal muscles are the basis of the abdominal wall, which is separated from the intestines by the peritoneum. The muscle layers are made up of different muscles. The flat, straight abdominal muscle, for example, connects the chest and pelvis. The lateral abdominal muscles cover the straight abdominal muscles with their flat tendons on each side and form the so-called rectus sheath there. In its center is the linea alba, which is affected in diastasis recti.

Diastasis recti: symptoms

A diastasis recti usually does not cause any symptoms. In those affected, a gap can be felt in the middle of the abdomen. Under tension, a visible and palpable bulge can occur.

As the pregnancy progresses, diastasis recti can manifest itself with pain in the lower back, buttocks, and hips during exercise. Women who have already had several pregnancies in particular suffer from this because the muscles have been stretched repeatedly.

Excess tissue and skin can protrude in the front part of the abdomen; in the last trimester of pregnancy, the upper part of the uterus protrudes from the abdominal wall. If the diastasis recti is very large, the outlines of the unborn baby can sometimes be seen.

The birth can be made more difficult by the diastasis rectus, as the abdominal muscles cannot be used with sufficient force to push the child out. An upright childbearing posture and the back muscles can compensate for this.

Diastasis recti: causes and risk factors

Most diastases of the rectus are acquired, especially pregnant women, and congenital risk factors rarely play a role.

Acquired diastasis recti

Pregnancy is a typical cause of diastasis recti. During pregnancy, as the child grows in the uterus, the abdominal muscles stretch and lose their tension. In addition, the pregnancy hormone relaxin has a relaxing effect and promotes stretching of the Linea Alba. The diastasis recti often develops in the last trimester of pregnancy, when the abdomen becomes more and more expansive. Women should therefore try not to put additional strain on their stomach - for example by lifting heavy things.

Repeated pregnancies or multiple pregnancies increase the risk of diastasis recti.

In some cases, being overweight also leads to diastasis rectus, as the abdominal fat can also stretch the abdominal wall.

Congenital diastasis recti

Diastasis recti rarely has congenital causes. In such a case, the abdominal muscles do not run parallel, but rather move apart upwards. The linea alba widens, which allows the abdominal wall to bulge.

Diastasis recti in newborns

Diastasis recti can also occur in newborns and infants, as the distance between the two straight abdominal muscles is comparatively wide in them. However, the diastasis recti disappears as soon as the children start running. An operation is usually not necessary.

Diastasis recti: examinations and diagnosis

If a diastasis rectus is suspected, the gynecologist or general practitioner is usually the first point of contact. To collect the medical history (anamnesis), the doctor will first have a detailed conversation with the patient, in which he asks, for example, whether someone already has several children.

Physical examination

In the case of diastasis recti, the doctor makes the diagnosis relatively easily on the basis of a tactile finding. To do this, the patient lies on his back and is asked to tense the abdominal wall, for example by lifting his head. The doctor can use his fingers above the navel to feel the gap in the abdominal wall between the tense muscles.

If the patient stands up, laughs or coughs, the diastasis rectus bulges out as a "bulge" between the two standing straight abdominal muscles. In women with a multiple pregnancy or a pathological increase in the amount of amniotic fluid (polyhydramnios), clearly drawn out abdominal muscles can often be felt.

An ultrasound examination is rarely necessary in the case of a diastasis recti; it shows how far the diastasis recti has progressed.

Diastasis recti: treatment

In order to correct a diastasis rectus, the abdominal muscles are first used. If necessary, excess weight is reduced. If there are hardly any complaints, surgery is rarely required.

In addition, the following should be observed in everyday life: As long as the doctor can feel a diastasis rectus, the straight abdominal muscles should not be strained or exercised so that the diastasis recti does not enlarge. It is best to stand up from lying down on your side only. To do this, roll yourself completely to the side and then prop yourself up on the side with your arm to sit down.

Physiotherapy exercises

There are various diastasis recti exercises to strengthen the abdominal muscles and reduce the gap. They should be completed together with an experienced physiotherapist or midwife.

The diastasis rectus exercises according to Angela Hellers are a good method to bring the abdominal muscles back together and are recommended for patients with a diastasis rectus over two centimeters in length: With even muscle work against the therapist's hand, tense the muscles diagonally from the hip to the shoulder . While the midwife or physiotherapist hold the two straight abdominal muscles together, pull your shoulders up a little and push slightly forward against the resistance. After a breath or two, relax again.

Already two days after a spontaneous delivery or two weeks after a caesarean section, each side can be trained once, at most twice. If the exercise is repeated over several days, the diastasis recti decreases and is usually only one centimeter wide. Even a diastasis rectus that has existed for several years can be positively influenced by this exercise.

Diastasis recti surgery

The diastasis recti usually does not need to be operated on. However, if the diastasis recti symptoms increase and fractures occur in the midline and the umbilical region with complications, surgery is advisable. The surgeon creates inner sutures that fix the abdominal muscles in the correct position. The abdominal wall can be additionally stabilized with plastic nets.

After the diastasis rectus operation, the patient wears an abdominal belt that compresses the abdomen and special compression garments for about six weeks. Heavy physical activity and sport are taboo for at least four weeks.

Diastasis recti: disease course and prognosis

In most cases, the diastasis recti regresses with appropriate training. A narrow diastasis recti of only one or more centimeters in length can heal on its own; after a pregnancy, the regression process may take longer. If there is pain, surgery may be necessary. Complications only occur if the diastasis recti breaks and organs or parts of organs are pinched, but this is only very rarely the case.

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