Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study

R L Kaufmann, C S Reiner, U A Dietz, P A Clavien, R Vonlanthen, S A Käser, R L Kaufmann, C S Reiner, U A Dietz, P A Clavien, R Vonlanthen, S A Käser

Abstract

Aim: The prevalence and definition of diastasis recti abdominis (DRA) is under debate. This retrospective cross-sectional study evaluated the interrectal distance and the prevalence of DRA in computed tomography (CT) in an asymptomatic population.

Materials and methods: Patients undergoing CT scans for suspected appendicitis or kidney stones from 01/2016 to 12/2018 were screened retrospectively to participate. A study population with equal distribution according to gender and age (18-90 years) was generated (n = 329 patients) and the interrectal distance was measured at six reference points.

Results: DRA (defined as > 2 cm at 3 cm above the umbilicus) was present in 57% of the population. The 80th percentile of the interrectal distance was 10 mm at the xiphoid (median 3 mm, 95% confidence interval (CI) 0-19 mm), 27 mm halfway from xiphoid to umbilicus (median 17 mm, 95% CI 0-39 mm), 34 mm at 3 cm above the umbilicus (median 22 mm, 95% CI 0-50 mm), 32 mm at the umbilicus (median 25 mm, 95% CI 0-45 mm), 25 mm at 2 cm below the umbilicus (median 14 mm, 95% CI 0-39 mm), and 4 mm halfway from umbilicus to pubic symphysis (median 0 mm, 95% CI 0-19 mm). In the multivariate analysis, higher age (p = 0.001), increased body mass index (p < 0.001), and parity (p < 0.037) were independent risk factors for DRA, while split xiphoid, tobacco abuse, and umbilical hernia were not.

Conclusion: The prevalence of DRA is much higher than commonly estimated (57%). The IRD 3 cm above the umbilicus may be considered normal up to 34 mm. To avoid over-treatment, the definition of DRA should be revised.

Keywords: Diastasis recti abdominis; Interrectal distance; Linea alba width; Normal width; Prevalence; Rectus abdominis diastasis.

Conflict of interest statement

All the authors declare that there are no known conflicts of interest or significant financial contribution for this publication that could have influenced its outcome.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
a, b Measurement of the IRD showed 20 mm at the umbilicus on a CT scan5. 5A aorta, K kidney, OAM oblique abdominal muscles, RAM rectus abdominis muscle, SE spinal erectors, VB vertebral body
Fig. 2
Fig. 2
Reference points for the measurement of the linea alba width
Fig. 3
Fig. 3
Distribution of the interrectal distances at different reference points above the umbilicus
Fig. 4
Fig. 4
Distribution of the interrectal distances at different reference points at and below the umbilicus
Fig. 5
Fig. 5
IRD (mm) according to BMI (kg/m2)
Fig. 6
Fig. 6
IRD (mm) according to age (years) with its linear regression of the 95% CI

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