Management Strategies for Diastasis Recti

Abstract

Diastasis recti is a relatively common condition in which there is a midline abdominal bulge that can affect a variety of individuals. The etiology and diagnosis is well understood and optimal management depends on the degree of severity. Patients at high risk for diastasis recti include multiparous women, obese patients, and those with multiple previous operations. Diagnosis includes clinical examination and assessment of symptoms. Physical characteristics include a midline abdominal bulge without a fascial defect. Classification systems are based on the degree of separation between the paired midline rectus and myofascial deformity. Optimal management varies and includes simple plication of the midline defect, extensive plication of the anterior abdominal wall, and sometimes the use of resorbable or nonresorbable mesh.

Keywords: Diastasis recti; abdominal bulge; abdominal hernia; pregnancy; rectus diastasis.

Figures

Fig. 1

Illustration of the anterior abdominal wall demonstrating the anterior rectus sheath, linea alba, linea semilunares, and the ventral muscles.

Fig. 2

A woman with rectus diastasis is depicted demonstrating the midline bulge.

Fig. 3

Preoperative image of a multiparous woman with diastasis recti.

Fig. 4

Lateral view demonstrating significant abdominal laxity and bulge.

Fig. 5

Intraoperative photograph demonstrating the midline bulge of the linea alba.

Fig. 6

Intraoperative lateral photograph demonstrating the degree of abdominal protrusion prior to repair.

Fig. 7

Intraoperative photograph following three-column plication of the linea alba and anterior rectus sheath using a two-layer technique.

Fig. 8

Intraoperative photograph following placement of the nonresorbable mesh over the plicated anterior rectus sheath.

Fig. 9

Intraoperative photograph of the redundant skin and fat constituting the abdominoplasty.

Fig. 10

Six-month postoperative anterior view following successful diastasis repair and abdominoplasty.

Fig. 11

Six-month postoperative lateral view.