Diastasis Recti Abdominis

Diastasis Recti Abdominis is also known as divarication of the recti. This often occurs during pregnancy when the pressure of the foetus stretches the rectus abdominis muscles apart. It is a common issue that affects a lot of women.

What is Diastasis Recti Abdominis (DRA)?

This is also known as divarication of the recti. Governing our anterior wall musculature is 4 set of muscles. The two central vertical muscles that runs from the sternal bone to the pubic bone are called the rectus abdominis muscle. These two muscles are the ones that gives an athletic appearance with the six-packs. Between these two muscles, there is a band of connective tissue called the linea alba. It functions as an attachment point for the abdominal muscles, helps to anchor and stabilize the torso. It also helps absorb forces or pressures to the intra-abdominal organs. Normal ranges of the width of the linea alba can be up to 2cm wide, just above the umbilicus.

What causes DRA?

Several factors can result in the stretching and weakening of the linea alba. Obesity, pregnancy as well as excessive pressure on the abdomen. With multiple pregnancy, higher birth weight, increased weight during pregnancy and having twins possibly increasing the risk. As a result of persistent stretching, the linea alba loses its elasticity and causes DRA. DRA is present when the width of the linea alba is over 2cm wide at its widest along the length of the linea alba.

We classify the severeity of DRA using this classification system

Type of Rectus Diastasis A

Description : Mild

Width of Rectus Diastasis : 2-3cm

Type of Rectus Diastasis B

Description : Moderate

Width of Rectus Diastasis : 3-5cm

Type of Rectus Diastasis C

Description : Severe

Width of Rectus Diastasis : 5-7cm

Type of Rectus Diastasis D

Description : Very Severe

Width of Rectus Diastasis : 7-9cm

There are various methods to measure the width of the diastasis of the recti. It can be measured with finger palpation, calipers and ultrasound. The gold standard measurement is still using a CT scan of the abdomen or direct measurement of the gap during surgery. Several fixed position throughout the length of the linea alba should be used to assess.

Symptoms of DRA

A weak of overstretched linea alba can cause these symptoms:

An unsightly bulge in the middle of the abdomen, particularly when you contract your abdominal muscles
This can also be associatd with an umbilical hernia
Difficulty lifting objects due to impaired abdominal strength
Lower back pain
Hip or pelvic pain
Poor posture
Pelvic floor disorders like urinary incontinence

Management of DRA

There is no consensus as to which type of exercise can improve the width of the linea alba. Some propose exercises focusing on the transverse abdominis muscle and the oblique muscles, some advocate curl-up or twisted curl-up exercises, some focus on pelvic floor muscle exercises or a combination of them.

With consistent and regular exercise to strengthen the abdominal muscles, the width of the diastasis of the rectus abdominis muscle may potentially improve over time. It may not return to its pre-stretched state entirely.

Electromagnetic muscle stimulation devices have been advertised for strengthening the abdominal muscles while lying comfortably on a couch. This is a non-invasive technology designed to also firm and tone the muscle. Multiple repeated sessions are required but it does not return the linea alba back to its pre-stretched state.

Ultimately the most powerful modality of treatment would be an abdominoplasty to repair the widened DRA and surgically bring the rectus abdominis muscle back to its midline position. This procedure can concurrently repair an umbilical hernia and remove lower abdomen excess skin and its associated stretch marks. Liposuction may also be performed at the same setting to improve the definition of the flanks and the upper abdominal tissue.

Some insurance companies may cover the cost of the procedure for symptomatic cases. Do check with your individual insurers on your coverage.

Frequently Asked Questions about Diastasis Recti

How do I know if I have Diastasis Recti?

Diastasis Recti is often noticeable as a bulge or ridge that appears in the midline of your abdomen, especially when you strain or contract your abdominal muscles. A common way to check for it is to lie on your back with your knees bent and feet flat on the floor. Gently place your fingers just above your belly button and lift your head slightly, as if you're starting a crunch. If you have Diastasis Recti, you may feel a gap of one or more finger-widths between your abdominal muscles. However, it's best to consult a healthcare professional for an accurate diagnosis and personalised advice.

Who is a good candidate for Diastasis Recti surgery?

Good candidates for Diastasis Recti surgery typically include individuals who:

Have a significant separation of the abdominal muscles that hasn't improved with conservative treatments like exercise.
Are finished having children, as future pregnancies can re-stretch the abdominal muscles.
Are in good overall health and have realistic expectations about the outcome of the surgery.

You should consult a doctor to determine if surgery is the right option for you.

Can Diastasis Recti be corrected without surgery?

Yes, in some cases, Diastasis Recti can be improved or corrected without surgery. Targeted exercises that focus on strengthening the deep core muscles, such as the transverse abdominis, can help to close the gap. However, the effectiveness of non-surgical treatments depends on the severity of the separation and individual factors. A doctor can give you advice based on your condition.

What does Diastasis Recti surgery involve?

Diastasis Recti surgery, also known as abdominoplasty with muscle repair, typically involves making an incision across the lower abdomen, similar to a tummy tuck. The surgeon then tightens the abdominal muscles by suturing them together in the midline, effectively closing the gap. In some cases, excess skin and tissue may also be removed to improve the overall appearance of the abdomen. The specific techniques used can vary depending on the extent of the Diastasis Recti and the patient's individual anatomy.

How long is the recovery after Diastasis Recti surgery?

The recovery period after Diastasis Recti surgery can vary, but it generally takes several weeks to months to fully recover. Initially, you can expect some pain, swelling, and bruising. You'll likely need to wear a compression garment to support your abdomen and promote healing. You will have to avoid strenuous activities and heavy lifting for several weeks. Following your surgeon's post-operative instructions carefully is crucial for a smooth recovery.