Rectus Abdominus Diastasis/Divarication (RADs) in adults

What is Rectus abdominus diastasis/divarication (RADs)?

The abdomen/tummy is made up of four layers of muscles. The top muscle layer is called the rectus abdominus, more commonly known as the ‘six pack’ muscles. The muscle runs from the bottom of your ribcage to the pubic bone of your pelvis. The muscle is in two halves, left and right, joined together by connective collagen tissue called the linea alba.

RADs occurs when there is separation or widening of the two halves of muscle, due to stretching of the connective tissue, of around  2 centimetres or more. The severity of RADs is usually dependent on the size of protrusion of under laying muscle/fat and the width of separation. RADs is sometimes known as abdominal muscle separation.

What causes the connective tissue to stretch?

There are a number of causes or risk factors for RADs. It can occur in male and female adults as well as children and babies. It can have many causes and can happen at any stage in life.

The most common type is one that happens naturally during pregnancy. As the baby grows, the connective tissue stretches to allow the uterus to enlarge.  For most women the connective tissue shrinks back into place after the baby is delivered, but for a small number of women the weakness between the abdominal muscles remains.

Other risk factors, more common in men but occur in females also, includes excessive weight gain in the abdominal area. The fatty tissue causes a forward pressure which stretches the connective tissue, resulting in the muscles pulling apart.

Rarer causes are genetic, where by some genes develop differently or mutate, leading to disorders of the bodies connective tissues.

Other contributing factors are thought to be:

  • Poor exercise technique - can exert pressure causing the connective tissue to stretch
  • Rapid weight fluctuations - Yo-yo dieting - can weaken the connective tissues
  • Poor posture – can increase the strain on the abdominal muscles
  • Abdominal Traumas.
Is RADs a serious condition?

For most people RADS is a normal variance, with little impact on lifestyle. The condition carries very little risk and abdominal wall hernias/ventral hernias do not usually develop, as the inner aspect of the muscle layer is smooth, making it difficult for bowel to push through and pinch (strangulate). However, ventral hernia should be excluded. RADs may make some people more to other types of hernias, such as umbilical (belly button) or epigastric hernias (under the breastbone).

What are the signs of RADS?

You may notice a doming or bulging area above or below your belly button, particularly when sitting up or leaning back.  It is a bulge that doesn’t go away after weight loss or exercise. It is not usually painful. Some people feel a ‘jelly like’ texture in-between the right and left abdominal muscles when contracting those muscles.

For a small minority of people RADs may affect their lifestyle in the following ways:

  • Loss of core strength – difficulty walking, lifting objects and performing everyday tasks
  • Abdominal discomfort
  • Lower back/hip pain
  • Pelvic floor dysfunction and pain
  • Impacts self-confidence and mental wellbeing
  • Bladder and bowel dysfunction, such as leaking urine or constipation (as the ability to increase abdominal pressure that assists bladder and bowel function is reduced).
  • If you notice doming/bulging when getting in and out of bed – try bending your knees, roll onto your side and use your arms to push yourself up.
Do I need treatment?

It is uncommon to need surgical intervention for RADS. This is usually determined by the size of the dome/bulge, width of separation and the degree to which your lifestyle is affected.

It is important that hernias are excluded as a cause, because these are likely to need surgery to repair them.

Your healthcare clinician will be able to advise you.

Usually RADs and hernias are diagnosed by a healthcare clinician examining your abdomen. Some people may also need an Ultrasound scan or CT- scan of the abdomen – these are special types of imaging performed in the X-ray department. Not everyone with RADs requires imaging.

Once hernias are excluded as a cause of the dome/bulge, surgery is not usually the first step. Your healthcare clinician will advise you.

Are there any steps that I can take which may help?

There are a number of ways you will be able to help yourself, which may be effective in reducing your symptoms. RADs dome/bulge doesn’t usually go away entirely, but can be improved. The first steps are:

  • Lifestyle changes – weight loss if overweight
  • Specific types of exercises movements which engage the deep abdominal muscles and pelvic floor. Most of these exercises involve deep breathing and slow, controlled movements.

NB Some types of exercises can worsen your condition. Physiotherapists advise avoiding certain types of movement if you have RADS.

Avoid:

  • Crunches or sit-ups of any kind
  •  Planks or push-ups unless using modifications
  •  Downward dog, boat pose or some other yoga poses
  •  Double leg lifts, scissors or some other pilates moves
  •  Any exercises that cause your abdominals to bulge or dome

If done correctly, a prolonged (minimum six months) specific abdominal core exercises programme can help. Your GP/physiotherapist can advise you.

Surgery

Surgery is not usually offered for cosmetic purposes but may be considered if your symptoms remain severe after weight loss and carrying out specific exercise programme. Your GP may refer you to a surgeon. Types of surgery include:

Open Surgery – this involves a small cut in the middle of the abdomen and plication (repositioning) of the defect.

Laparoscopic Surgery – three small incisions are made on the left hand side of the abdomen and the defect is tightened from inside the abdomen. Mesh is used to reinforce the abdominal wall which is secured in place by small staples or sutures.

Endoscopic Surgery – this involves creating space under the skin and above the abdominal wall muscles. This method does not rely on ‘entering’ the abdominal cavity and is undertaken by the use of three small incisions below the umbilicus. Sometimes mesh is used to strengthen the defect.

There are various benefits and risks associated with all types of surgery. These will be discussed with your surgeon. Overall RAD is usually managed with lifestyle changes and specific exercises. Abdominoplasty/surgical repair is rarely required.

 We hope you have found this leaflet useful to help you understand RADs.

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