Post-Pregnancy Surgery for Diastasis Recti to repair Split Tummy Muscles in Melbourne
Pregnancy is a magical time but growing another human takes a toll on your body. Excess skin, bulging belly, and stretch marks are only some of the cosmetic results of pregnancy. One very common, yet rarely mentioned, cosmetic problem after pregnancy is diastasis recti – separation of the rectus abdominis (the 6-pack muscle). When you have ab muscle separation, your belly will bulge forward. It can be a purely cosmetic problem, however, many studies have linked it to lower back pain, incontinence, hernia, and digestive problems. Diastasis recti repair surgery is the best method to treat split tummy muscles. It’s usually done during tummy tuck surgery (abdominoplasty), which aims to tighten and rejuvenate the belly, restoring the pre-pregnancy physique and improve your symptoms.
Dr Craig Rubinstein is one of the top certified plastic surgeons in Australia, and he has performed thousands of tummy tucks with and without muscle repair throughout the years.
What is diastasis recti?
Diastasis recti is a physical complication that usually happens after pregnancy, affecting more than half of women. Diagnoses can occur in the later stages of pregnancy or sometimes after delivery. There are several other names for diastasis recti including;
- Rectus diastasis
- Rectus divarication
- Ab separation
- Split tummy muscles
The condition happens as a result of the separation of the rectus abdominis muscle. The rectus abdominis muscle is the large muscle that extends along with the height of your belly. It has a right part and a left part, separated by a narrow band of tough collagenous tissue called “linea alba” that runs along your midline. When the linea alba becomes weak, thin, and wide, usually in the aftermath of pregnancy, the right and left parts of the rectus abdominis to become too far apart with a soft gap in between. The gap along the midline of your belly can be small or can extend along the whole midline of your abdomen. This makes your belly bulge forward (like a balloon), and can cause many problems like; a hernia, incontinence, and back pain, all of which can be treated with a tummy tuck.
What is the cause of rectus diastasis?
The main cause of rectus divarication is pregnancy and childbirth. During pregnancy, a woman’s body goes through a lot of hormonal and physical changes. The uterus grows and becomes massive to accommodate the developing fetus, pushing your organs away and stretching your abdomen in all directions. To help the muscles relax and stretch more, your placenta and ovaries also produce a hormone called “relaxin” in addition to progesterone.
Things don’t usually go back to how they were before pregnancy. In many women, the linea alba becomes irreversibly overstretched, and a soft gap in the middle of the abdomen between the ab muscles will develop. Abdominoplasty (tummy tuck) with muscle repair restores the integrity of the rectus abdominis, tightens your belly, and removes all the excess skin.
What problems does diastasis recti cause?
The problems and symptoms of diastasis recti are not purely cosmetic. Rectus divarication can cause a variety of aesthetic and functional problems, such as;
The most common symptom of rectus diastasis is a bulging belly. Women who have separated tummy muscles usually complain of an obvious protrusion above, below, or all-around their belly button. In some women, the soft gap between the muscles becomes so wide that bulging can reach the size of a football.
Your abdominal cavity is usually well protected and contained by your tough abdominal wall, which includes the rectus abdominis and the linea alba. Women who have rectus divarication have a very weak and stretched linea alba. In some of these women, the linea alba may rupture. When this happens, intestines and abdominal fat can slide through the defect and push up from under your skin. This is what doctors call a hernia.
A very common site of hernia is through the umbilicus (In many women, the belly button becomes “an outie” after giving birth, and this is usually a hernia). In such cases, the Rectus diastasis and hernia repair can be done simultaneously.
Hernias can cause many problems. If a bowel loop gets stuck in the defect, you can develop intestinal obstruction, which is a medical emergency that requires immediate surgery. This is why it is important to consult a surgeon if you suspect that you have ab separation or a hernia.
Lower back pain
One of the symptoms of diastasis recti is lower back pain. The rectus abdominis muscle is a crucial part of your core muscles; the muscles largely responsible for balance and posture. Rectus divarication weakens the rectus abdominis muscle and puts more stress on your back muscles which contract disproportionately to make up for the imbalance. This abnormal straining of the back muscles can cause chronic lower back pain. Fortunately, a tummy tuck with muscle repair can help improve back pain post-pregnancy.
Urinary incontinence is not uncommon after pregnancy and childbirth. Weak abdominal muscles and a weak pelvic floor are usually the cause of incontinence in women after pregnancy. Many women tend to use pads to avoid leaking urine when laughing, sneezing, or exercising. Abdominoplasty may help treat urinary incontinence after pregnancy. According to a 2018 study published in the journal of The American Society of Plastic Surgeons (ASPS), diastasis recti repair during a tummy tuck can significantly reduce incontinence.
Rectus divarication can allow your intestines to move around inside your abdomen in ways they’re not meant to. This can lead to gastrointestinal problems, such as constipation and abdominal discomfort. If you have a hernia, the bowel loops can get stuck in the defect every now and then. This can cause both pain and constipation. If a loop gets stuck and doesn’t go back in, you risk developing a bowel obstruction. If this occurs you will need immediate surgery.
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How do you treat rectus divarication?
Occasionally, rectus diastasis can improve without any intervention as your body recovers after pregnancy. For most women, however, this is not the case. One non-surgical way to treat diastasis recti is through physiotherapy. Special focused exercises with a certified physiotherapist can reduce tummy muscle separation and improve your bulging belly, however, this is not usually very effective.
The best and most effective way to treat diastasis recti is surgery. Diastasis recti surgery can permanently close the defect and bring the two sides of the rectus abdominis muscle tight together. Diastasis recti repair is usually done during abdominoplasty (tummy tuck) and not alone. A tummy tuck will strengthen your abdominal wall, remove the excess skin, and tighten your belly, all in one procedure. If you happen to have a hernia as well, Dr Rubinstein will also repair it during surgery.
Tummy tuck surgery has been shown to be effective in treating urinary incontinence and back pain after pregnancy. Moreover, abdominoplasty aims to restore your pre-pregnancy body by removing all the excess saggy skin. Liposuction can also be done during the same procedure to sculpt your body and remove the stubborn fat around your belly.
Can you get diastasis recti surgery without a tummy tuck?
Theoretically, yes you can, however, in practice, rectus repair is mostly done as part of a full tummy tuck. Nearly all women who have separation of the rectus abdominis muscle also have stretched tummy skin, lower belly fat, and excess tissue all over the abdomen. Diastasis recti surgery alone does not address the saggy abdominal skin and excess fat. This is why the vast majority of women choose to have the full abdominoplasty procedure, as they get the full cosmetic benefit of the surgery.
Who’s a good candidate for a tummy tuck?
Abdominoplasty is an invasive surgical procedure, and there are several factors that play a role in reducing complications and determining the quality of the outcomes. You’re a good candidate for a tummy tuck if:
- You’re not planning on getting pregnant again
- More than 12 months have passed since your last pregnancy
- You don’t smoke (or you’re willing to quit 4-6 weeks before surgery)
- You’ve had a stable weight for the past 6 months and not planning further weight loss
- You have generally good health and your chronic conditions are under control
- You have realistic expectations for the surgery and can accept a thin scar along your bikini line
What are the benefits of diastasis recti repair surgery?
Diastasis recti repair surgery does not only improve aesthetics – it has functional benefits as well. Some of the benefits of a tummy tuck with muscle repair are:
- Rejuvenation of the abdomen: A tummy tuck removes saggy or overhanging skin, tightens your belly, and gives you a flat young belly without any irregularities.
- Decreased back pain: Diastasis recti surgery strengthens your core and improves lower back pain after pregnancy
- Decreased urinary incontinence: Rectus diastasis surgery strengthens your abdominal wall and helps reduce urinary incontinence after pregnancy.
- Hidden scar: The scar of the tummy tuck is well hidden in your bikini line, so it won’t be apparent if you wear revealing clothes or a swimsuit.
How is diastasis recti surgery performed?
- Diastasis recti repair surgery is usually done during a tummy tuck and will be carried out a hospital operating room.
- First, you will be given inhaled and intravenous anaesthetic drugs to go to sleep.
- Then, Dr Craig will perform a horizontal incision along your bikini line, right above your pubis.
- After pulling your skin aside, he will identify the two sides of your rectus abdominis and bring them closer to each other.
- Next, Dr Craig will plicate the muscles and suture them together, tightly closing the defect in-between.
- If you have a hernia as well, Dr Craig will also remove it and close the opening.
- In order to rejuvenate the abdomen, Dr Rubinstein will cut out the excess lax skin, subcutaneous tissue, and fat from your lower belly.
- He will then pull the skin together so that your whole abdomen is tight with no bulges or irregularities.
- In some case, your surgeon may need to create a new belly button.
- When all the tissue is removed and the edges approximated, Dr Craig will close your skin with a fine suture line.
- Your surgeon will also apply a compressive dressing before you wake up.
The procedure usually takes 2-4 hours to complete. You can choose to combine liposuction with a tummy tuck to further contour the abdomen and hips.
You can check abdominoplasty and diastasis recti surgery before and after pictures on our website.
What to expect during recovery from rectus diastasis surgery?
After your surgery, you will be sent to your hospital room to recover, you might spend a night at the hospital for monitoring and be discharged the next day. You might notice one or two surgical drains coming out from your wounds to allow the fluid to drain away. These may be kept for a few days after your discharged and will be removed later in the clinic.
Since diastasis recti surgery involves muscle repair, you should expect some muscle soreness and pain for the first few days after your surgery. Your wounds will also show some swelling and bruising. These symptoms might take up to 2 weeks to subside. During this period you should rest and avoid moderate physical activity. Recovery time after rectus diastasis repair can take up to 6 weeks, after which you can usually resume your normal activities and get back to work. You will also need to wear compressive abdominal garments during this period.
Read more about Recovery after Cosmetic Surgery.
Does rectus diastasis repair leave a scar?
Like any other surgery, abdominoplasty with muscle repair leaves a thin scar. The scar will be located along your bikini line, which means that it can be well hidden under your underwear. You can wear a swimsuit without worrying about your scar. We also offer several post-operative treatments to reduce scarring after surgery.
What are the possible complications of diastasis recti surgery?
Rectus diastasis repair is a safe procedure, however, there are some uncommon complications that can occur:
- Wound infection
- Blood collection in the wound (hematoma)
- Fluid collection in the wound (seroma)
- Wound dehiscence (sutures breaking)
You can reduce the risk of these complications with great aftercare and follow up by your plastic surgeon.
Does Medicare cover diastasis recti surgery?
Yes. If rectus diastasis is causing you abdominal discomfort, urinary incontinence, and/or lower back pain, the surgery will be covered by Medicare and third-party insurers. You will be eligible for a rebate if more than 12 months have elapsed since your last pregnancy, and rectus diastasis symptoms are interfering with your quality of life.
However, it’s important to note that you will most likely still have some out of pocket costs.
For more information, read Will Medicare Cover my Tummy Tuck Surgery?
Can exercise help fix diastasis recti?
Home exercises like crunches, planks, and sit-ups may worsen tummy muscle split since they increase the intraabdominal pressure. The only exercises that can help reduce rectus diastasis are certain exercises that focus on core exercises performed with a certified physiotherapist.
Rectus diastasis is a very common condition in women after pregnancy. Lower back pain, incontinence, hernia, and abdominal discomfort, are all possible complications of rectus diastasis. Thankfully, a tummy tuck with muscle repair can treat these symptoms and rejuvenate your abdomen, restoring your pre-pregnancy body.
Further Reading – Medical Sources: