Diastases of direct muscles of a stomach
Diastases of direct muscles of a stomach — stretching of the intermuscular aponeurosis connecting longitudinal superficial bunches of muscles of an abdominal tension. It is shown by protrusion on the median line of a stomach, pains in epigastralny and okolopupochny area, dispepsichesky frustration, a meteorizm, locks, an urine incontience at loadings. It is diagnosed by means of a palpation, an ekhografiya of a belly wall, a stomach cavity X-ray analysis. Correction of loadings and physical activity, a diet, LFK, massage, kinesiological taping, an endoscopic and classical abdominoplastika is applied to treatment.
Diastases of direct muscles of a stomach
Stretching of the tendinous aponeurosis of direct muscles located on the average line of a stomach is noted at 1% of the population. Physiological diastases of belly muscles it is observed at babies and at 66-100% of pregnant women in the 3rd trimester of the gestational period. The women of a slender constitution who were taking out more than one child, men of middle and advanced age having abdominal obesity are more subject to the resistant expressed divergence of muscles. Due to the epidemic nature of spread of HIV infection the number of the cases caused by secondary dystrophy of muscular and soyedinitelnotkanny fibers increases in recent years.
Reasons diastase of direct muscles of a stomach
Developing of a disease is promoted by long increase in intra belly pressure in combination with violation of structure of the fibers forming a median tendinous membrane of a forward belly wall. According to experts in the sphere of plastic and abdominal surgery, are the most common causes of a divergence of direct muscles:
- Pregnancy. Growth of a uterus leads to considerable stretching of a wall of a stomach and increase in belly pressure. The situation is aggravated with the weakening action of a relaksin who oppresses synthesis of collagenic fibers and stimulates their disintegration owing to what connecting fabric becomes more elastic. Muscular diastases it is more expressed at a mnogoplodiya, a mnogovodiya, incubation of a large fruit, earlier postponed Cesarean sections, the early beginning of physical trainings after the delivery.
- Insolvency of musculotendinous structures. The underdevelopment of muscular fibers of a wall of a stomach provokes a physiological divergence of bunches of direct muscles at newborns. Infantile abdominal diastases it is more often observed at prematurity of children. Expansion of the white line owing to dystrophic changes of fabrics occurs at adult women and men seldom, however at some states its risk increases, for example, to diastases suffers to 3% of patients with HIV infection.
Obesity, rapid weight loss, considerable physical activities, locks, chronic diseases of respiratory organs with hoarse cough which play the leading role in development of pathology in male patients belong to number of the factors exponentiating a divergence of belly muscles. Patients with a congenital dysplasia of connecting fabric also enter into risk group, diastases it is often associated with hereditary kollagenopatiya — hernias different localizations, varicose veins, a miopiya, scoliosis, flat-footedness with valgusny deformation, frequent incomplete dislocations of anklebones, hemorrhoids.
The starting moment of formation the diastase of direct muscles of a stomach becomes the long stretching of a belly wall caused by growth of a uterus, large volume of visceral fat, violations of digestion at the use by the newborn of the products causing a meteorizm. Under the influence of the holding apart loadings direct muscles disperse, and the white line connecting them stretches. Weakening of an intermuscular aponeurosis owing to insolvency of fibers at kollagenopatiya, a loosening of connecting fabric under the influence of a relaksin, immaturity of tendinous and muscular structures of a stomach at premature or their dystrophies in terminal stages of various pathological processes becomes the aggravating factor. In physiological conditions the aponevrotichesky membrane is independently reduced in process of strengthening of connecting fabric and muscles at babies, gradual reduction of volume of an abdominal cavity in the postnatal period and at smooth weight loss.
The divergence of direct superficial muscles in infancy usually disappears by 6-12 monthly age, however recovery process can be dragged out a little at the weakened children and come to the end not completely at a Down syndrome. At the given rise woman of diastases normal spontaneously it is closed within 2-12 months after natural childbirth. Restoration of the sizes of an intermuscular aponeurosis can be broken at early intensive trainings for restoration of physical shape as reduction of direct muscles of a press with simultaneous increase in intra belly pressure fixes the white line in the stretched state. The similar effect is rendered by hard physical activity, frustration at which the abdominal tension quickly intensively strains (a lock, cough). Preservation a diastase at sharp weight loss is caused by slower reduction of tendinous fibers which do not manage to be tightened behind the belt decreasing in volume.
Systematization of forms abdominal a diastase is carried out taking into account localization of the site of stretching and distance between inner edges of direct muscles. Such approach allows to decide on tactics of maintaining the patient and volume of surgical intervention (at its need). Plastic and abdominal surgeons distinguish the following views and degrees of stretching of the white line:
- On localization diastase. Allocate the nadpupkovy, podpupkovy, mixed options (with a simultaneous divergence of direct muscles above and below a navel). Aponeurosis stretching in the area an epigastriya is more often diagnosed for men, in mezogastralny and gipogastralny area — for women after the postponed childbirth.
- On expressiveness diastase. At a divergence of the I degree the distance between edges of direct abdominal muscles makes from 2 to 5 cm, at the II degree — from 5 to 7 cm, at the III degree — more than 7 cm. The stretching is more expressed, the clinical symptomatology is heavier and alleged operation is more difficult.
The classification of options of a disease used in plastic surgery considers a condition of both direct, and other groups of muscles of a stomach. Respectively allocate diastases of type A — classical postnatal, to B — with relaxation of the lower part and side departments of a stomach, C — extending to costal arches and a xiphoidal shoot, D — combined with lack of a waist.
Symptoms diastase of direct muscles of a stomach
The clinical picture of a disease directly depends on degree of stretching of a tendinous aponeurosis. At the initial stage the diastase is the only manifestation cosmetic defect in the form of protrusion of a stomach on the white line. At a tension of a press it is possible to see the "fillet" dividing edges of direct muscles. The divergence can be followed by discomfort, moderate morbidity in an epigastriya, okolopupochny area during physical activities, waist pain, difficulties when walking. When progressing a disease violations of motility of intestines (a meteorizm, locks), nausea are noted. At 66% of women with postnatal stretching of an aponeurosis dysfunction of muscles of a diaphragm of a basin which is clinically shown by an urine incontience at the time of cough, sneezing is observed. At expressed to a diastase signs of an atrophy of muscles of a stomach, venous stagnation in vessels of the lower extremities can come to light.
At a considerable divergence of edges of direct muscles (7 cm and more) at patients hernias of an umbilical ring and the white line of a stomach which are caused by existence of defects of an aponeurosis and an exit of abdominal organs together with a peritoneum under skin are quite often formed. A frequent complication of a disease is — omission of internals owing to weakening of muscles of a stomach that is clinically shown by chronic locks up to development of intestinal impassability, nausea, tachycardia, dizzinesses. At a diskoordination of muscle work there is excessive load of a backbone which can lead to constant back pains, violation of a bearing.
Diagnosis does not represent difficulties as diastases of direct muscles of a stomach is always followed by a characteristic clinical picture. Diagnostic search at a heavy stage of a disease is directed to identification of possible complications and violations in work of internals. The plan of inspection of the patient includes the following fizikalny and tool methods:
- Stomach palpation. The diastase allows to define existence the test: the patient is asked to lay down on a back, having bent legs in knees and to strain an abdominal tension. At the same time the doctor can propalpirovat the acting rollers at the edges of direct muscles and estimate divergence width. The method is insufficiently effective at patients with excess body weight owing to difficulties when carrying out a palpation.
- Ultrasonography of a belly wall. Sonografiya – an available noninvasive research, with its help stretching and thinning of the white line by which increase in distance between direct muscles is followed visualize. When using an ultrasonic method it is possible to define existence of such complications as hernias of a forward wall of a stomach, omission of belly bodies.
- Survey X-ray analysis of an abdominal cavity. The radiological research gives the chance to estimate the sizes and a relative positioning of internals. At 84% of patients it is observed various degree of expressiveness. The method also helps to differentiate diastases with other pathological states which are followed by a similar clinical picture.
In standard laboratory researches (clinical blood test, urine) at an uncomplicated divergence of direct muscles of an aberration it are not found to a koprogramma. For complex assessment of a condition of internals KT, MCKT of an abdominal cavity, measurement of acidity of gastric juice, ultrasonography of bodies of a small pelvis can be recommended to patients who had disease complications.
Differential diagnostics a diastase is carried out with congenital anomalies of development of connecting fabric, hernias of the white line and an umbilical ring, chronic diseases of a digestive tract (gastritises, enterokolita), diseases of urinogenital system. Except survey of the abdominal and plastic surgeon to the patient consultations of the gastroenterologist, the urologist, the gynecologist are recommended, to babies — a neonatolog or the pediatrician.
Treatment diastase of direct muscles of a stomach
Tactics of maintaining the patient is defined by duration of existence of aponevrotichesky stretching, its degree and type. At development the diastase against the background of gastrointestinal, bronchopulmonary and other diseases is surely appointed treatment of the main pathology. At infantile age waiting approach with making decision on expeditious strengthening of a belly wall after 6 months in the presence of the accompanying hernias and after 12 months is used at preservation a diastase and the expressed clinical symptomatology. The period of observation of the woman after the delivery usually makes not less than a year, at the same time the stretching of an aponeurosis of muscles of a stomach to 2,0-2,5 cm remaining within the first 6-8 postnatal weeks is considered physiological.
Conservative approach with use of the LFK special complex and massage is admissible at a diastase of the I degree. The patient is recommended to keep to a diet for maintenance of normal body weight, to exclude a raising of weights more than 5-6 kg, exercises in an emphasis and a knee and elbow position, including a level and push-up, deflections, twisting, the return twisting. Carrying a bandage for 2-4 months after the delivery, refusal of use of baby slings, correction of food for ensuring normal defecation, support of a stomach is shown to women with a divergence of abdominal muscles at cough and sneezing. As an auxiliary method kinesiological taping can be applied.
Expeditious treatment a diastase is carried out at a divergence of muscles of a stomach 2-3 degrees, existence of the accompanying umbilical hernia. At women surgical intervention is carried out not earlier than a year later after the delivery in the absence of plans for new pregnancy and good shape of belly muscles. Taking into account degree and the nature of stretching, a condition of surrounding fabrics different types of operations are applied:
- Endoscopic abdominoplastika. During intervention can be established mesh , be sewed regional sites of direct muscles, become stronger a hernial grid potentially weak zones of an aponeurosis. Perhaps simultaneous carrying out gernioplastika. Advantage of low-invasive operation is the minimum cosmetic defect, however this method is inapplicable in need of excision of excess fabric.
- Plasticity a diastase through a section. The traditional ushivaniye of defect is recommended in the presence of the flabby and stretched sites of skin which are planned to be removed in the course of operation. During intervention nodal seams on vaginas of direct muscles can be imposed, be removed surplus of an aponeurosis with sewing together of the remained edges, be sewed a polypropylene grid. At considerable deposits of subcutaneous fat the abdominoplastika is carried out.
Forecast and prevention
At diagnostics and treatment the diastase at early stages at most of patients is observed an absolute recovery without carrying out surgical interventions. Forecast of a disease favorable. In the started cases the dangerous complications (infringement of hernia) demanding urgentny operation can develop. For prevention of stretching of an aponeurosis it is necessary to carry out systematically exercises for strengthening of muscles of a stomach, to avoid heavy lifting, to normalize work of intestines, to increase the content of cellulose in a diet, to control body weight. According to researches, performance by pregnant women of a special set of exercises for stomach muscles reduces risk of development by 35% postnatal a diastase.