Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation

M Cavalli, A Aiolfi, P G Bruni, L Manfredini, F Lombardo, M T Bonfanti, D Bona, G Campanelli, M Cavalli, A Aiolfi, P G Bruni, L Manfredini, F Lombardo, M T Bonfanti, D Bona, G Campanelli

Abstract

Purpose: Diastasis recti abdominis (DRA) or rectus diastasis is an acquired condition in which the rectus muscles are separated by an abnormal distance along their length, but with no fascia defect. To data there is no consensus about risk factors for DRA. The aim of this article is to critically review the literature about prevalence and risk factor of DRA.

Method: A total of 13 papers were identified.

Results: The real prevalence of DRA is unknown because the prevalence rate varies with measurement method, measurement site and judgment criteria, but it is certainly an extremely frequent condition. Numbers of parity, BMI, diabetes are the most plausible risk factors. We identified a new anatomical variation in cadaveric dissection and in abdominal CT image evaluation: along the semilunar line the internal oblique aponeurosis could join the rectus sheath with only a posterior layer, so without a double layer (anterior and posterior) as usually described. We conducted a retrospective review of abdominal CT images and the presence of the posterior insertion only could be considered as a risk factor for DRA.

Conclusion: Further studies with large sample size, including nulliparous, primiparous, pluriparous and men too, are necessary for identify the real prevalence.

Keywords: Abdominal rectus muscle; Diastasis recti abdominis; Intra-rectus distance; Risk factor; Semilunar line.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. The Author(s).

References

    1. Reinpold W, Köckerling F, Bittner R, Conze J, Fortelny R, Koch A, Kukleta J, Kuthe A, Lorenz R, Stechemesser B. Classification of rectus diastasis—a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS) Front Surg. 2019;6:1. doi: 10.3389/fsurg.2019.00001.
    1. Mommers EHH, Ponten JEH, Al Olmar AK, et al. The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options. Surg Endosc. 2017;31:4934–4949. doi: 10.1007/s00464-017-5607-9.
    1. Brauman D. Diastasis recti: clinical anatomy. Plast Recosntr Surg. 2008;122(5):1564–1569. doi: 10.1097/PRS.0b013e3181882493.
    1. Köhler G, Kuketina RR, Emmanuel K. Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg. 2015;39:121–126. doi: 10.1007/s00268-014-2765-y.
    1. Mota PGFD, Pascoal AG, Bø K. Diastasis recti abdominis in pregnancy and postpartum period. Risk factors, functional implications and resolution. Curr Womens Health Rev. 2015;11:59–67. doi: 10.2174/157340481101150914201735.
    1. Sperstad JB, Tennfjord MK, Hilde G. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50:1092–1096. doi: 10.1136/bjsports-2016-096065.
    1. Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med. 1990;43(10):5–8.
    1. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321–328. doi: 10.1007/s00192-006-0143-5.
    1. Goossen K, Tenckhoff S, Probst P, et al. Optimal literature search for systematic reviews in surgery. Langenbecks Arch Surg. 2018;403:119–129. doi: 10.1007/s00423-017-1646-x.
    1. Ferrari R. Writing narrative style literature reviews. Med Writ. 2015;24:230–5. doi: 10.1179/2047480615Z.000000000329.
    1. Mota PGFD, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015;20(1):200–205. doi: 10.1016/j.math.2014.09.002.
    1. Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA. The normal width of the linea alba in nulliparous women. Clin Anat. 2009;22(6):706e11. doi: 10.1002/ca.20836.
    1. Touran V, Colluoglu C, Turkyilmaz E, Korucuoglu U. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol. 2011;82(11):817–821.
    1. Wu L, Gu Y, Gu Y, Wang Y, Lu X, Zhu C, Lu Z, Xu H. Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: prevalence, risk factors and its impact on life. J Clin Nurs. 2021;30(3–4):518–527. doi: 10.1111/jocn.15568.
    1. Rath AM, Attali P, Dumas JL. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat. 1999;18(4):281–288. doi: 10.1007/BF01627606.
    1. McPhail I. Abdominal aortic aneurysm and diastasis recti. Angiology. 2008;59(6):736–9. doi: 10.1177/0003319708319940.
    1. Coldron Y, Stokes M, Newham D, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008;13(2):112–121. doi: 10.1016/j.math.2006.10.001.
    1. Werner LA, Dayan M. Diastasis recti abdominis-diagnosis, risk factors, effect on musculoskeletal function, framework for treatment and implications for the pelvic floor. Curr Womens Health Rev. 2019;15:86–101. doi: 10.2174/1573404814666180222152952.
    1. Axer H, von Keyserlingk DG, Prescher A. Collagen fibres in linea alba and rectus sheaths. II. Variability and biomechanical aspects. J Surg Res. 2001;96:239–45. doi: 10.1006/jsre.2000.6071.
    1. Grassel D, Prescher A, Fitzek S, Keyserlingk DGV, Axer H. Anisotropy of human linea alba: a biomechanical study. J Surg Res. 2005;124(1):118–125. doi: 10.1016/j.jss.2004.10.010.
    1. Liaw L-J, Hsu M-J, Liao C-F, Liu M-F, Hsu A-T. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther. 2011;41(6):435–443. doi: 10.2519/jospt.2011.3507.
    1. Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L. Osteosarcopenic obesity: the role of bone, and fat on health. J Cachexia Sarcopenia Muscle. 2014;5(3):183–192. doi: 10.1007/s13539-014-0146-x.
    1. Grossi JV, Nicola FF, Zepeda IA, Becker M, Trindade EN, Diemen VV, Cavazzola LT, Trindade MR. Linea alba collagen assessment in morbidly obese patients. Arq Bras Cir Dig. 2016;29Suppl 1(Suppl 1):8–11. doi: 10.1590/0102-6720201600s10003.
    1. Guerrero N, Bunout D, Hirsch S, Barrera G, Leiva L, Henriquez S, De la Maza MP. Premature loss of muscle mass and function in type 2 diabetes. Diabetes Res Clin Pract. 2016;117:32–38. doi: 10.1016/j.diabres.2016.04.011.
    1. Xi H, Yu PL, Liu X. Sarcopenia and its relationship with frailty syndrome. Chin J Geriatr. 2015;34(12):1289–1292.
    1. Antoun G, McMurray F, Thrush AB, Patten DA, Peixoto AC, Slack RS, Mcpherson R, Dent R, Harper ME. Erratum to: impaired mitochondrial oxidative phosphorylation and supercomplex assembly in rectus abdominis muscle of diabetic obese individuls. Diabetologia. 2016;59(2):396–397. doi: 10.1007/s00125-015-3821-3.
    1. Vesentini G, Marini G, Piculo F, Damasceno DC, Mathes SMM, Felisbino SL, Calderon IMP, Hijaz A, Barbosa AMP, Rudge MVC. Morphological changes in rat rectus abdominis muscle induced by diabetes and pregnancy. Braz J Med Biol Res. 2018;51(4):e7035. doi: 10.1590/1414-431x20177035.
    1. Sorensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jorgense LN. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140(2):119–123. doi: 10.1001/archsurg.140.2.119.
    1. Sorensen LT, Friis E, Jorgensen T, et al. Smoking is a risk factor for recurrence of groin hernia. World J Surg. 2002;26(4):397–400. doi: 10.1007/s00268-001-0238-6.
    1. Wagh P. Collagen deficiency in rectus sheath of patients with inguinal herniation. Proc Soc Exp Biol Med. 1971;37:382–384. doi: 10.3181/00379727-137-35582.
    1. Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F. Less collagen production in smokers. Surgery. 1998;123(4):450–455. doi: 10.1016/S0039-6060(98)70167-9.
    1. Gitta S, Magyar Z, Tardi P, Füge I, Járomi M, Ács P, Garai J, Bódis J, Hock M. A rectus diastasis prevalenciája, lehetséges rizikófaktorai és szövődményei. Orvosi Hetilap. 2017;158(12):454–460. doi: 10.1556/650.2017.30703.
    1. Rett MT, Araújo FRde, Rocha I, Silva R Ada. Diástase dos músculos retoabdominais no puerpério imediato de primíparas e multíparas após o parto vaginal. Fisioterapia e Pesquisa. 2012;19(3):236–241. doi: 10.1590/S1809-29502012000300008.
    1. Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health. 2005;97:49–54.
    1. Wang Q, Yu XJ, Yang X, Sun XL, Wang JL. Study on influencing factors of postpartum rectus abdominis separation. Progress in Obstetrcs and Gynecology. 2005;28(12):913–916.
    1. Doubkova L, Andel R, Palascakova-Springrova I, Kolar P, Kriz J, Kobesova A. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil. 2018;31(1):107–112. doi: 10.3233/BMR-169687.
    1. Champion P. Mind the gap: diastasis of the rectus abdominis muscles in pregnant and postnatal women. Pract Midwife. 2015;18(5):16–20.
    1. Zhou BH, Liao DM, Wei LY, Shi Q. MPelvic floor screening was performed in 1462 women at 6-8 weeks postpartum. Chinese Journal of Reproductive Health. 2014;25(1):50–25.

Source: PubMed

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