From the Guidelines
The rectus abdominis and hernias are distinct anatomical concepts, with the rectus abdominis being a normal muscle structure and hernias representing a pathological condition that may require surgical intervention. The rectus abdominis is a paired muscle running vertically along the anterior abdominal wall, commonly known as the "six-pack" muscle, and it functions to flex the spine, stabilize the core, and assist with breathing and abdominal pressure 1. In contrast, a hernia occurs when an organ or tissue protrudes through a weakness in the surrounding muscle or connective tissue. Abdominal hernias often develop near the rectus abdominis, with common types including umbilical, incisional, and inguinal hernias.
Key Differences
- The rectus abdominis is a normal anatomical structure
- A hernia represents a pathological condition requiring medical attention
- Hernias typically present as visible bulges that may increase with straining or coughing and can cause pain or discomfort
- Some hernias require surgical repair to prevent complications like strangulation, where blood supply to the protruding tissue becomes compromised, creating a medical emergency. According to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1, emergency repair of complicated abdominal hernias remains one of the most common and challenging surgical emergencies and is associated with a significant burden for health care systems worldwide.
Clinical Implications
- If you notice a new bulge in your abdominal area, especially one that changes with position or pressure, you should seek medical evaluation
- The management of hernias should be stratified according to the CDC wound classification, which is a widely used and standardized classification of the surgical wounds 1
- Surgical repair according to the CDC wound classification and antimicrobial prophylaxis are crucial in the management of complicated abdominal wall hernias 1.
From the Research
Rectus Abdominis vs Hernia
- The rectus abdominis muscle is a flat, long muscle that extends from the pubic bone to the fifth, sixth, and seventh ribs [(2,3)].
- A hernia occurs when an organ or tissue bulges through a weakened area in the muscle or connective tissue that normally holds it in place [(2,4)].
- Spontaneous ventral hernia through the rectus abdominis sheath is a rare condition, with only eight previously reported cases since 1937 2.
- Diastasis recti is an abnormality of the anterior abdominal wall, characterized by a separation of the rectus abdominis muscles along the linea alba 3.
- Imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can aid in the classification of diastasis recti and guide surgical planning [(3,5)].
Diagnosis and Management
- A thorough history and physical exam can diagnose most cases of diastasis recti 3.
- Ultrasonography is often needed in women to diagnose inguinal hernias, and is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain is suspected 4.
- Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings 4.
- Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair 4.
- Dynamic Abdominal Sonography for Hernia (DASH) is an accurate alternative to CT scan for diagnosing abdominal wall hernias, with additional benefits of no radiation exposure and instant bedside interpretation 5.