Abstract
AimThe 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 methodsPatients 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.ResultsDRA (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.ConclusionThe 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.
Highlights
In the linea alba, collagen fibers from both sides of the abdominal wall muscle sheets cross in an interwoven pattern
The prevalence of diastasis recti abdominis at 3 cm above the umbilicus according to the current definition was as high as 57%
The German Hernia Society (DHG) and the International Endohernia Society (IEHS) recently published a definition and a classification of diastasis recti abdominis (DRA) based on a consensus conference
Summary
Collagen fibers from both sides of the abdominal wall muscle sheets cross in an interwoven pattern. Beer et al evaluated the normal linea alba width in 150 nulliparous women with a BMI < 30 kg/ m2 in women between 20 and 45 years. Based on a study on 40 cadavers, Rath et al defined an IRD > 15 mm at halfway from the xiphoid to the umbilicus, > 27 mm at the umbilicus and > 14 mm at halfway from the umbilicus to the symphysis as a pathologic separation of the rectus muscles after the age of 45 years (classification based on width) [20]. Chiarello et al studied 34 cadavers between 47 and 99 years to measure the IRD 45 mm above the umbilicus, at the umbilicus and 45 mm below the umbilicus as well as to identify possible risk factors for DRA [22] using the Rath classification. Clinical symptoms and findings of physical examination are rarely discussed in the context of definition of DRA, bearing the potential bias of suggesting treatment for a body-part mean measurement
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