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This activity describes the common presenting complaints of diastasis recti and highlights the interprofessional team's role in treating patients with diastasis recti. Diastasis recti is an increased distance between the rectus abdominis muscles at the midline caused by weakness in the anterior abdominal wall. Diastasis recti's signs and symptoms caused by diastasis recti are common patient complaints to healthcare providers in many different clinical settings, including emergency medicine, plastic surgery, general surgery, family medicine, and obstetrics and gynecology. Diastasis recti treatment is somewhat controversial and ranges from recommendations for conservative management with lifestyle modifications and exercises to recommendations for surgical repair with mesh. Objectives: Identify the typical physical exam findings associated with diastasis recti. Review the risk factors for developing diastasis recti. Describe the treatment considerations for patients with diastasis recti. Summarize the common complications of treatment for diastasis recti. Access free multiple choice questions on this topic.

Diastasis recti is an increased distance between the rectus abdominis muscles at the midline caused by weakness in the anterior abdominal wall.[1] Most experts agree that there is a weakness, thinning, and widening of the linea alba and weakness of the associated abdominal musculature. Signs and symptoms caused by diastasis recti are common patient complaints to healthcare providers in many different fields, including emergency medicine, plastic surgery, general surgery, family medicine, and obstetrics and gynecology. Patients may notice an overall feeling of instability and/or a bulge in the midline of the anterior abdominal wall, which worsens with increased abdominal pressure, such as with the movement of an abdominal crunch. Diastasis recti has been shown to contribute to urinary stress incontinence and back pain. While diagnosis and treatment options should focus on patient perception of the bulge or other symptoms, several studies have been performed to look at normal versus widened distance between the rectus muscles. While it is accepted that the supraumbilical distance of the rectus muscles is usually higher than the infraumbilical distance, most authorities consider separation more than two centimeters to be abnormal, although less or more may be present with or without bothersome symptoms. Diastasis recti can be confused with a ventral hernia; however, there is no fascial defect in diastasis recti. Diastasis recti is associated with conditions in which there is an increase in intraabdominal pressure, including pregnancy and obesity, as well as diseases that result in weakness of the connective tissues. The treatment of diastasis recti is somewhat controversial and ranges from conservative management with lifestyle modifications and exercises to surgical repair with mesh recommendations.[2][3]

Complications from physiotherapy and other conservative treatments for diastasis recti are rare; however, patients may complete treatment regimens and be dissatisfied with the results obtained.[28] Complications from surgical repairs for diastasis recti include lack of satisfaction in surgical repair or improvement in appearance or symptoms, recurrence of diastasis, hematoma, especially of the rectus sheath, wound complications, infection, damage to surrounding structures, scarring from the incision, and mesh-related complications if a mesh is used.[29][21][30] If a ventral or umbilical hernia is mistaken for diastasis recti, serious complications can occur, including bowel obstruction and/or strangulation within the hernia.[31]

Abdominal diastasis recti and the treatment options for management are relevant topics for obstetricians, gynecologists, nurse midwives, general surgeons, family practitioners, physical therapists, and many other healthcare team members. Recognizing abdominal diastasis recti is important in order to prevent unnecessary interventions or alarms and provide evidence-based treatment options to patients with symptoms of diastasis recti. Over the course of evaluation and treatment, the patient may benefit from care and insight from many different healthcare team members.