The rectus abdominis muscles are joined in the midline by a fibrous membrane that runs from the sternum to the pubis. A separation or distance between the internal borders of the two rectus muscles of up to 2 centimeters can be considered normal or “physiological”.
Certain situations that produce an important increase in abdominal pressure, as occurs mainly with pregnancy (also due to obesity, constipation, intense efforts, etc.), can produce a “separation” or widening of the space between the rectus muscles of more than 2 centimeters, which is known as rectus diastasis.
This separation or diastasis produces an area of decreased resistance in the midline of the abdomen and is evident when the abdomen is contracted, in the form of an elongated bulge in the midline, and a “sagging” of the midline when the patient is lying down.
Diastasis can affect both men and women. In men it is usually associated with abdominal obesity and appears in the supraumbilical area. In women it is directly related to pregnancy, especially in the gestation of large babies or in twin pregnancies, and usually appears above and below the umbilicus.
Aesthetic concern
Diastasis recti has traditionally been considered a purely aesthetic problem.
Due to the alteration of the muscular structure of the abdominal wall that diastasis produces, there are more and more studies that relate it to spinal pathologies that produce low back pain, rectification of the alignment (lumbar lordosis), constipation due to lack of abdominal “press” and that can diminish the quality of life of patients.
Likewise, many studies have shown a higher incidence of urinary incontinence and pelvic floor weakness in relation to long-standing diastasis recti.
Diagnostic tests
Diastasis recti can be diagnosed by a simple clinical examination, measuring the space between the rectus muscles about 3 cm above the umbilicus in the resting position. If in this space “fit” two or more fingers we have a diastasis recti.
It may be necessary to perform an imaging test (usually an ultrasound) to make a more correct measurement and to assess the presence of umbilical or supraumbilical hernias, which are associated with diastasis with a very high frequency (up to 90% according to some studies).
Treatment
Isometric and hypopressive exercises help to strengthen the abdominal and pelvic musculature, but do not correct diastasis recti.
The only treatment that is currently capable of correcting pathological diastasis is surgery. Recently, minimally invasive techniques have been developed that do not leave visible scars and that manage to bring both rectus muscles closer to the midline achieving, in addition to an excellent aesthetic result, a reconstruction of the abdominal musculature.
Thanks to the minimally invasive approach, postoperative pain is minimal and hospital stay is very short (usually less than 24 hours).
In Laparoscopic Surgery Madrid, we have extensive experience in the treatment of diastasis recti with the REPA Technique (Endoscopic Preaponeurotic Repair), with excellent results and a high degree of satisfaction of our patients.