From the Guidelines
Diastasis recti and hernias are two distinct abdominal conditions that require different treatment approaches, with diastasis recti typically managed with physical therapy and hernias often requiring surgical repair, especially if they cause pain or risk strangulation. Diastasis recti is a separation of the rectus abdominis muscles along the midline of the abdomen, creating a gap between them, commonly occurring during pregnancy, but also affecting men, women who aren't pregnant, and newborns 1. In contrast, a hernia occurs when an organ or tissue pushes through a weakness in the muscle or surrounding tissue wall, creating a bulge that can be painful and potentially dangerous, with umbilical, inguinal, and incisional hernias being common types.
The key difference between diastasis recti and hernias is that diastasis recti involves muscle separation without tissue protrusion, while hernias involve actual tissue pushing through a defect in the abdominal wall. According to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias, laparoscopic approach may be a useful tool for assessing bowel viability after spontaneous reduction of strangulated groin hernias, and repair of incarcerated hernias may be performed with a laparoscopic approach in the absence of strangulation and suspicion of the need of bowel resection 1.
Some key points to consider when differentiating between diastasis recti and hernias include:
- Diastasis recti typically requires physical therapy and specific exercises for treatment, while hernias often require surgical repair, especially if they cause pain or risk strangulation.
- Hernias can lead to serious complications if left untreated, such as strangulation, bowel obstruction, and peritonitis.
- The use of biological meshes in hernia repair has been shown to be effective in contaminated fields, with cross-linked mesh prosthetics having the lowest failure rate in contaminated and outright infected fields 1.
- Physical activity during pregnancy, such as brisk walking, stationary cycling, swimming, or aquafit, can help reduce the risk of developing diastasis recti, while avoiding abdominal strengthening exercises, such as abdominal curls, can help prevent worsening of the condition 1.
In terms of treatment, hernias often require surgical repair, especially if they cause pain or risk strangulation, while diastasis recti typically requires physical therapy and specific exercises for treatment. The choice of treatment approach depends on the individual case and the severity of the condition, with the goal of minimizing morbidity, mortality, and improving quality of life. According to the 2017 update of the WSES guidelines, primary repair is recommended for stable patients with strangulated hernia with bowel necrosis and/or gross enteric spillage during intestinal resection, while open management is recommended for unstable patients experiencing severe sepsis or septic shock 1.
From the Research
Diastasis Recti vs Hernia: Key Differences
- Diastasis recti is an abnormality of the anterior abdominal wall, characterized by a separation of the rectus abdominis muscles along the linea alba 2.
- A hernia, on the other hand, is a protrusion of an organ or tissue through a weakened area in the muscle or fascia.
- Diastasis recti can be diagnosed through a thorough history and physical exam, while imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can aid in classification and guide surgical planning 2, 3.
Risk Factors and Associations
- Diastasis recti is common in postpartum women, and risk factors include age, number of pregnancies, BMI, and diabetes 4.
- There is a significant association between diastasis recti and low back pain, but no clear correlation between diastasis recti and pelvic floor dysfunction in early postpartum women 4, 5.
- Ultrasound diagnostic criteria for diastasis recti have been established, including an inter-rectus distance of >2 mm at 3 cm below the umbilicus, >20 mm at the umbilicus, and >14 mm at 3 cm above the umbilicus 5.
Imaging and Diagnosis
- Imaging modalities such as ultrasound, CT, and MRI can depict the abdominal wall in detail and permit simultaneous assessment of the degree and craniocaudal extent of diastasis recti, evaluation for co-existent hernia, and subjective judgement of muscle quality 3.
- Dynamic imaging techniques can show both static anatomy and muscle movement and function, aiding in the diagnosis and management of diastasis recti and associated hernias 3.