Treatment Options for Abdominal Rectus Diastasis

Abstract

Background: Abdominal rectus diastasis is a condition where the abdominal muscles are separated by an abnormal distance due to widening of the linea alba causing the abdominal content to bulge. It is commonly acquired in pregnancies and with larger weight gains. Even though many patients suffer from the condition, treatment options are poorly investigated including the effect of physiotherapy and surgical treatment. The symptoms include pain and discomfort in the abdomen, musculoskeletal and urogynecological problems in addition to negative body image and impaired quality of life. The purpose of this review was to give an overview of treatment options for abdominal rectus diastasis.Results: The first treatment step is physiotherapy. However, evidence is lacking on which regimen to use and success rates are not stated. The next step is surgery, either open or laparoscopic, and both surgical approaches have high success rates. The surgical approach includes different plication techniques. The recurrence and complication rates are low, complications are minor, and repair improves low back pain, urinary incontinence, and quality of life. Robotic assisted surgery might become a possibility in the near future, but data are still lacking.Conclusions: Evidence on what conservatory treatment to use is sparse, and more research needs to be done. Both open and laparoscopic surgery have shown positive results. Innovative treatment by robotic assisted laparoscopic surgery has potential, however, more research needs to be done in this area as well. An international guideline for the treatment of rectus diastasis could be beneficial for patients and clinicians.

Avoidance and Correction of Deformities in Body Contouring

“…79 Most frequently, rectus diastasis presents as a centrally located epigastric bulge in a patient with a history of truncal obesity or pregnancy; however, patients can present with abdominal pain or discomfort, back pain, or urogynecological symptoms in rare cases. 79,80 Plication of the rectus sheath is the gold standard treatment for rectus diastasis. There are several techniques that may be employed for rectus diastasis repair, though plastic surgeons typically use an open approach (via abdominoplasty) and plicate the anterior rectus sheath.…”

“…Recurrence of rectus diastasis is uncommon following plication, with studies reporting recurrence in only 0% to 4% of patients. [80][81][82]…”

Impact of Rectus Diastasis Repair on Abdominal Strength and Function: A Systematic Review

“…Details of strength and functional outcome scales can be found in Table 3 . Objective and subjective measurements of abdominal strength were reported in three studies, and the details of each study can be found in Table 4 [ 1 , 18 , 20 ]. Overall, rectus plication did not consistently improve abdominal strength.…”

“…Abdominal rectus diastasis (ARD) is the separation of the rectus muscles due to thinning along the linea alba [ 1 ]. This separation may be caused by abdominal obesity, pregnancy, or congenital collagen abnormalities, and can lead to a permanent increase in the width of the aponeuroses from the patient's baseline by several centimetres [ 2 ].…”

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

“…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.…”