— In most cases, diastasis rectus abdominis can be diagnosed clinically. It happens that inspection, palpation and simple measurements are enough.

In the standing position, you can see the divergence of the muscles when the woman does not have subcutaneous fat. In this case, diastasis is defined as a vertical defect between the rectus muscles.

With tension of the abdominal press, a longitudinal protrusion is observed in the diastasis zone. Such a protrusion is especially noticeable if the patient in the supine position is asked to raise her head and legs. If necessary, you can measure the width of the defect simply with a ruler. nine0005

Ultrasound may be the most accurate diagnostic method. With ultrasound, the inner edges of the rectus muscles are clearly visible and the distance between them at different levels can be measured.

Computed tomography is used in the diagnosis of diastasis extremely rarely, mainly in scientific research.

For the diagnosis of symphysiopathy and diastasis pubis there is no one test as a "gold standard".

The first place, of course, is the questioning and examination of the patient. We pay attention to the gait of the pregnant woman, to how she sits down, lies down and how she gets up. Symphysiopathy is characterized by a “duck gait”, when a pregnant woman rolls from foot to foot. On palpation in the area of ​​the womb, pain and swelling are noted. The so-called pain provocative tests are used, for example, a mat-test (pulling up an imaginary rug, mat with your foot towards you). nine0005

The following questionnaires are used to assess quality of life, pain and disability: Health-Related Quality of Life (HRQL), Oswestry Disability Index (ODI), Disability Rating Index (DRI), Edinburgh Postpartum Depression Scale (EPDS), Pregnancy Mobility Index (PMI), and Pelvic Ring Score (PGQ).

Of the instrumental methods, ultrasound is the most widely used, less often computed or magnetic resonance imaging. Ultrasound allows you to assess the condition of the ligaments of the pubic joint and the interpubic disc, the severity of the changes and the risk of natural childbirth. nine0005

— What is the treatment for diastasis recti or pubis?

— Primary prevention: when planning and during pregnancy, it is necessary to strengthen all muscle groups of the pelvic girdle, as well as the pelvic diaphragm.

More often, diastasis of the rectus muscles disappears on its own during the first months after childbirth. Special physical exercises to correct the work of muscles, to tone them and restore their basic functions should be performed under the guidance of a competent instructor. There are types of physical exercises that can, on the contrary, worsen the situation with diastasis of the rectus abdominis muscles. In some cases, when there is no effect from physiotherapy exercises, it is necessary to resort to surgical correction of the defect. Currently, both endoscopic and open surgery are practiced. The choice of method depends on the size and localization of the defect. nine0005

With symphysiopathy, therapeutic exercises reduce lumbar and pelvic pain. Acupuncture and wearing a pelvic bandage have a positive effect on symphysiopathy.

Initial treatment of pubic symphysis should be conservative even if symptoms are severe. Treatment includes bed rest and the use of a pelvic brace or corset that tightens the pelvis. Early appointment of physiotherapy with dosed therapeutic exercises will help to avoid complications associated with prolonged immobilization. Walking should be done with assistive devices such as walkers. nine0005

In most cases (up to 93%), the symptoms of dysfunction of the pelvic ring, including the pubic joint, progressively subside and completely disappear six months after birth. In other cases, it persists, becoming chronic. However, if the diastasis exceeds 40 mm, then surgical treatment may be required. Most studies recommend surgery only after failure of conservative treatment, inadequate enlargement of diastasis, or its recurrence. Several procedures have been described, including external fixation and open reduction of the pubic bones with internal fixation. nine0005

The best advice for prevention, diagnosis and treatment: ask a competent doctor all the questions that worry you. Only the joint efforts of the doctor and the patient can overcome all problems and find the best solutions.

Diastasis of the rectus abdominis muscles - symptoms, signs, degrees, causes and treatment in men and women in Moscow in the "SM-Clinic"

The surgeon deals with the treatment of this disease

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• What is diastasis rectus abdominis?
• About disease
• Species
• Symptoms of diastasis recti
• Causes of diastasis recti
• Diagnostics of diastasis of the rectus abdominis muscles
• Expert opinion
• Treatment of diastasis recti
• Surgical treatment of diastasis recti
nine0085 Prevention
• Rehabilitation after surgery
• Questions and Answers
• Sources

About the disease

The disease is based on stretching and expansion of the white line of the abdomen - a tendon that is located between the rectus muscles, connects and holds them. This is a strip of connective tissue, consisting of several layers, located vertically in the middle of the abdomen from the xiphoid process to the pubic joint. nine0005

Due to an increase in intra-abdominal pressure or a violation of the properties of the connective fibers, the structure of the tendon changes, it weakens, becomes thinner and stretches. The trigger mechanism is prolonged pressure on the abdominal wall associated with pregnancy or visceral obesity. An aggravating factor is the loosening of the white line against the background of collagenopathy, the effects of relaxin, the immaturity of cellular structures, etc.

As a result, the white line becomes thinner and stretched. Normally, its dimensions are restored with a gradual decrease in the abdomen or as the properties of the connective tissue normalize. Thus, physiological diastasis is eliminated during the neonatal period or in women after childbirth. nine0005

If abdominal training is started early in the postpartum period, this leads to contraction of the rectus muscles and a simultaneous increase in intra-abdominal pressure, and the white line is fixed in a stretched position and does not hold the internal organs well. As a result, unaesthetic vertical folds form on the abdomen, a rounded protrusion appears, dysfunction of the digestive tract occurs and the risk of hernia formation increases.

Species

Depending on the magnitude of the stretching of the tendon ligament, there are 3 degrees of diastasis of the rectus abdominis muscles:

• first - the muscles move away from each other by 2.5-5 cm;
• second - ligaments diverge by 5-8 cm;
• third - the line is stretched more than 8 cm.

According to the localization of the place of maximum stretching, supra-umbilical, sub-umbilical and mixed forms of diastasis are distinguished.

According to the degree of involvement of other muscles of the anterior abdominal wall, the pathology is classified into types:

• A - classical divergence of muscles after natural childbirth; nine0086
• B - relaxation of the lower lateral sections of the muscles;
• C - expansion affects the region of the ribs and the xiphoid process;
• D - diastasis is combined with a curvature of the waistline.

Symptoms of diastasis of the rectus abdominis muscles

Manifestations of BPMD increase as the pathology progresses. In women, a vivid clinical picture manifests itself abruptly (shortly after childbirth), while in men the disease develops gradually.

At the onset of the disease, there may be no symptoms at all. The patient then notices a characteristic rounded vertical protrusion in the center of the abdomen. With deliberate tension of the press, the inner edges of the rectus muscles and the groove between them are clearly visible. Due to muscle dysfunction, pain in the spine, lower back, fatigue, and posture disorders are possible.

With the progression of the pathology, manifestations of dysfunction of the gastrointestinal tract join:

• heartburn;
nine0085 belching;
• flatulence;
• abdominal pain;
• constipation.

In the third stage of diastasis, patients are faced with the formation of hernias, which are formed due to structural defects in the white line. Possible ptosis (omission) of internal organs and serious disturbances in the work of the intestines (in severe cases, intestinal obstruction develops). Women often experience urinary incontinence, renal colic.

Causes of diastasis recti

Increase the risk of developing diastasis pathology of the connective tissue and increased pressure in the abdominal cavity. In different categories of patients, the causes of the development of PMSD are different.

Divergence of muscles in children is due to the failure of the musculature and tendons. After 2-12 months after birth, the muscles come into tone, the ligaments and tendons are strengthened - the process resolves itself. In premature babies and infants with intrauterine developmental pathologies, this may take longer. With Down syndrome, there is a risk of maintaining diastasis for life. nine0005

Pregnancy is the provocateur of diastasis of the rectus abdominis muscles in women. The growing uterus puts considerable pressure on the linea alba, stretching it. Under the action of hormones, the synthesis of collagen fibers is inhibited, the ligaments become looser. But a few months after the birth, the white line of the abdomen is normally restored.

In men, BMD is often provoked by obesity, physical activity and hereditary collagenopathies. The risk of diastasis increases with a tendency to constipation, as well as with chronic respiratory diseases accompanied by coughing. nine0005

Treatment of pathology by conservative methods is possible with a small diastasis. At the later stages of development, the pathological divergence of muscles is eliminated with the help of abdominal plastic surgery.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

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Treatment is carried out in accordance with clinical recommendations

2

A comprehensive assessment of the nature of the disease and treatment prognosis

Modern diagnostic equipment and own laboratory

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Diagnosis of diastasis of the rectus abdominis muscles

Identification of BPMD is not difficult, since the disease has characteristic clinical manifestations. With signs of diastasis, you should contact the surgeon.

An increase in the space between the rectus muscles is determined during palpation of the abdomen. To conduct the test, the patient is asked to lie on his back, legs slightly bent at the knees, and then tighten the abdominal muscles, raising his head and shoulder blades. In patients with obesity, the doctor is not always able to fully explore the width of the white line. nine0005

The exact size of the sprain is determined by ultrasound. This diagnostic method also allows you to detect complications (hernia, displacement of internal organs). In order to differentiate the symptoms of diastasis and manifestations of chronic diseases of the gastrointestinal tract or the genitourinary system, consultations of specialized specialists are prescribed.

Expert opinion

Surgeons warn that diastasis rectus abdominis is asymptomatic for a long time. Therefore, in the presence of predisposing factors (recent pregnancy and childbirth, chronic constipation, obesity) or non-specific complaints, you should independently feel the white line of the abdomen in the navel. If the distance between the rectus muscles is more than 2.5 cm, contact the surgeon. Also, do not delay the visit in any doubtful cases. Only a doctor can establish the correct diagnosis, self-examination does not exclude the need for an in-person consultation. nine0005

Egiev Valery Nikolaevich, surgeon, oncologist, doctor of medical sciences, professor, head of the department of surgery and oncology, FPC MR MI PFUR

Treatment of diastasis recti

Functional diastasis in newborns and puerperas does not require treatment. Doctors use expectant tactics, recommend adhering to the principles of rational nutrition, doing massages, and doing gymnastics. The observation period can last up to 12 months. If after this time the problem persists, the surgeon decides on an operative method of correction. nine0005

Conservative treatment

Patients are prescribed a diet to prevent constipation and excessive gas formation, as well as to gradually reduce weight. In the postpartum period, incl. after a caesarean section, women are advised to wear a bandage, support the stomach during sneezing and coughing. The general strengthening of the muscles allows you to quickly restore the tone of the anterior abdominal wall, so patients are prescribed exercise therapy, swimming, yoga classes. It is important to exclude any training of the abdominal muscles. You can not perform exercises in the knee-elbow position, as well as in the emphasis (bar). Such loads can be resumed after the restoration of the size of the white line. Conservative treatment is effective only at the 1st stage of BPMD. nine0005

Surgical treatment of diastasis of the rectus abdominis muscles

In case of complicated and uncomplicated diastasis of the rectus abdominis muscles of the 2-3rd degree, surgical treatment is indicated. It is possible to use the following surgical techniques:

• Tension plastic using own tissues. It involves stitching the edges of the muscles with the removal of excess connective tissue. To date, it is not used due to the high risk of recurrence.
• Tension-free repair with a mesh prosthesis. It implies the introduction of an endoprosthesis under the site of stretching. nine0086
• Tension plastic with prosthesis installation. It involves the removal of excess connective tissue, suturing the edges of the muscles and strengthening the zone with a polypropylene mesh.
• Combined technique. Includes muscle suturing, mesh strengthening, removal of excess adipose tissue and stretched skin.

Prevention

To reduce the risk of developing diastasis rectus abdominis, you should keep your body in shape - engage in regular exercise, train your muscles. However, do not overdo it: lifting weights can, on the contrary, become the main cause of muscle divergence. nine0005

It is also important to eat a nutritious and balanced diet - a lack of nutrients will lead to a decrease in the elasticity of the connective tissue.

It is necessary to control your weight - body mass index should not exceed 26 kg/m3. Obesity, especially of the abdominal type, is an important risk factor for BLV.

Prevention and timely treatment of chronic lung diseases accompanied by cough, pathologies of the digestive system, occurring with constipation, will reduce the possibility of increasing intra-abdominal pressure and, as a result, the likelihood of diastasis. nine0005

Rehabilitation after surgery

After surgery, the patient is under inpatient observation, receiving analgesic and antibiotic therapy. Full recovery lasts 1-3 months. During this period, the patient is prescribed a diet to normalize defecation, it is recommended to avoid significant physical exertion, weight lifting. To prevent excess tension, it is necessary to wear a bandage.

Questions and Answers

A surgeon deals with the treatment of pathology. nine0005

In the stronger sex, obesity and connective tissue dysplasia are considered to be the main cause of BMD. Sharp weight loss or weight gain, excessive passion for power loads are capable of provoking muscle divergence. If a man or close relatives have hernias, varicose veins, valgus flat feet, hemorrhoids, this is regarded as an increased tendency to PMSD.

There is no need to rush in this matter. Just the desire to quickly get in shape is the main reason for the progression of diastasis in women. Physical activity can be resumed 1-2 months after delivery. You can start with hiking or yoga. Abdominal exercises can be performed soon after the white line is reduced to 2 cm. It is advisable to pay attention to the diet. A smooth decrease in weight and volume of visceral fat will ensure gradual and timely muscle contraction. Sharp weight loss, on the contrary, can increase diastasis. nine0005

You can lie on a hard surface on your back, tense your abs. With gentle movements of the fingers, you should begin to probe the stomach in the middle in the navel. With a normal width of the white line and with diastasis, a depression will be found - this is the median ligament. If its width is equal to or greater than the width of two fingers, you should contact the surgeon. Constipation, bloating and abdominal pain should be alarming. If there are such symptoms, it is necessary to get to the surgeon in the near future.

Pathogenesis and treatment of ventral hernias and diastasis of the rectus abdominis muscles: Abstract of the thesis / Zagirov U.Z. - nineteen95.

Comparative aspects of methods for eliminating diastasis of the rectus abdominis muscles / Topchiev MA, Bondarev VA, Elderov S.Sh.// Astrakhan medical journal. - 2010.

Jessen M. L., Öberg S., Rosenberg J. Treatment Options for Abdominal Rectus Diastasis // Front Surg. - 2019. - No. 6. - R. 65

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Diseases referred by a surgeon

Esophageal ulcer Appendicitis Ascites Atheroma femoral hernia Crohn's disease Bursitis Hernia Hernia of the white line of the abdomen hiatal hernia Cholelithiasis Keratoma salivary gland cyst Lipoma Bowel obstruction Oleogranuloma kidney tumor Acute pancreatitis Inguinal hernia Peritonitis Barrett's esophagus Polycystic kidney disease Postoperative hernia Umbilical hernia Stomach cancer Reflux esophagitis (GERD) Thyroiditis Furuncle (boil) Furunculosis cholestasis Cholecystitis Chronic cholecystitis Erosive gastritis Peptic ulcer of the stomach and duodenum

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