出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/02 22:52:58」(JST)
| Diastasis recti | |
|---|---|
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Diastasis recti in an infant
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| Classification and external resources | |
| ICD-10 | M62.0 |
| ICD-9 | 728.84 |
| MedlinePlus | 001602 |
Diastasis recti (also known as abdominal separation) is commonly defined as a gap of roughly 2.7 cm or greater between the two sides of the rectus abdominis muscle.[1] This condition has no associated morbidity or mortality.[2]
The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba, a connective collagen sheath created by the aponeurosis insertions of the transverse abdominis, internal oblique, and external oblique.[3]
Diastasis of this muscle occurs principally in two populations: newborns and pregnant women. It is also known to occur in men.
A diastasis recti may appear as a ridge running down the midline of the abdomen, anywhere from the xiphoid process to the umbilicus. It becomes more prominent with straining and may disappear when the abdominal muscles are relaxed. The medial borders of the right and left halves of the muscle may be palpated during contraction of the rectus abdominis.[5] The condition can be diagnosed by physical exam, and must be differentiated from an epigastric hernia or incisional hernia, if the patient has had abdominal surgery.[2] Hernias may be ruled out using ultrasound.
In infants, they typically result from a minor defect of the linea alba between the rectus abdominis muscles. This allows tissue from inside the abdomen to herniate anteriorly. On infants, this may manifest as an apparent 'bubble' under the skin of the belly between the umbilicus and xiphisternum (bottom of the breastbone).
Examination is performed with the subject lying on their back, knees bent at 90° with feet flat, head slightly lifted placing chin on chest. With muscles tense, examiners then place fingers in the ridge that is presented. Measurement of the width of separation is determined by the number of fingertips that can fit within the space between the left and right rectus abdominis muscles. Separation consisting of a width of 2 fingertips (approximately 1 1/2 centimeters) or more is the determining factor for diagnosing diastasis recti.[6]
No treatment is necessary for women while they are still pregnant. In children, complications include development of an umbilical or ventral hernia, which is rare and can be corrected with surgery.[7]
Alerting a medical professional is important when an infant displays signs of vomiting, redness or pain in the abdominal area.
Typically the separation of the abdominal muscles will lessen within the first 8 weeks after childbirth, however the connective tissue remains stretched for many postpartum women. The weakening of the abdominal muscles and the reduced force transmission from the stretched linea alba may also make it difficult to lift objects, and cause lower back pain. Additional complications can manifest in weakened pelvic alignment and altered posture.[6]
A Systematic Review of the evidence found that exercise may or may not reduce the size of the gap in pregnant or postpartum women. The authors looked at 8 studies totaling 336 women and concluded, “Due to the low number and quality of included articles, there is insufficient evidence to recommend that exercise may help to prevent or reduce DRAM.”[1]
Nevertheless, the following exercises are often recommended to help build abdominal strength, which may or may not help reduce the size of diastasis recti[8]
It is also noted that incorrect exercises, including crunches can actually increase the distasis recti separation. All corrective exercises should be in the form of pulling in of the abdominal muscles rather than a pushing of them outwards. Consultation of a professional physiotherapist is recommended for correct exercise routines.[8]
In addition to the above exercises, the Touro College study concluded the "quadruped" position yielded the most effective results.[6] A quadruped position is defined as "a human whose body weight is supported by both arms as well as both legs".[9] In this position, the subject would start with a flat back, then slowly tilt the head down, and arch the back, contracting the abdominal muscles towards the spine, holding this position for 5 seconds, then releasing back to starting position. Complete 2 sets of 10 repetitions.[6]
In extreme cases, diastasis recti is corrected during the cosmetic surgery procedure known as an abdominoplasty by creating a plication or folding of the linea alba and suturing together. This creates a tighter abdominal wall.
In adult females, a laparoscopic Venetian blind technique can be used for plication of the recti.[10]
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| リンク元 | 「腹直筋離開」 |