What is Diastasis Recti?
Diastasis recti is a separation of the rectus abdominis muscles along the linea alba (the midline connective tissue of the anterior abdominal wall), resulting in weakness of the abdominal musculature and visible bulging of abdominal contents. 1, 2
Anatomical Definition
- The condition involves disintegration of both rectus abdominis muscles to the sides, accompanied by extension/widening of the linea alba tissue and bulging of the abdominal wall 3
- This creates an abnormal distance between the paired rectus muscles, characterized by midline abdominal bulge without an actual fascial defect 4
- While diastasis recti may result in herniation of abdominal viscera, it is not a hernia per se, though it can be complicated by concurrent abdominal hernia 1, 3
Clinical Presentation
- Patients present with a visible midline abdominal bulge that becomes more prominent with activities that increase intra-abdominal pressure 4
- Associated symptoms include pain and discomfort in the abdomen, musculoskeletal problems, and urogynecological issues 5
- The condition can significantly impair quality of life and cause negative body image 5
High-Risk Populations
Multiparous women are at highest risk, particularly during pregnancy and the postpartum period 6, 4:
- During pregnancy, visible separation of abdominal muscles occurs due to hormonal changes that relax ligaments and increase intra-abdominal pressure 6
- Most women develop some degree of muscle separation in the postpartum period 1
- The women-to-men ratio for related complications is 9:1 7
Other high-risk groups include 4:
- Obese patients
- Those with multiple previous abdominal operations
- Patients with chronic increases in intra-abdominal pressure
Diagnosis and Classification
- Diagnosis is primarily clinical, based on thorough history and physical examination showing midline separation of rectus muscles 2, 4
- Classification schemes are based on inter-rectus distance and location of the defect 2
- Imaging with ultrasound, CT, or MRI can aid in classification and surgical planning, particularly when hernias are present within the diastasis 2
Important Clinical Considerations
Women with diastasis recti should seek physiotherapy advice and avoid abdominal strengthening exercises (such as abdominal curls), as these may worsen the condition and increase the likelihood of requiring postnatal repair 6. However, continuing aerobic exercise such as walking is associated with decreased odds of developing diastasis recti 6.
If severe diastasis recti persists in the postpartum period, it should be corrected to prevent concurrent abdominal hernia, strangulation, or incarceration 1.