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 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 xiphoid 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 xiphoid and the umbilicus, and increased from 1700 to 2400 micrometers from the umbilicus to the pubic symphysis .
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- CLASSIFICATION AND RISK FACTORS
- - Prevention of diastasis
- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS
- Weight loss
- Postpartum exercise
- Spontaneous resolution
- SURGICAL REPAIR
- - Laparoscopic repair
- - Abdominoplasty
- - Plication alone
- - Plication with mesh
- Postoperative care and follow-up
- Recurrence and other outcomes
- SUMMARY AND RECOMMENDATIONS