Management Strategies for Diastasis Recti

Nahabedian, Maurice Y.

doi:10.1055/s-0038-1661380

Cited by 58 publications

(54 citation statements)

References 31 publications

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“…Even though it is mainly puerperium women who consult physiotherapists with their DRA, the issue concerns many potentially healthy subjects [20,21]. We may even risk a statement that with the rising general awareness on the benefits of physical activity on health, the DRA problem will intensify.…”

Section: Discussionmentioning

confidence: 99%

Diastasis recti abdominis - what may cause it in postpartum women?

Gruszczyńska¹,

Dąbek²,

Rekowski³

2021

areh

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Introduction: Diastasis recti abdominis (DRA) is both a structural and a functional disorder. It is believed that the main cause of DRA is the extensive stretching of the abdominal wall resulting from pregnancy; yet the condition is also found in men and in children. There are several, seemingly mutually exclusive, DRA risk factors, such as the pathological abdominal muscle tension and chronic exercise deficits. The aim of the study was to determine the factors affecting the size of DRA in postpartum women. Material and methods: The study involved 239 postpartum women. The study was conducted with the use of an online survey. The subjects completed the DRA test, the Beighton test and International Physical Activity Questionnaire. Results: The analysis found DRA in majority of studied women (60.7%). The relationship between the BMI index and DRA was statistically significant (p=0.01). The relationship between surgeries in the abdominal cavity and the DRA was statistically significant, too (p=0.05). We showed that DRA correlates with other pelvic dysfunctions (p=0.03). Conclusions: The most significant risk factors for diastasis recti abdominis in postpartum women are abnormal BMI and surgeries to the abdominal cavity. Diastasis recti abdominis correlates with other dysfunctions, such as: spinal pain, urinary incontinence, peristaltic disorders, sexual disorders, abdominal hernia, groin hernia, lowering of the lesser pelvis organs. Further studies into DRA risk factors under close supervision of a physiotherapist are necessary.

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Section: Discussionmentioning

confidence: 99%

Diastasis recti abdominis - what may cause it in postpartum women?

Gruszczyńska¹,

Dąbek²,

Rekowski³

2021

areh

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“…Clinical management of DRA is challenging [ 10 ]. Based on the pathophysiology described by Baumann et al [ 11 ], the combination of physiotherapy and surgical repair has the potential to improve the anatomical divarication and the laxity of the ventral abdominal muscles.…”

Section: Introductionmentioning

confidence: 99%

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

Zhou

Zhu

et al. 2021

Insights Imaging

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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.

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“…The plication-based techniques include open plication, laparoscopic plication, or hybrid plication of either the anterior or posterior rectus fascia. Plication can be performed with single-or double-layer sutures, using an interrupted or continuous, absorbable, slowly absorbable, or permanent sutures according to the surgeon's preferences [2][3][4]. In the case of coexistence of extensive laxity of the abdominal wall, onlay mesh reinforcement is generally used, even though there is a lack of evidence on which type of mesh should be used.…”

mentioning

confidence: 99%

“…The condition is due to an increase in intra-abdominal pressure in which the forces applied to the linea alba cause it to stretch, resulting in a widening of the inter-rectus distance. For these reasons, it occurs most frequently after pregnancy, but obesity or previous abdominal surgeries can also be the cause [ 1 , 2 ].…”

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confidence: 99%

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A new minimally invasive technique for the repair of diastasis recti: a pilot study

et al. 2021

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Background Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. Methods It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. Results Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. Conclusions This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

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Management Strategies for Diastasis Recti

Cited by 58 publications

References 31 publications

Diastasis recti abdominis - what may cause it in postpartum women?

Diastasis recti abdominis - what may cause it in postpartum women?

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

A new minimally invasive technique for the repair of diastasis recti: a pilot study

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