yogabook / pathologie / rectus diastasis

(persistent) rectus diastasis

Definition of

Lateral divergence of the two sides of the rectus abdominis due to widening of the normally 1-2 cm wide linea alba. From 2.7 cm, this is referred to as a rectus diastasis. It is not a hernia, as the fascia remains intact, i.e. there is no hernia ring or defect, and this only occurs very rarely as a complication. Physiologically, a rectus diastasis is present in

1. Newborns
2. pregnant women due to the effect of the hormone relaxin in the last trimester up to a maximum of 8 weeks after birth. As the weeks of pregnancy progress, the diastasis becomes more pronounced and a hand-width gap can be achieved between the sides of the rectus abdominis. In the weeks following pregnancy, however, it should begin to recede noticeably. In one study, 60% of the new mothers still had a rectus diastasis 6 weeks postpartum.

Rectal diastases are usually more pronounced above the umbilicus. They can be divided into grades:

1. 1: up to 3 cm
2. 2: up to 5 cm
3. 3: from 5 cm

The classification of symptoms into degrees of severity is still inconsistent among doctors. The poorer lever arm of the rectus abdominis and the lack of pretension of the oblique abdominal muscles can limit their performance. Pregnant women are advised to do abdominal muscle training up to the 20th week of pregnancy, preferably static rather than dynamic. The rectus abdominis should also be exercised, unless there is a feeling of pressure in the abdomen, which would suggest inadmissible compression of the amniotic sac. However, the best prevention against rectus diastasis is to build up robust abdominal muscles before pregnancy.

Cause

1. Pregnancy, in particular a) from the age of 35 b) with high birth weight of the child c) with multiple pregnancies d) with multiple births
2. Repeated increases in abdominal pressure, such as constipation
3. Obesity
4. Congenital, especially in premature births

Predisposing

1. Multiple births
2. Multiple pregnancy
3. Age over 35 during pregnancy
4. High weight of the unborn child
5. Position of the child that strongly protrudes the abdomen
6. Physical overload after pregnancy
7. Longer duration of the birth
8. Excessive amount of fresh water (polyhydramnios)
9. Relaxin production ends with birth, but breastfeeding keeps it at a higher level.

Diagnosis

1. Palpatory in prone position with tensed abdominal muscles (raise head)
2. Sono. After completion of 12 months of intensive training without sufficient success, surgery may be indicated in approx. 5% of those affected. The width of the gap is not the most important parameter, but the condition and the risk of fracture

Symptoms

1. Visible and palpable gap between the two sides of the rectus abdominis, the „two-finger width rule“.
2. Possible protrusion of the abdominal organs due to increased pressure in the abdominal cavity
3. typically symptom-free
4. Possibly protruding abdomen
5. possibly during pregnancy: Back pain (but this can also result from the hollow back ), hip pain, pelvic floor problems
6. Difficult birth due to reduced effect of the rectus abdominis

Complications

1. Very unlikely: Incarceration
2. Lowering of the abdominal organs with a tendency to incontinence
3. Incarceration of intestinal tissue

Therapy

1. Conservative: pelvic floor and abdominal muscle training. Well-trained women can generally exercise as usual after the wound has healed, including the straight abdominal muscles(rectus abdominis), but the pelvic floor muscles should be well trained beforehand to minimize the risk of prolapse. Incomplete continence is a contraindication to resuming training. Lack of training tends to lead to persistence of the diastasis, training and physical activity promote its disappearance if they are not contraindicated. Basically, women should listen to their body’s signals. The „nine months in, nine months out“ rule applies to the changes that take place in the body during pregnancy. Contrary to the widespread opinion that straining the rectus abdominis, especially exercises such as sit-ups, should be avoided, a study with an intervention group that performed straight and inclined sit-ups, abdominal pull-ups in prone position and quadruped position, as well as half-plank (knees on the floor) and half-side-plank once a week under supervision and daily at home from the diagnosis of rectus diastasis (6 weeks postpartum) to 12 months postpartum, showed no worse results after 6 and 12 months than a control group without intervention. The question of the optimal configuration remains open, i.e. whether less training of the oblique abdominal muscles would have improved the result of the training group. Furthermore, the frequently propagated predominant training of the oblique abdominal muscles is contraindicated, as these muscles, attached to the rectus sheath, pull the two sides of the rectus abdominis apart. Instead, it is important that the transversus abdominis is actively used in all abdominal muscle training in order to keep the abdominal cavity „compact“ and the sides of the rectus abdominis as close together as possible. Leisurely jogging is contraindicated at least as long as the pelvic floor and abdominal muscles are still weak due to the unfavorable ratio of low strengthening of the abdominal muscles and frequent impact on the pelvic floor. In running, the ratio is much more favourable, as the centre of gravity curve has less curvature or less pronounced extremes and the three-dimensional movement of the pelvis and the necessary limitation of the impact on the upper body by the abdominal muscles contribute significantly to stabilizing and toning the abdominal muscles.
2. Postnatal gymnastics
3. Pelvic floor training should precede abdominal muscle training: the pelvic floor also becomes more flexible during pregnancy and otherwise suffers from the pressure that abdominal muscle training exerts indirectly on the pelvic floor via the abdominal organs, which can lead to prolapse and incontinence.
4. Adapted behavior (depending on the status of the pelvic floor and abdominal muscles) to relieve the abdominal cavity from stretching influences, e.g. standing up from the side, avoiding bending forward without tensioning the transversus abdominis, avoiding backbends and abdominal presses as well as lifting heavy loads without using the transversus abdominis
5. Diet that does not lead to constipation or measures against existing constipation
6. Pregnancy belt/girdle if the baby’s weight is high or the protrusion is excessive. This is worn up to a maximum of 8 weeks postpartum
7. Postnatal exercises can be started immediately in the case of a spontaneous birth or after several weeks in the case of a caesarean section.
8. Surgery only if optically necessary (surgery can be indicated at the earliest 12 months after insufficiently successful training therapy) or complications. Tendency to recurrence!