Diastasis Recti Abdominis

正当你认为有足够的屏幕在怀孕期间，这篇文章会告诉你它是多么的重要，以保持眼睛上舒张后期直肌腹直肌或经常简称为舒张后期。它可以影响的次级问题，一个长长的清单，不仅仅是外观和产后妈妈的肚子的总基调。

What is Diastasis Recti Abdominis?

舒张后期RECTI腹直肌是在腹壁的整流肌肉的白线中线的分离。超过2.5厘米上用力任何可见的凸出甲扪中线间隙被认为是舒张后期。舒张后期整流腹直肌通常发生脐部周围，但可在剑突和耻骨之间的任何地方发生。它是从母体荷尔蒙的变化腹部肌肉拉伸无力和被生长的子宫增加的张力的结果。舒张后期整流腹可发生在妊娠期间不同程度的，不得在产后自行缓解。

症状腹直肌舒张后期

美容腹看起来像一个山脊,制作h runs down the middle of the belly area. It stretches from the bottom of the xiphoid process to the umbilicus and pubic bone and increases with muscle straining.

Diastasis Recti Abdominis is commonly seen in women who have multiple pregnancies causing repeated stretching of the muscles. Extra skin and soft tissue in the front of the abdominal wall may be the only signs of this condition in early pregnancy. Diastasis Recti Abdominis usually appears in the second trimester. Its incidence peaks in the third trimester and remains high in the immediate postpartum period. In the later part of pregnancy, the top of the pregnant uterus is often seen bulging out of the abdominal wall. An outline of parts of the unborn baby may be seen in some severe cases. This phenomenon is more common in multi-parous mothers, as the linea alba is repeatedly stretched. The occurrence and size of Diastasis Recti Abdominis are much greater in non-exercising pregnant women than in exercising pregnant women.

腹直肌的这种分离可引起一系列问题。没有动态稳定腹肌通常提供，在腹壁可危及躯干的稳定性和流动性无力;造成背部疼痛，正确的姿势，盆底功能障碍，疝气，外观瑕疵和阴道分娩。背部和/或骨盆腔疼痛是舒张后期整流腹的最常见的表现。通过Spitznagle等人在2007年所做的一项回顾性研究调查舒张后期整流腹的患病率在urogynecological患者人群中发现66% of all patients with Diastasis Recti Abdominishad support-related pelvic floor dysfunction (SPFD) diagnoses of stress urinary incontinence, faecal incontinence, and pelvic organ prolapsed.

诊断腹部分离

Ultrasonography (real-time ultrasound imaging) is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level. However, a health provider can conduct a quick palpation test to assess for Diastasis Recti Abdominis. Diastasis is difficult to find on a relaxed abdomen. A slight head lift in crook lying will require a rectus abdominis contraction and will allow for assessment of the Diastasis Recti Abdominis. A small separation of the midline at the abdominals, approximately one to two fingers’ width, is common after most pregnancies and is not a problem. But if the gap at the midline is:

• 超过2 1/2手指宽度
• does not shrink as the patient tighten her abdominals or
• 一个小土堆在她的中线突出

那么她可能有舒张后期直肌腹直肌和需要锻炼等活动过程中一些特殊的注意事项。

舒张后期是本如果你可以在两个或更多个手指（宽度方向）配合到空间优于脐。在进一步的腹部收缩，间隙应关闭。然而，如果存在仍然比1个手指宽较大的间隙，这是一个正的舒张后期​​RECTI腹。这样的测试通常在给予产后妇女检查整流腹直肌的完整性，但必须强调的是，这个测试可能在后剖腹产的妇女进行后，才自己切口痊愈，对手术后6-10周。

如何检查，如果你有舒张后期直肌到见

Conservative Management of The Separation

保守的管理，如通过物理治疗师，或者非常熟悉与舒张后期整流腹保健专业人士针对特定的治疗练习，通常是干预的第一道防线。这些演习的目的是strengthening the deep core muscles如肋骨和腹直肌盆底肌肉。不佳执行腹部练习可以引起腹内压力的升高，该力可能会导致进一步整流分离和伴随的凸起/疝恶化。

因此，规定任何腹部练习之前，监控舒张后期整流腹直肌（如果有任何疝）是很重要的。不合适的腹部练习包括仰卧起坐，举腿试验，拉提的动作即“的100S”，特别是树干旋转活动，如纵横交错仰卧起坐靶向斜肌，可能过度拉紧腹部。疲软核心肌肉有助于骶髂关节，导致骨盆不稳定，最终会导致低背部和髋关节疼痛的力闭合不足。在最坏的情况下，该整流分离可导致疝气。因此，一旦舒张后期被识别，女病人被要求预订分娩后2〜3周的物理治疗师的最初任命。Follow up visits are made at 2, 3 or 4-week intervals depending on: i) the condition of the patient’s abdominal musculature, ii) the ability of the patient to comprehend the exercise program, and iii) the compliance of the patient to follow through.

在初次就诊时，患者被给予在我的指示）正确的身体力学，二）正确的姿势，iii）相关舒张后期整流演习，以激活腹部肌肉，和iv）适当的运动，以重新逼近整流肚子不增加细胞内腹压。

在随后的每次访问时，患者被教导i）至重新训练腹肌同心和偏心控制，和ii）以模拟躯干稳定腹部肌肉的功能作用。

在家庭和社会上的物理活动和运动建议在随后的访问中也给出。辅助腹部支撑/可推荐夹板。当舒张后期被关闭或桥接在一起患者出院。

Prognosis

The patient usually does very well. In most cases, recti diastasis usually heals on its own over a postpartum period of 6 weeks to 3 months. However, Diastasis Recti Abdominis may also persists long after the woman delivered. Further intervention may be required if the recovery of Diastasis Recti Abdominis does not occur. Specific therapeutic exercise may help improve the condition. Umbilical hernia may occur in some cases. If pain is present, surgery may be needed. In general, complications only result when a hernia develops.

Conclusion

Women with Diastasis Recti Abdominis were more likely to be older and of higher parity, have had twins, bigger babies, and birth by caesarean section. Studies suggested that earlier recovery may be associated with lower parity, singleton births, weight gain under 35 pounds, birth weight of baby <3.7 kg, increased activity levels before, during and after pregnancy. Clinically, good compliance with the treatment program and early initiation of treatment may also enhance recovery. Therefore, prophylactic measures, such as routine screening/identification of diastasis and subsequent diastasis management to all mothers during pregnancy and in the immediate postpartum period may be beneficial in the long run.

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