What causes linea alba?

From the Guidelines

Linea alba is primarily caused by the separation or weakness of the abdominal muscles, particularly during surgical procedures or open abdomen management, rather than hormonal changes or pigmentation. This condition can arise from various factors, including:

• Surgical techniques, such as component separation or the use of biologic meshes in abdominal wall reconstruction 1
• The presence of a large abdominal wall defect, bacterial contamination, or comorbidities that complicate wound healing 1
• The choice of mesh material, with non-cross-linked biologic meshes preferred in sublay position when the linea alba can be reconstructed, and cross-linked biologic meshes preferred in fascial-bridge position (no linea alba closure) to reduce ventral hernia recurrence 1
• The use of negative pressure wound therapy (NPWT) in combination with biologic mesh to facilitate granulation and skin closure 1

In the context of abdominal wall reconstruction, the primary goal is to achieve definitive closure of the fascia and abdomen as soon as possible, with primary fascia closure being the ideal solution 1. The use of biologic meshes, particularly non-cross-linked ones, can be reliable for definitive abdominal wall reconstruction in the presence of large wall defects or contaminated fields 1. However, the choice of mesh material and technique should be carefully considered to minimize complications and promote optimal outcomes.

From the Research

Causes of Linea Alba

• Linea alba is a result of the separation of the rectus abdominis muscles, which can be caused by various factors such as pregnancy, obesity, and abdominal surgery 2, 3.
• During pregnancy, the abdominal wall is stretched by the growing uterus, leading to a widening of the linea alba 2.
• Repeated stretching of the abdominal wall, such as in multiparous women, can cause a persistent weakness in the linea alba, leading to symptoms such as back pain and abdominal discomfort 2.
• The width of the linea alba can also be affected by factors such as body mass index (BMI) and age 3.

Related Conditions

• Diastasis recti is a condition characterized by a widening of the linea alba, which can be caused by pregnancy, obesity, and other factors 2, 4.
• Abdominal compartment syndrome is a condition characterized by increased pressure in the abdominal cavity, which can cause a widening of the linea alba 5.
• Linea nigra is a condition characterized by a darkening of the skin on the abdomen, which can be caused by hormonal changes during pregnancy 6.

Factors Affecting Linea Alba Width

• The width of the linea alba can be affected by factors such as pregnancy, obesity, and abdominal surgery 2, 3.
• The width of the linea alba can also be affected by the performance of certain exercises, such as abdominal hypopressive exercises 4.
• The normal width of the linea alba in nulliparous women has been found to be up to 15 mm at the xiphoid, up to 22 mm at the reference point 3 cm above the umbilicus, and up to 16 mm at the reference point 2 cm below the umbilicus 3.