Brief overview
- Treatment: Dependent on symptoms, primarily through physiotherapy or certain abdominal muscle exercises; surgery possible in the case of symptoms, high levels of suffering or the presence of genuine hernias of the abdominal wall (ventral hernias)
- Causes and risk factors: widening of the long tendon strips in the middle of the abdomen by more than two centimetres, mostly acquired causes (obesity, pregnancy), less frequently congenital causes; risk factors: Abdominal girth increase due to obesity and before/during pregnancy(s), weight training, chronic constipation
- Symptoms: sometimes visible and palpable bulge under tension, aesthetic discomfort, sometimes severe back pain with increased thinning, also noticeable in the buttocks and hips during physical exertion, pelvic floor weakness sometimes with urinary incontinence, hernia formation possible with increased thinning at the linea alba
- Diagnosis: Medical consultation (medical history), physical examination with palpation while lying down with tense abdominal muscles, visual diagnosis of “bulge formation”, degree of progression visible with ultrasound
What is a rectus diastasis?
Doctors refer to a rectus diastasis as a palpable gap in the abdominal wall, a widening of the so-called linea alba by more than two centimetres. The linea alba is a vertical connective tissue suture on the abdomen. If there is a widening, the right and left straight abdominal muscles deviate to the side and a palpable gap remains.
The linea alba is normally one to two centimetres wide and is caused by the intertwining of connective tissue structures of the straight abdominal muscles, which cover the surface of the front abdomen. Rectus diastasis is not a true hernia, even if it resembles a hernia when standing or when there is increased pressure in the abdominal cavity due to the protrusion.
The rectus diastasis is usually most pronounced in the area of the navel and is between one and ten centimeters long. Sometimes it extends from the costal arch to the pubic bone.
If the abdominal muscles are weak, it is possible for the muscle strands to become more than a hand’s breadth apart. As a result, this impairs the holding, supporting and carrying function of the muscles. In this case, despite weight loss, a protrusion remains on the anterior abdominal wall after pregnancy.
In men, rectus diastasis is usually limited to the area above the navel.
How is rectus diastasis treated?
To correct rectus diastasis, the first step is to train the abdominal muscles. If necessary, the doctor will recommend weight reduction if you are overweight. If there are hardly any complaints, doctors rarely suggest surgery. Surgery for rectus diastasis is not necessary in most cases, as rectus diastasis in particular disappears on its own after pregnancy and can be treated with physiotherapy.
In some cases, however, rectus diastasis leads to physical or psychological complaints, or complications such as hernias occur, in which case doctors advise surgery. If there is excess skin tissue, a plastic surgeon is usually part of the surgical team.
How is rectus diastasis surgery performed?
The surgeon applies internal sutures to fix the abdominal muscles in the correct position. Doctors additionally stabilize the abdominal wall with plastic mesh. Due to the minimal tissue damage during this endoscopic procedure, the recovery period after the operation is shorter.
After rectus diastasis surgery, the patient usually wears an elastic abdominal bandage that compresses the abdomen and a special compression garment for around six weeks. Heavy physical activity and sport (abdominal exercises) should be avoided for about four to six weeks.
As long as the rectus diastasis is palpable for the doctor, it is important not to strain or exercise the straight abdominal muscles (yet). This will prevent the rectus diastasis from getting bigger.
In everyday life, for example, this means making sure that you only stand up from a lying position on your side. To do this, first roll onto your side and then support yourself laterally with your arm in order to sit up.
Physiotherapy exercises
It is possible to start exercising shortly (= a few days) after a spontaneous delivery or after a slightly longer period (= a few weeks) after a caesarean section. With targeted and regular exercise sessions, the rectus diastasis decreases and is usually only one centimeter wide.
Even rectus diastasis that has existed for several years can be positively influenced by certain exercises.
When can rectus diastasis occur?
Rectus diastasis mainly occurs in pregnant women. Most rectus diastases are acquired; congenital risk factors rarely play a role.
Acquired rectus diastasis
Pregnancy is a typical trigger for rectus diastasis. During pregnancy, the abdominal muscles stretch due to the growing child in the uterus and lose their tension as a result.
In addition, the pregnancy hormone relaxin has a relaxing effect and promotes stretching of the linea alba. Rectus diastasis often occurs in the last trimester of pregnancy when the abdomen increases in size. To avoid putting additional strain on the abdomen, it is advisable for pregnant women not to lift heavy objects, for example.
Repeated pregnancies or multiple pregnancies increase the risk of rectus diastasis.
Congenital rectus diastasis
Rectus diastasis rarely has congenital causes. In such cases, the abdominal muscles do not run parallel but diverge upwards. The linea alba widens, which may cause the abdominal wall to bulge.
Rectus diastasis in newborns
Rectus diastasis also occurs in newborns and infants, as the distance between the two straight abdominal muscles is comparatively wide. However, rectus diastasis disappears again as soon as children start walking. Surgery is not usually necessary.
What symptoms does rectus diastasis cause?
Rectus diastasis causes different symptoms. For many, there are usually no or only a few symptoms, especially at the beginning. Those affected can feel a gap in the middle of the abdomen. Under tension, there is sometimes a visible and palpable bulge. With increasing thinning of the linea alba, there is a growing risk of real hernias occurring.
The psychological aspect is also stressful for those affected. In some patients, the aesthetic distress leads to reduced self-esteem, which, in addition to the physical stress, results in a reduced quality of life.
Some women have severe pelvic floor weakness as a result, which sometimes leads to urinary incontinence. They are then sometimes unable to hold in their urine. Excess tissue and skin may protrude in the front of the abdomen, and in the last trimester of pregnancy the upper part of the uterus protrudes from the abdominal wall. In the case of very large rectal diastases, the outline of the unborn baby can sometimes even be seen.
In some cases, rectus diastasis makes delivery more difficult. The reason for this is that the abdominal muscles cannot be used with sufficient strength to push the baby out. There are simple measures to compensate for this. For example, it helps if the woman giving birth sits upright and uses her back muscles.
Bowel problems or abdominal pain are not typical signs of rectus diastasis. These are more likely to be signs of a real hernia such as an abdominal wall hernia. Pain occurs when organs (e.g. a piece of bowel) become trapped in the gap in the abdominal wall, otherwise genuine hernias are not usually painful. At the same time, abdominal wall hernias often occur together with rectus diastasis.
How can a rectus diastasis be diagnosed?
If rectus diastasis is suspected, the gynecologist or general practitioner is usually the first point of contact. To take a medical history, the doctor will first have a detailed discussion with the patient. He will ask about possible risk factors. For example, whether there have already been several childbirths.
Physical examination
In the case of rectus diastasis, the doctor makes the diagnosis relatively simply on the basis of palpation. To do this, lie on your back and tense the abdominal wall, for example by lifting your head. This allows the doctor to feel the gap in the abdominal wall between the tense muscle cords above the navel with their fingers.
In many cases, the rectus diastasis bulges out as a “bulge” between the two standing straight abdominal muscles when those affected laugh or cough. In women with a multiple pregnancy or an abnormal increase in the amount of amniotic fluid (polyhydramnios), a clearly drawn-out abdominal muscle can often be felt.
An ultrasound examination is rarely necessary in the case of rectus diastasis. However, it allows the doctor to see how far the rectus diastasis has progressed.
How does rectus diastasis progress?
If there is pain in the lower back, it should be clarified whether an operation is advisable. Complications only occur if the rectus diastasis develops into a hernia, resulting in the trapping of organs or organ parts.
