Diastasis of the rectus abdominis muscles (DRAM)

Diastasis of the rectus abdominis muscles (DRAM) is characterised by a protruding midline following an increase in intra-abdominal pressure

• characterised by a gradual thinning and widening of the linea alba, combined with a general laxity of the ventral abdominal wall muscles (1)
• frequently misclassified as a primary ventral hernia
  • though the musculofascial continuity of the midline and subsequent absence of a true hernia sac is what sets DRAM apart from a ventral hernia
• DRAM occurs most frequently during pregnancy and regresses spontaneously after childbirth in most women
  • 12 months postpartum, 33% of women still experience DRAM (2)
• not all patients with abdominal rectus diastasis have symptoms, but when they do, treatment can be considered (3)
  • symptoms include pain and discomfort in the abdomen, musculoskeletal problems like pelvic instability and lumbar back pain, and urogynecological symptoms such as urinary incontinence, faecal incontinence, and pelvic organ prolapse

Evidence on what conservatory treatment to use is sparse, and more research needs to be done. Both open and laparoscopic surgery have shown positive results (3).

Reference:

• Brauman D. Diastasis recti: clinical anatomy. Plast Reconstr Surg. 2008;122(5):1564–1569. doi: 10.1097/PRS.0b013e3181882493
• Sperstad JB, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50(17):1092–1096. doi: 10.1136/bjsports-2016-096065.
• Jessen LJ et al.Treatment Options for Abdominal Rectus Diastasis.Front Surg. 2019; 6: 65.