A rectal diastasis is the widening of the straight abdominal muscles, so that there is a noticeable gap in the abdominal wall. How the midline break occurs and which treatment is suitable.
- Rectal diastasis is often the result of pregnancy, it can also occur in men or children.
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What is rectal diastasis?
A rectal diastasis is also called a midline fracture or "out of alignment". Right and left straight abdominal muscles (M. rectus abdominis) are further apart than usual in the area of the so-called Linea alba, so that a gap of different length and width can arise in the middle of the abdominal wall.
The consequence of a rectal diastasis is the impairment of the holding, supporting and carrying functions of the muscles and an unsightly bulging of the anterior abdominal wall. The rectal diastasis must be differentiated from an umbilical hernia, in which there is a gap in the connective tissue of the abdominal wall, through which the abdominal organs can protrude.
Building the straight abdominal muscles
The straight abdominal muscle pulls in two strands from the sternum to the pelvis, the outer and inner oblique abdominal muscles run from the ribs to the pelvis and with the same course from the pelvis to the ribs. In the middle of the abdomen is the linea alba (white line) from the sternum to the pubic bone. It is a vertical connective tissue suture, which is created by the union of the flat tendon plates of the lateral abdominal muscles and also connects the muscle bellies of the straight abdominal muscle.
The Linea alba is usually taut and narrow like a cord and at most two centimeters wide. In rectal diastasis, the connective tissue of the linea alba is overstretched and thinned out, the gap between the right and left straight abdominal muscles can now be up to ten centimeters wide, in exceptional cases up to 30 centimeters wide. Rectal diastasis is usually up to 15 centimeters long, but in pronounced cases it can extend from the sternum to the pubic bone. The umbilical region is usually the most affected, especially the region directly above the navel.
How does rectal diastasis develop?
Rectal diastases can be congenital, but in most cases they are acquired. The reason for the appearance of acquired rectal diastases is an overstretching of the abdominal muscles.
Acquired rectal diastasis
In very overweight people, large amounts of abdominal fat cause the abdominal muscles to stretch, especially the straight abdominal muscles. This can cause rectal diastasis in the long term.
In pregnant women, the rapid growth of the uterus pushes the abdominal muscles forward. As a result, the straight abdominal muscles expand and give way in their tension. The hormone Relaxin, which is formed by the body in the last phase of pregnancy and serves to relax and loosen the cervix, is also beneficial. This loosening property also favors the stretching of the linea alba. Lifting heavy weights, pressing hard to defecate, and finally pressing at birth increases the risk of rectal diastasis in the last third of pregnancy.
Congenital rectal diastasis
In rare cases, rectal diastasis is congenital. In some people, the straight abdominal muscles are not connected to each other in the normal way via their muscle attachments and do not run in parallel. As a result of this malformation, they diverge upwards, the linea alba widens and the abdomen bulges forward.
In babies, on the other hand, one often sees a congenital rectal diastasis, which is caused by the fact that the distance between the two straight abdominal muscles in newborns is comparatively wide. The resulting gap, which becomes visible when crying and pressing, usually disappears as soon as the child starts to walk.
Symptoms of rectal diastasis
Most often, rectal diastasis is a purely cosmetic problem that does not cause any noticeable discomfort. You can feel a vertical gap in the middle of the belly of those affected and, if the abdominal wall tightens, a bulge can be seen in the area. This lighter form of rectal diastasis does not cause pain, but it is an aesthetic problem for many sufferers. In addition to sagging the abdominal wall, the abdomen can also hang down, causing the abdomen to hang down.
In pregnancy and in very pronounced cases, rectal diastasis in the advanced stage with pain in the lower back, buttocks and hip area can be noticeable. These occur particularly during physical exertion. At the end of pregnancy, the uterus can clearly emerge in the gap, sometimes you can see the movements of the child and the outline of the unborn child in the area. At birth, the abdominal muscles can be too weak to support the pressing sufficiently in certain childbearing positions, so that other positions must be selected.
A rectal diastasis is not a hernia, the abdominal wall is extended but intact. However, if it persists for a long time and often great pressure is exerted on the gap between the straight abdominal muscles, this weak point can lead to a hernia. These can cause parts of the abdominal organs to protrude and trigger pain and pinching symptoms.
Examinations to diagnose rectal diastasis
The diagnosis of rectal diastasis is easy to make. The examinations can be carried out by the family doctor, surgeons and gynecologists, pregnant women can also be examined by the midwife. An examination is advisable from eight weeks after birth, because the abdominal muscles should only be back to normal within this time.
The anamnesis interview clarifies whether there are physical complaints due to the rectal diastasis and how severe they are. A tactile examination of the abdomen is sufficient to confirm the diagnosis. The rectal diastasis is clearly visible and palpable when the patient lies on his back and tightens the abdominal muscles by lifting the head or upper body. If additional pressure is built up in the abdominal cavity through coughing or pressing, the rectal diastasis emerges as a bulge between the straight abdominal muscles.
In rare cases, the exact extent of the rectal diastasis can be determined by an ultrasound examination. In the event that a hernia may have formed in the area of the rectal diastasis, further examinations are necessary.
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How can you treat rectal diastasis?
In most cases, rectal diastasis is easy to treat through targeted training of the abdominal muscles. Especially if the midline break is short and does not exceed a length of two centimeters, it disappears on its own or the normal state can be restored with gymnastics. If you are overweight, weight loss is another key factor in getting rid of rectal diastasis.
The training of the abdominal muscles must be learned under physiotherapy guidance or with midwife aftercare as part of the regression. Wrong exercises make the rectal diastasis worse. It is particularly important that the straight abdominal muscles are not directly stressed. Getting up from lying down must also be practiced to avoid this. You should get up in such a way that you roll on your side in the lying position and push up with your arm. This protects the straight abdominal muscles.
Surgery only for pain or hernias
An operation only needs to be considered if there is persistent pain, the gap increases in length and width, or if the intestine has broken. The straight abdominal muscles are fixed in the correct position with inner seams and the abdominal wall is stabilized with inserted plastic nets. Most of the time the surgery can be performed with keyhole surgery, but sometimes the abdominal wall has to be opened.
After the operation, the abdominal wall is pressed together for a few weeks using an abdominal belt and special compression garments. Four to six weeks after the operation, physical work and sport are allowed again within normal limits.
Can you prevent rectal diastasis?
In addition to pregnancy, excessive weight is the main factor that can lead to rectal diastasis. By maintaining or returning to normal weight, the risk of developing a midline fracture can be reduced. Weight loss is also often accompanied by increased sporting activity, which is conducive to building the muscles of the abdominal, trunk and pelvic floor muscles. Strengthening these muscles is also good prophylaxis against rectal diastasis and a good starting point for an upcoming pregnancy.
Since the last three months in pregnancy are particularly risky for the development of rectal diastasis, any stress that overstrains the straight abdominal muscles should be avoided during this time. These include, for example, sports with a high level of exertion, carrying heavy loads or carelessly sitting up straight while lying down.
After giving birth, every woman should start with well-guided post-exercise gymnastics as soon as possible. It is also important that the straight abdominal muscles are not stressed and that the training focuses on the transverse and oblique abdominal muscles.
Course and prognosis of rectal diastasis
Rectal diastases are easy to treat and those affected can make their own contribution. The course and the result depend on the expression. In many cases, small bulges remain visible, but they are a purely cosmetic problem.
Small rectal diastases with a maximum length of five centimeters and a maximum width of two centimeters usually heal on their own within a few weeks after birth. Supportive regression exercises are helpful. If the gap is more pronounced or if it is independent of pregnancy, a complete decrease is not expected.
If the symptoms are so pronounced that an operation had to be carried out, the postoperative results are very good and the straight abdominal muscles maintain their position in the long term in most cases.