Overview of Diastasis Recti Rehabilitation
Diastasis recti is a condition where the two large muscles that meet in the middle of your abdomen separate, causing a gap. This happens because the front of the abdominal wall becomes weak. This weakening and separation create a thin, wide line, known as the linea alba, down the middle of the belly.
If you’re having this problem, you might feel like your middle is unstable, or you might even see a bulge in the midsection of your belly, which can become more noticeable when you do things that strain your abdomen, like doing sit-ups. Diastasis recti can also cause urinary leaks when you cough, laugh, or sneeze and back pain.
It’s important to note that diastasis recti can cause some confusion because it can seem like another condition called a ventral hernia. The main difference is that while diastasis recti is a separation of the muscles, a ventral hernia is a hole or tear in the abdominal wall.
Diastasis recti is often linked to conditions that increase pressure in your belly, such as pregnancy or obesity, as well as diseases that weaken the tissues that connect your muscles. The way doctors treat diastasis recti differs—some suggest altering your lifestyle and doing specific exercises, while others suggest surgery.
Everyone’s body is different, so what’s considered a “normal” gap between the two belly muscles varies. However, most experts suggest a separation wider than two centimeters is usually abnormal, but also point out, more or less separation can exist without necessarily causing discomfort or bothersome symptoms.
Anatomy and Physiology of Diastasis Recti Rehabilitation
The rectus abdominis diastasis is a condition that concerns the anatomy of the stomach wall. To understand this, we need to talk a bit about the layers of the stomach area. These are, in order from outside to inside: the skin, a layer of fat (which includes what doctors call ‘Scarpa’s fascia’), the front part of the rectus abdominis muscle, the muscle itself, more fat, and finally the layer called parietal peritoneum.
At the center of the stomach muscles is a structure known as the linea alba, which separates the rectus abdominis muscles. These are the muscles lining the midsection of your stomach, running from the rib cage down to the pubic bone.
The linea alba is an extension of the tissue surrounding the rectus abdominis muscle, which is made from the layering of other muscles in your stomach area. The rectus abdominis muscle and the rest of the front of your stomach mainly get their blood supply from the inferior epigastric artery, a blood vessel that’s linked to the one running from the leg up to the heart. There are also some other vessels that supply blood to the outer layers of the stomach, including the skin.
The exact cause of rectus abdominis diastasis is unclear, but it seems to be tied to either weakness in the linea alba and the front stomach muscles, or to weight gain. It can also be born with, which may be linked to abnormal genes.
Doctors can often tell if someone has rectus abdominis diastasis by doing a simple physical exam. If they need more information, they might use ultrasound, a CT scan, or an MRI to check for other issues.
Why do People Need Diastasis Recti Rehabilitation
Diastasis recti is a condition where the large abdominal muscles separate, often causing a bulge in the middle of the stomach. People with this condition might experience other symptoms, but it doesn’t always cause problems. It’s important to note that diastasis recti is not a type of hernia, and it doesn’t pose any serious health risks.
If the appearance or other symptoms of diastasis recti are bothering the person, then intervention may be considered. This intervention can be as simple as exercises to help strengthen the abdominal muscles, or could be surgical intervention in more extreme cases. Some experts define diastasis recti as an abnormal distance more than 2cm between the larger abdominal muscles at the midpoint of the stomach.
Different experts look for this distance at various points along the center of the stomach area, such as above the belly button, at the belly button, or below it. Generally, the distance between the muscles tends to be larger above the belly button than below it, even in people without diastasis recti. Rather than focusing purely on the exact measurements, it is more essential to understand and address the patient’s concerns and symptoms.
While progress can be tracked using these measurements, satisfaction with treatment is often determined based on whether the patient’s symptoms have improved and whether they are happier with their appearance, rather than by how much the distance has reduced.
When a Person Should Avoid Diastasis Recti Rehabilitation
If a patient is showing symptoms of diastasis recti, which is the separation of the abdominal muscles, doctors must first ensure they don’t have a different problem called a ventral or umbilical hernia. How do we do this? Sometimes a simple physical check-up could be enough. But in cases where the diagnosis is unclear, the doctor might use imaging techniques like an X-ray or ultrasound to make sure it’s not a hernia. A hernia, which is a bulge or protrusion of body tissue or an organ through the structure that normally contains it, can come with its own risks and a different method of treatment compared to diastasis recti.
Interestingly, a person can have diastasis recti and a hernia at the same time. It’s crucial to pinpoint patients with actual abdominal hernias (protruding tissue or organ), as this condition can lead to serious problems like blockage of the intestine, cutting off blood circulation, or an organ getting trapped.
Each patient’s overall health status should guide the treatment plan, weighing the advantages and disadvantages of each option. Also, it’s worth noting that surgery for diastasis recti is usually a planned procedure, not an emergency one. Therefore, prior to the procedure, the patient’s overall health should be in the best possible condition. This ensures the best outcomes from the procedure.
Equipment used for Diastasis Recti Rehabilitation
If you’re having surgery to treat rectus abdominis diastasis, or separation of your abdominal muscles, it will be carried out in a specially equipped operation room. The doctor will use regular surgical tools for this procedure. Normally, there’s no need for any special equipment to perform this type of surgery.
How is Diastasis Recti Rehabilitation performed
Diastasis recti, which is a separation observed between the abdominal muscles, usually fixes itself naturally, especially in infants. However, sometimes the separation remains and further treatment is needed. The best treatment method isn’t exactly determined yet, but usually, doctors suggest simple changes in everyday life. These include healthier lifestyle habits, losing weight where necessary, and physiotherapy. Various exercises and physiotherapy routines have been established for treating diastasis recti, which, research suggests, might bring more functional rather than cosmetic benefits.
There are also several programs focused on preventing this condition during pregnancy and alleviating symptoms after childbirth. These programs might also include exercises for strengthening the pelvic floor muscles, which can be useful in preventing or treating urinary leakage issues.
When simple methods aren’t effective, doctors might consider surgery. Numerous surgical approaches are available for treating diastasis recti, including tightening the connective tissue between the separated abdominal muscles, altering hernia repair techniques, and combining hernia repair with tightening of the abdominal connective tissue. These surgical procedures can be performed with an open incision approach, through tiny incisions using a laparoscope or a robot, with or without implanting a mesh (a surgical fabric used to provide extra support).
Laparoscopy (surgery performed through small incisions using a scope) is usually considered if the patient hasn’t had previous hernia surgery and doesn’t prefer a belly tuck procedure. Research suggests that laparoscopic treatment could have a lower risk of complications compared to open surgery. During a belly tuck surgery, excess skin and fat can be removed while repairing diastasis recti.
Surgery can also be an option in cases where diastasis recti coexists with an abdominal or belly-button hernia needing surgical repair, or if the patient experiences difficulty with the functioning of their abdominal wall. However, if future pregnancy is planned, surgical procedure for diastasis recti is usually not recommended.
There are instances when the repair of diastasis recti and a tummy tuck procedure are done together, especially if patients show skin looseness along with their diastasis recti.
Possible Complications of Diastasis Recti Rehabilitation
Complications from physical therapy and other non-surgical treatments for diastasis recti, a condition where your belly sticks out because the space between your left and right belly muscles have widened, is quite rare. However, some people may not be happy with the results after completing their treatment.
There are also potential complications from surgical treatments for diastasis recti. These can include not being happy with how the surgery improved their appearance or symptoms, and the diastasis recti may even come back. Some people might experience a hematoma, which is a swelling of clotted blood within the tissues, especially in the muscle sheath or casing of the abdomen muscles. There could also be complications with the surgical wound or an infection.
Damage to structures near the surgery site, scarring from the cut made during surgery, and complications related to the use of a mesh, if one is used during surgery, are also potential issues. If a hernia, which is a bulge of organs or tissues through the wall that contains it, is mistaken for diastasis recti, there can be serious issues like bowel obstruction or strangulation within the hernia.
What Else Should I Know About Diastasis Recti Rehabilitation ?
If a person has a condition called diastasis recti, where the large abdominal muscles separate, they might worry about the presence of a hernia or other issues. Some individuals are relieved to know that if diastasis recti is left untreated, it won’t cause any dangerous health troubles. However, some might want medical intervention, and doctors should talk them through their treatment choices.
In the long term, diastasis recti has been linked to a health condition called aneurysmal disease, which is when an artery swells up like a balloon due to the weakness of the tissue around it. However, currently, there are no official recommendations suggesting that people with diastasis recti should get screened for abdominal aortic aneurysms (another type of swollen artery condition) or other types of aneurysms.
