Rectus abdominis diastasis
- Maurice Nahabedian, MD
Maurice Nahabedian, MD
- Professor of Plastic Surgery
- Georgetown University
- David C Brooks, MD
David C Brooks, MD
- Associate Professor of Surgery
- Harvard Medical School
- Section Editors
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
- Michael Rosen, MD
Michael Rosen, MD
- Section Editor — Hernia Surgery
- Professor of Surgery
- Cleveland Clinic Foundation
Rectus abdominis diastasis (RAD) (diastasis recti, divarication of the rectus abdominis, abdominal muscle separation) is an anatomic term describing a condition in which the two rectus muscles are separated by an abnormal distance [1,2]. Acquired rectus abdominis diastasis (RAD) can result from any number of conditions that weaken the linea alba resulting in protrusion of abdominal contents.
The definition, clinical features, and management of RAD are reviewed here. RAD is not to be confused with abdominal wall hernia, which is a potentially serious condition that can lead to bowel obstruction. (See "Overview of abdominal wall hernias in adults".)
The anterior abdominal wall consists of the abdominal rectus muscles separated by the linea alba, which is a fusion of the external and internal abdominal oblique muscle and transversus abdominis aponeuroses [3-5]. (See "Anatomy of the abdominal wall", section on 'Muscles'.)
Rectus abdominis diastasis (RAD) describes a condition in which an abnormally wide distance separates the two rectus muscles. However, there is controversy regarding what constitutes a normal inter-rectus distance, at what level measurements should be taken, and by what means, and thus, when the distance can be considered abnormal . We consider any separation more than 2 cm to be abnormal.
What is considered abnormal may differ below as compared with above the umbilicus. In one anatomic study, the normal width of the linea alba in nulliparous women from 20 to 45 years of age with a body mass index <30 was up to 15 mm at the xiphoid, up to 22 mm at 3 cm above the umbilicus and up to 16 mm at 2 cm below the umbilicus . In another anatomic study, the width of the linea alba ranged from 11 to 21 mm when measured from the xyphoid process to the umbilicus, and decreased from 11 mm to 2 mm when measured from the umbilicus to the pubic symphysis. The thickness of the linea alba ranged from 900 to 1200 micrometers between the xyphoid and the umbilicus, and increased from 1700 to 2400 micrometers from the umbilicus to the pubic symphysis .
- Akram J, Matzen SH. Rectus abdominis diastasis. J Plast Surg Hand Surg 2014; 48:163.
- Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 1990; 43:5.
- Digilio MC, Capolino R, Dallapiccola B. Autosomal dominant transmission of nonsyndromic diastasis recti and weakness of the linea alba. Am J Med Genet A 2008; 146A:254.
- Brauman D. Diastasis recti: clinical anatomy. Plast Reconstr Surg 2008; 122:1564.
- Beer GM, Schuster A, Seifert B, et al. The normal width of the linea alba in nulliparous women. Clin Anat 2009; 22:706.
- Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths. I. General scheme and morphological aspects. J Surg Res 2001; 96:127.
- Rath AM, Attali P, Dumas JL, et al. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat 1996; 18:281.
- Nahas FX. An aesthetic classification of the abdomen based on the myoaponeurotic layer. Plast Reconstr Surg 2001; 108:1787.
- Christ B, Jacob M, Jacob HJ. On the origin and development of the ventrolateral abdominal muscles in the avian embryo. An experimental and ultrastructural study. Anat Embryol (Berl) 1983; 166:87.
- Okayasu I, Kajita A, Shimizu K. A variant form of median defect syndrome. Syndrome of combined congenital defects involving the supraumbilical abdominal wall, sternum, diaphragm, pericardium, and heart. Acta Pathol Jpn 1978; 28:287.
- McPhail I. Abdominal aortic aneurysm and diastasis recti. Angiology 2008; 59:736.
- Lockwood T. Rectus muscle diastasis in males: primary indication for endoscopically assisted abdominoplasty. Plast Reconstr Surg 1998; 101:1685.
- Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother 2000; 46:301.
- Fernandes da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015; 20:200.
- Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol 2011; 82:817.
- Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:321.
- Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 1988; 68:1082.
- Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 2014; 100:1.
- Moesbergen T, Law A, Roake J, Lewis DR. Diastasis recti and abdominal aortic aneurysm. Vascular 2009; 17:325.
- Bursch SG. Interrater reliability of diastasis recti abdominis measurement. Phys Ther 1987; 67:1077.
- Mota P, Pascoal AG, Sancho F, Bø K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther 2012; 42:940.
- Liaw LJ, Hsu MJ, Liao CF, et al. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther 2011; 41:435.
- Mendes Dde A, Nahas FX, Veiga DF, et al. Ultrasonography for measuring rectus abdominis muscles diastasis. Acta Cir Bras 2007; 22:182.
- Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther 2008; 13:112.
- Nahas FX, Augusto SM, Ghelfond C. Nylon versus polydioxanone in the correction of rectus diastasis. Plast Reconstr Surg 2001; 107:700.
- Emanuelsson P, Gunnarsson U, Strigård K, Stark B. Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up. J Plast Reconstr Aesthet Surg 2014; 67:1082.
- Hickey F, Finch JG, Khanna A. A systematic review on the outcomes of correction of diastasis of the recti. Hernia 2011; 15:607.
- Mesquita LA, Machado AV, Andrade AV. Physiotherapy for Reduction of Diastasis of the Recti Abdominis Muscles in the Postpartum Period. Rev Bras Ginecol Obstet 1999; 21:267.
- https://diastasisrehab.com (Accessed on May 25, 2015).
- Nahas FX, Augusto SM, Ghelfond C. Should diastasis recti be corrected? Aesthetic Plast Surg 1997; 21:285.
- Williams TC, Hardaway M, Altuna B. Ambulatory abdominoplasty tailored to patients with an appropriate body mass index. Aesthet Surg J 2005; 25:132.
- Nahas FX, Ferreira LM. Concepts on correction of the musculoaponeurotic layer in abdominoplasty. Clin Plast Surg 2010; 37:527.
- Nahas FX, Ferreira LM, Mendes Jde A. An efficient way to correct recurrent rectus diastasis. Aesthetic Plast Surg 2004; 28:189.
- Palanivelu C, Rangarajan M, Jategaonkar PA, et al. Laparoscopic repair of diastasis recti using the 'Venetian blinds' technique of plication with prosthetic reinforcement: a retrospective study. Hernia 2009; 13:287.
- Chang CJ. Assessment of videoendoscopy-assisted abdominoplasty for diastasis recti patients. Biomed J 2013; 36:252.
- Zukowski ML, Ash K, Spencer D, et al. Endoscopic intracorporal abdominoplasty: a review of 85 cases. Plast Reconstr Surg 1998; 102:516.
- Yousif NJ, Lifchez SD, Nguyen HH. Transverse rectus sheath plication in abdominoplasty. Plast Reconstr Surg 2004; 114:778.
- van Uchelen JH, Kon M, Werker PM. The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography. Plast Reconstr Surg 2001; 107:1578.
- Ferreira LM, Castilho HT, Hochberg J, et al. Triangular mattress suture in abdominal diastasis to prevent epigastric bulging. Ann Plast Surg 2001; 46:130.
- Asaadi M, Haramis HT. A simple technique for repair of rectus sheath defects. Ann Plast Surg 1994; 32:107.
- Brauman D, Capocci J. Liposuction abdominoplasty: an advanced body contouring technique. Plast Reconstr Surg 2009; 124:1685.
- Dabb RW, Hall WW, Baroody M, Saba AA. Circumferential suction lipectomy of the trunk with anterior rectus fascia plication through a periumbilical incision: an alternative to conventional abdominoplasty. Plast Reconstr Surg 2004; 113:727.
- Ramirez OM. Abdominoplasty and abdominal wall rehabilitation: a comprehensive approach. Plast Reconstr Surg 2000; 105:425.
- Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg 2000; 105:2583.
- Nahas FX, Ferreira LM, Augusto SM, Ghelfond C. Long-term follow-up of correction of rectus diastasis. Plast Reconstr Surg 2005; 115:1736.
- Veríssimo P, Nahas FX, Barbosa MV, et al. Is it possible to repair diastasis recti and shorten the aponeurosis at the same time? Aesthetic Plast Surg 2014; 38:379.
- Tadiparthi S, Shokrollahi K, Doyle GS, Fahmy FS. Rectus sheath plication in abdominoplasty: assessment of its longevity and a review of the literature. J Plast Reconstr Aesthet Surg 2012; 65:328.
- Cardenas Restrepo JC, Munoz Ahmed JA. New technique of plication for miniabdominoplasty. Plast Reconstr Surg 2002; 109:1170.
- Batchvarova Z, Leymarie N, Lepage C, Leyder P. Use of a submuscular resorbable mesh for correction of severe postpregnancy musculoaponeurotic laxity: an 11-year retrospective study. Plast Reconstr Surg 2008; 121:1240.
- Kanjoor JR, Singh AK. Lipoabdominoplasty: An exponential advantage for a consistently safe and aesthetic outcome. Indian J Plast Surg 2012; 45:77.
- Mestak O, Kullac R, Mestak J, et al. Evaluation of the long-term stability of sheath plication using absorbable sutures in 51 patients with diastasis of the recti muscles: an ultrasonographic study. Plast Reconstr Surg 2012; 130:714e.
- Rosen A, Hartman T. Repair of the midline fascial defect in abdominoplasty with long-acting barbed and smooth absorbable sutures. Aesthet Surg J 2011; 31:668.
- Cheesborough JE, Dumanian GA. Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs. Plast Reconstr Surg 2015; 135:268.
- van Uchelen JH, Werker PM, Kon M. Complications of abdominoplasty in 86 patients. Plast Reconstr Surg 2001; 107:1869.
- de Castro EJ, Radwanski HN, Pitanguy I, Nahas F. Long-term ultrasonographic evaluation of midline aponeurotic plication during abdominoplasty. Plast Reconstr Surg 2013; 132:333.
- Elkhatib H, Buddhavarapu SR, Henna H, Kassem W. Abdominal musculoaponeuretic system: magnetic resonance imaging evaluation before and after vertical plication of rectus muscle diastasis in conjunction with lipoabdominoplasty. Plast Reconstr Surg 2011; 128:733e.
- CLASSIFICATION AND RISK FACTORS
- - Prevention of diastasis
- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS
- Weight loss
- Postpartum exercise
- Spontaneous resolution
- SURGICAL REPAIR
- POSTOPERATIVE CARE AND FOLLOW-UP
- SUMMARY AND RECOMMENDATIONS