Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor

2019 ◽  
Vol 15 (2) ◽  
pp. 86-101 ◽  
Author(s):  
Laura Anne Werner ◽  
Marcy Dayan
Keyword(s):  
Risk Factors ◽  
Pelvic Floor ◽  
Abdominal Wall ◽  
Transversus Abdominis ◽  
Abdominal Pressure ◽  
Linea Alba ◽  
Diastasis Recti ◽  
Pregnancy And Postpartum ◽  
The Impact ◽  
Diastasis Recti Abdominis

Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.

scholarly journals Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kai He ◽  
Xiuling Zhou ◽  
Yulan Zhu ◽  
Bo Wang ◽  
Xiaojian Fu ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Shear Wave ◽  
Muscle Thickness ◽  
Transversus Abdominis ◽  
Maximum Diameter ◽  
Oblique Muscle ◽  
Healthy Controls ◽  
Shear Wave Speed ◽  
Diastasis Recti ◽  
Diastasis Recti Abdominis

Abstract Objective To determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls. Methods From October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients. Results The maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001). Conclusions The application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.

Diastasis Recti Abdominis in Pregnancy and Postpartum Period. Risk Factors, Functional Implications and Resolution

2015 ◽  
Vol 11 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Patricia Mota ◽  
Augusto Gil Pascoal ◽  
Kari Bo
Keyword(s):  
Risk Factors ◽  
Postpartum Period ◽  
Postpartum Women ◽  
Diastasis Recti ◽  
Abnormal Posture ◽  
Pregnancy And Postpartum ◽  
Functional Implications ◽  
Postnatal Women ◽  
Diastasis Recti Abdominis

Diastasis recti abdominis (DRA) or the increased inter rectus distance (IRD) is described as the separation of the rectus abdominis muscles. It can occur during pregnancy and after childbirth. Mota et al. (2015) found DRA may affect up 100% of pregnant women [1], and it may persist separated in the immediate postpartum period in 35% to 60% of women [2]. Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis [1-7] and use of different measurement methods. To date limited studies about the normal width of the IRD in postpartum women are available [8, 9], and there is scarce information about risk factors for DRA. There are some theories stating that failure to treat DRA effectively can lead to long term sequelae [10], including abnormal posture [1], lumbo-pelvic pain and cosmetic imperfections [10]. Postnatal women are stimulated to resume abdominal exercises shortly after delivery [3] to improve trunk function and restore abdominal figure and fitness [8]. To date there is scant knowledge on the most effective abdominal exercises both during pregnancy and after childbirth. In particular there is little evidence on which exercises are most efficient in the narrowing of the recti diastasis. The aim of this article is to critically review the literature on the risk factors, functional implications and the effect of exercise on DRA. This information is expected to be relevant for physiotherapists and exercise professionals.

scholarly journals Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

2020 ◽  
Vol 7 (10) ◽  
pp. 3348
Author(s):  
Sheetal Ishwarappagol ◽  
Rohit Krishnappa
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Wall Reconstruction ◽  
Tobacco Consumption ◽  
Transversus Abdominis ◽  
Abdominal Pressure ◽  
Postural Stabilization ◽  
History Of ◽  
And Function ◽  
Ventral Hernias

Background: Loss of continuity of abdominal wall significantly affects the functions of protection of viscera, postural stabilization, and maintenance of intra-abdominal pressure. The newer understanding of abdominal wall reconstruction (AWR) aims at restoring abdominal wall anatomy and function, instead of simply patching the defect. We want to showcase the changing trends and results in hernia repair at a Medical Institution.Methods: This is an observational retrospective study conducted in RRMCH, Bengaluru from July 2018-2019 including all patients with ventral hernia undergoing the specified hernia repairs.Results: A total of 54 patients with ventral hernias undergoing routine hernia repairs/AWR surgeries were retrospectively analysed. The overall mean age was 46.62±12.44 year. Majority subjects were females (n=37; 68.5%), and overweight (Mean BMI=28.07±3.01/m2). 14 patients (25.92%), all males, had history of tobacco consumption. There were 38 (70.37%) primary ventral hernias and 7 recurrent hernias. Overall mean defect size was 10.2±0.4 cm. Most frequently performed was open retro rectus Hernioplasty (n=18; 33.33%), followed by open Preperitoneal Hernioplasty (n=17; 31.48%), laparoscopic intraperitoneal onlay mesh (IPOM) (n=16; 29.62%) and open transversus abdominis release (TAR) (n=3; 5.5%). On statistical analysis, it was found that Open repairs had higher post-operative pain (p=0.0005), longer hospitalization (p=0.0002) and higher incidence of surgical site events (p=0.0134) when compared to Laparoscopic repairs.Conclusion: As known already, minimally invasive techniques of hernia surgeries are shown to have acceptable outcomes when compared to radical open surgeries. Newer techniques of AWR are being employed to routine cases in larger numbers, and not just for complex reconstruction, at most centres with acceptable outcomes. 

Diastasis recti abdominis and pelvic floor dysfunction in peri- and postmenopausal women: a cross-sectional study

2020 ◽  
pp. 1-7
Author(s):  
Beatriz Souza Harada ◽  
Thainá Tolosa De Bortolli ◽  
Letícia Carnaz ◽  
Marta Helena Souza De Conti ◽  
Adoniz Hijaz ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Postmenopausal Women ◽  
Pelvic Floor Dysfunction ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Diastasis Recti ◽  
Diastasis Recti Abdominis

scholarly journals Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Hernia ◽  
2020 ◽  
Vol 24 (6) ◽  
pp. 1317-1324
Author(s):  
Y. Yurtkap ◽  
F. P. J. den Hartog ◽  
W. van Weteringen ◽  
J. Jeekel ◽  
G. J. Kleinrensink ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Suture Material ◽  
Abdominal Pressure ◽  
Postoperative Phase ◽  
Burst Abdomen ◽  
Linea Alba ◽  
Custom Made ◽  
Suture Tension ◽  
Significant Difference

Abstract Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the ‘AbdoMan’. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07–0.19) vs. large bites 0.57 N (IQR 0.23–0.92), p  < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p  < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.

Sign in / Sign up

Export Citation Format

Share Document