It is estimated that over 60% of women suffer from diastasis recti weeks, months, and even years after giving birth. You may be feeling something in your abdomen doesn’t feel right, or you continue experiencing overall core weakness despite various targeted programs. Perhaps, it’s been months of consistently working on diet and exercise, yet you are still seeing a protruding belly resembling pregnancy.
Chances are, you have abdominal separation interchangeably called diastasis recti. Although this condition is very common, it is often not talked about frequently enough. Whether this is your first time hearing about diastasis recti or you are researching corrective interventions, it’s important to have foundational knowledge and stay educated with what is happening within your body as you navigate this process.
We encourage you to set up an in person or virtual consultation with diastasis recti expert, and Board Certified Plastic and Reconstructive Surgeon, Dr. Rady Rahban. During your consultation, you will be carefully examined, and assessed regarding your individual case. You will be provided with a thorough personalized plan encompassing your options to correct and treat this condition, and alleviate the various symptoms associated with diastasis recti.
Understanding Diastasis Recti
Diastasis recti is a condition where the abdominal muscles have separated due to weakened connective tissue, leaving a gap between the left and right muscles. This occurs with nearly all pregnancies, to varying degrees from mild to severe, and is generally diagnosed during the second or third trimester of pregnancy.
During pregnancy, your body undergoes many changes both physically and hormonally. On a hormonal level, your body secretes a set of hormones called Prostaglandins. More specifically, a hormone called Relaxin is secreted which helps loosen the muscles, joints, and ligaments in order to safely dilate and stretch, to accommodate a growing fetus. These hormones continue to be secreted throughout the lactation process.
In addition to the hormones floating throughout your body, you are also undergoing physical changes, which is increased internal pressure from your growing baby. The combination of the physiological changes and internal abdominal pressure, results in the connective tissue or fascia that lies in between the right and left abdominal muscles, to stretch, and thin out. As your baby grows larger, the internal pressure continues to increase and can lead to the overstretching of the fascial band.
After giving birth, the abdominal separation becomes a vulnerable and weakened area in your abdominal wall. The visible abdominal bulge is the result of your internal contents pushing through this damaged connective tissue. Often times, the muscles do not return to their original state despite consciously working on diet and exercise.
According to a new study done by the Journal of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS), "restoring the pre-pregnancy shape of the abdomen, abdominoplasty (tummy tuck) surgery with muscle repair can improve back pain and urinary incontinence after childbearing. Functional improvements may result from restoring strength and stability in the abdominal and pelvic region as the operation incorporates repair of the abdominal muscle separation (rectus diastasis) that can occur after pregnancy. The results demonstrate that tummy tucks do have functional benefits, as well as cosmetic ones particularly in the postpartum population."
As you learn more about your abdominal separation, it is vital to be informed of the exercises that can worsen the condition. In fact, some of the more common exercises that you may be tempted to try such as sit ups, crunches, planks, and certain yoga moves, can increase abdominal pressure and worsen the separation.
Diastasis recti is a diagnosable condition when there is a separation present of at least 2 finger widths or beyond between the two sides of the rectus muscles. At this point, surgery becomes your most viable option to address the condition from the root of where it stems from.
Symptoms of Diastasis Recti
The abdominal bulge is just one of the symptoms associated with diastasis recti. In addition, you may be experiencing “tenting” or “doming”. This is most commonly seen while executing simple tasks such as coughing, sitting up, or even laughing. What you are experiencing is two fold. The overly thinned and stretched connective tissue creates a lack of support in the weakened abdominal wall, combined with internal pressure. So when you cough for example - the internal pressure from the cough pushes its way thru the midline resembling the shape of a football.
Another very common symptom of diastasis recti is lower back pain. Think of your abdominal wall and back as a connected unit that works simultaneously to properly function as your core. When part of your core in malfunctioning, it becomes problematic. When this happens, the back begins to overcompensate the lack of support and the back muscles go into overdrive. The overworked back muscles then become fatigued which contributes to lower back pain. Living with this pain is debilitating and can affect your overall quality of life. Not to mention the chicken and egg concept of not easily being able to exercise or rehab the core in order to strengthen the core. In the long run, continuously straining your back can lead to more serious chronic low back pain. In addition to having an abdominal bulge and back pain, you may be symptomatic in other ways, such as digestive discomfort, pelvic floor instability, and urinary incontinence.
By surgically repairing the abdominal wall, the fascia is brought back into the midline, restoring the proper anatomical structure of the abdominal wall. This will create the necessary support your back is desperately seeking. Once the abdominal wall is corrected, the overall core will be properly supported and functioning normally, which should alleviate the associated symptoms.
Diastasis Recti and Hernias
If you are suffering from diastasis recti, it is common to have a hernia coexist alongside the diastasis recti.
A hernia is a potentially serious condition that often goes hand in hand with diastasis recti but are slightly different by definition. A hernia is an actual hole in the connective tissue in which fatty tissue and intestines can squeeze through. The element that makes this condition unsafe is that the intestines can get trapped in the hole causing obstruction of the bowels. This can be painful and can lead to an immediate need for surgical intervention.
One of the more common types of hernias among postpartum women are umbilical hernias. This is where the hole is near the belly button area and often makes your belly button from the outside look like an “outie”.
The common denominator between the two conditions is that they are both caused by the increase in internal abdominal pressure in a weakened area of the abdominal wall. When the tissue is stretched and weakened thru the pregnancy process, it creates the perfect storm for the development of an umbilical hernia.
Correcting Diastasis Recti and Hernias Together
It is optimal to correct both the hernia and diastasis at the same time. Research suggests that if you corrected just the hernia without correcting the diastasis, you are essentially setting yourself up for a greater chance of reoccurrence. If the hernia is repaired independently of the diastasis, the repair has a higher chance of failing due to the buttonholes that are created while suturing the hernia.
These buttonholes can actually create a new hernia since the surrounding tissue is so thin and damaged. If you think of a stretched out rubber band and try to sew into it, you will notice that because it’s so thin, the hole may get larger and/or it can open another hole nearby. The successful outcome when repaired together occurs because the reinforcement of bringing the tissue to the midline also serves as additional reinforcement for the existing hernia and vice versa. The extra reinforcement results in a stronger supporting hold for both conditions resulting in greater long-term success and sustainability.
The potential complications from diastasis recti and hernias signifies the importance of seeing a highly skilled, Board Certified Plastic and Reconstructive surgeon to perform your surgery. When undergoing diastasis recti and hernia repair, it’s important to be correctly diagnosed by a qualified doctor who has extensive knowledge of the anatomical and physiological implications of these conditions.
Diastasis Recti Treatments
Sometimes patients come to Dr. Rahban's Beverly Hills office inquiring about non-surgical ways to treat diastasis recti. Although there is some evidence showing that certain types of exercises may help overall function, at any given point in time the separation may return. Often times, fully healing the damaged fascia is not possible without surgical intervention, as it addresses the root of the issue.
Diastasis Recti Surgery
With the understanding that surgery is the ideal treatment option for diastasis recti, it’s important to discuss what the surgery entails. Dr. Rahban makes a low incision, below the bikini line allowing him access to the separated muscles as well as the hernia if it exists. The fascia is then plicated by sewing the weakened and thinned connective tissue to the midline. In doing so, this will provide the necessary reinforcement to pull the muscles back to their original destination and therefore the gap is eliminated, and strength is restored. You will notice that once this is done, the symptoms associated with the condition are gone.
This procedure closely resembles that of a tummy tuck. Diastasis recti surgery and a tummy tuck are similar in many ways as they both address the muscle laxity and separation of the abdominal wall. In addition to the muscle repair, a tummy tuck also includes the removal of excess skin, and sometimes the removal of fat as well as the reconstruction of the belly button. This surgery requires very keen and meticulous execution in order to obtain optimal and long-term results.
Before & Afters
Dr. Rahban’s Meshless Approach to Diastasis Recti Surgery
Board Certified Plastic and Reconstructive surgeon, Dr. Rady Rahban, has mastered the technique of successfully correcting both conditions simultaneously without the use of mesh. Dr. Rahban strongly advocates against the use of mesh due to the potential risks involved to your future health and surgical outcome. In greater detail, the use of mesh in diastasis recti repair has been linked to infection, obstruction, significant pain, and perforation. Mesh has been recalled in the past due to these concerns.
Other more problematic long-term associations with mesh are that it can cut through your tissue, causing chronic pain, and irreparable damage. This can lead to healing delays and further warrant additional surgeries putting the patient at higher risk for other complications.
Instead, Dr. Rahban utilizes a MESHLESS technique requiring great accuracy and intricate surgical skills. He is a renowned diastasis recti expert and has mastered his craft by using a natural tissue approach to reinforce and correct the weakened tissue in even the most severe hernia and diastasis recti cases.
Dr. Rahban believes that the body tolerates its own tissue best and by doing so, minimizes the potential complications that mesh puts you at risk for. Dr. Rahban does not believe in sacrificing his patients’ safety and results by taking the easier, faster, or cheaper route. His strong and ethical standards are the driving forces to successfully executing diastasis recti and hernia repair in the safest way possible with favorable outcomes.
Recovery After Surgery for Diastasis Recti
After undergoing surgery to repair your diastasis recti, you can expect limited movement for approximately 2 weeks. You will want to give yourself the necessary time to rest and allow your body to heal. Ideally, you will take time away from work, and have support with daily tasks such as childcare, cooking, cleaning, and especially lifting. Approximately two weeks post op, many patients are cleared to go back to work but are to avoid strenuous activity and heavy lifting. By 4-6 weeks post op, you can begin to slowly resume all normal activities and are generally cleared to return back to the gym. It’s important to be mindful and nurture the recovery process to obtain the best possible outcomes and prevent complications.