Diseases

Diastasis recti

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At a diastasis recti (Out of Alignement, midline fracture) the straight abdominal muscles diverge. This causes abdominal wall fractures. The cause is an abdominal wall weakness, which is often caused by pregnancy or obesity. The therapy consists in the strengthening of the abdominal muscles, in some cases must be operated on. Read more about symptoms, diagnostics and therapy of rectus diastase.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. M62ArtikelübersichtRektusdiastase

  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Rectus diastase: description

As a rectus diastase, the doctor refers to the expansion of the so-called Linea alba, a vertical connective tissue suture on the abdomen. As a result, the right and left straight abdominal muscles deviate to the side and a tactile gap remains. The linea alba is usually one to two centimeters wide and is formed by the intertwining connective tissue structures of the straight abdominal muscles, which obscure the surface of the anterior abdomen. Rectal diastasis does not count as a true fracture, even if it is similar to a fracture on standing or under increased pressure in the abdomen due to protrusion.

The rectus diastase is most pronounced in the navel and is between one and ten centimeters long. Sometimes it extends from the costal arch to the pubic bone.

In women, the rectus diastase is much more common than in men: The strains of pregnancy, the straight abdominal muscles are overstretched and diverged (Out of Alignement). If the abdominal muscles are weak, the muscle strands can even diverge more than a hand's breadth. This affects the maintenance, support and support function of the muscles. Despite weight loss remains in this case, after pregnancy, an ugly protrusion back to the front abdominal wall.

In men, the rectal diastasis usually occurs limited to the area above the navel.

Abdominal muscles build up

Under the skin of the abdominal wall is the more or less pronounced layer of fat, which is separated from the musculature by a connective tissue structure (fascia). The abdominal muscles are the basis of the abdominal wall, which is still separated from the intestines by the peritoneum. The muscle layers are made up of different muscles. The flat straight abdominal muscle, for example, connects the ribcage and the pelvis. The lateral abdominal muscles envelop the straight abdominal muscles with their flat tendons on each side, where they form the so-called rectus sheath. In its center is the linea alba, which is affected by rectal diastasis.

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Rectus diastase: symptoms

A rectus diastase usually causes no complaints. For those affected, a gap in the middle of the stomach is palpable. Tension can cause a visible and palpable bulge.

As pregnancy progresses, rectal diastasis can be felt with low back pain, buttocks, and hips during exercise. In particular, women who have already had several pregnancies suffer as the muscles have been repeatedly stretched.

Excess tissue and skin may protrude from the front of the abdomen, while in the last trimester of pregnancy the upper part of the uterus protrudes from the abdominal wall. With very large rectus diastases, sometimes even the outlines of the unborn baby can be seen.

The birth can be complicated by the rectus diastase, since the abdominal muscles can not be sufficiently strong used to push out the child. An upright posture and the back muscles can compensate for this.

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Rectus diastasis: causes and risk factors

Most rectal diastases are acquired, especially pregnant women suffering from it, infrequently innate risk factors play a role.

Acquired rectus diastase

Pregnancy is a typical trigger of a rectus diastase. During pregnancy, the abdominal muscles stretch through the growing child in the uterus and lose their tension. In addition, the pregnancy hormone Relaxin has a relaxing effect and promotes stretching of the Linea Alba. The rectus diastase often arises in the last trimester of pregnancy, when the stomach becomes more and more expansive. Women should therefore try not to put extra strain on their tummy, for example by lifting heavy things.

Repeated pregnancies or multiple pregnancies increase the risk of rectal diastasis.

Obesity also leads in some cases to a rectus diastase, since the abdominal wall can also be overstretched by the abdominal fat.

Congenital rectus diastase

Rarely does the rectus diastase have congenital causes. In such a case, the abdominal muscles do not run parallel, but diverge upwards. The linea alba widens, causing the abdominal wall to bulge.

Rectus diastase in newborns

Rectal diastasis can also occur in newborns and infants, as the distance between the two straight abdominal muscles is comparatively wide. However, the rectal diastasis disappears as soon as the children start to walk. An operation is usually not necessary.

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Rectus diastase: examinations and diagnosis

In case of suspected rectal diastasis, the gynecologist or general practitioner is usually the first point of contact. To collect the medical history (anamnesis), the doctor will first have a detailed conversation with the patient, in which he asks, for example, if someone already has several children.

Physical examination

In the case of rectus diastasis, the doctor makes the diagnosis relatively easily on the basis of a palpation finding. For this, the patient lies on his back and is asked to tense the abdominal wall, for example by raising his head. The doctor can feel well with his fingers above the navel the gap in the abdominal wall between the strained muscle strands.

When the patient straightens up, laughs or coughs, the rectus diastasis bulges out as a "ridge" between the two standing straight abdominal muscles. In women with a multiple pregnancy or a pathological increase in the amount of amniotic fluid (polyhydramnios) is often a clearly drawn abdominal muscles palpable.

An ultrasound examination is rarely necessary with a rectus diastase, it makes visible how far the rectus diastase has progressed.

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