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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.

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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.