Post-Pregnancy Surgery for Diastasis Recti to Repair Split Stomach Muscles in Melbourne
Pregnancy can have lasting effects on your body. Alongside issues like excess skin, diastasis recti (the separation of the rectus abdominis muscles) is common post-pregnancy. This condition not only alters the appearance of the abdomen, but is also associated with lower back pain, incontinence, hernias, and digestive problems.
Diastasis recti repair surgery, often performed in conjunction with Abdominoplasty surgery, offers a solution. This procedure, when executed by an experienced plastic surgeon like Dr Craig Rubinstein may address related health issues. Dr Craig Rubinstein is an experienced plastic surgeon in Australia, and he has performed many procedures both with and without muscle repair throughout the years.
URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck/Abdominoplasty for some post-pregnancy patients suffering from Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new 30175 Medicare Item Number – is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.
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What is Diastasis Recti?
Diastasis recti is a physical complication that usually happens after pregnancy. 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
This 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 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, and can cause many problems like; a hernia, incontinence, and back pain, all of which may be treated with an abdominoplasty.
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 to accommodate the developing foetus, 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 with muscle repair restores the integrity of the rectus abdominis, tightens your belly, and removes 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, including:
Bulging
The most common symptom of rectus diastasis is a bulging abdomen. Women who have separated tummy muscles usually have an obvious protrusion above, below, or 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.
Hernia
The 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 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 an 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 the back muscles which contract disproportionately to make up for the imbalance. This abnormal straining of the back muscles can cause chronic lower back pain.
Incontinence
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 an abdominoplasty can significantly reduce incontinence.
Digestive problems
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.
How Do You Treat Rectus Divarication?
Occasionally, rectus diastasis can improve without any intervention as your body recovers after pregnancy. For many, however, this is not the case. One non-surgical way to treat diastasis recti is through physiotherapy. Special focused exercises with a certified physiotherapist may reduce stomach muscle separation and improve the distention in the stomach.
Diastasis recti surgery can permanently repair the defect and bring the two sides of the rectus abdominis muscle tight together. Diastasis recti repair is usually done during abdominoplasty and not alone. An abdominoplasty 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.
Abdominoplasty surgery has been shown to be effective in treating urinary incontinence and back pain after pregnancy.
Can You Get Diastasis Recti Surgery Without an Abdominoplasty?
Theoretically, yes you can, however, in practice, rectus repair is mostly done as part of a full abdominoplasty. Nearly all women who have separation of the rectus abdominis muscle also have stretched stomachs, excess lower belly fat, and excess tissue over the abdomen.
Diastasis recti surgery alone does not address the excess abdominal skin and stomach fat.
Possible Candidates for Abdominoplasty Surgery
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 may be a suitable candidate 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)
- Your weight has been stable for the past 6-12 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 what the surgery can achieve.
What are the Potential Outcomes of Diastasis Recti Repair Surgery?
Some of the outcomes of an abdominoplasty with muscle repair include:
- Cosmetic Appearance: Surgery can reshape the abdominal area. Repairing separated abdominal muscles can significantly reduce the bulging appearance, resulting in a reshaped contour.
- Relief from Associated Symptoms: Diastasis recti is often associated with symptoms such as lower back pain, incontinence, hernias, and digestive issues. Repairing the abdominal muscles can alleviate or reduce these symptoms
- Enhanced Core Strength: By bringing the abdominal muscles back together, diastasis recti repair can improve core strength and stability. This is particularly beneficial for individuals who experience back pain or reduced core strength due to muscle separation.
- Posture Improvement: A stronger core and abdominal area can lead to better posture. This can have a positive impact on your overall body mechanics and may help prevent future issues related to poor posture.
- Functional Benefits: Beyond aesthetics, diastasis recti repair can improve physical functionality. It may make it easier to perform daily tasks, engage in exercise, and lead an active lifestyle.
It’s important to consult with a board-certified plastic surgeon to determine if diastasis recti repair surgery is suitable for you. They can assess your condition, discuss your goals, and provide recommendations for the most appropriate treatment approach.
How is Diastasis Recti Surgery Performed?
- Diastasis recti repair surgery is done during an abdominoplasty procedure and carried out in 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 perform the abdominoplasty portion of the procedure, 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
- In some case, your surgeon may need to create a new belly button.
- When all the excess tissue is removed and the edges approximated, Dr Craig will close your skin with a fine suture line.
- Your surgeon will then apply a compressive dressing before you wake up.
The procedure usually takes 2-4 hours to complete. You can check abdominoplasty and diastasis recti surgery before and after pictures on our website.
Recovery
After your surgery, you will be sent to your hospital room to recover. You will likely spend a night or two in hospital for monitoring before you are discharged. 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 you are discharged and will be removed later in the clinic.
Since diastasis recti surgery involves muscle repair, you should expect some muscle soreness and pain after your surgery; swelling and bruising are also to be expected. These symptoms will slowly improve but can 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 invasive surgery, abdominoplasty with muscle repair leaves a scar. The scar will be located along your bikini line, which means that it can usually be hidden under your underwear line. We also offer several post-operative treatments to reduce scarring after surgery for those that require it.
What are the Possible Complications of Diastasis Recti Surgery?
Diastasis recti surgery, like any surgical procedure, carries potential risks and complications. It’s essential to be aware of these before undergoing the surgery and to discuss them thoroughly with your surgeon. Possible complications may include:
- Infection
- Poor Scarring
- Hematoma
- Seroma
- Numbness or Altered Sensation
- Delayed Wound Healing
- Unsatisfactory Results
- Anaesthesia Risks
- Deep Vein Thrombosis (DVT)
- Wound dehiscence (sutures breaking)
To minimise these risks, it’s crucial to choose a board-certified plastic surgeon with extensive experience in diastasis recti repair surgery. Follow your surgeon’s preoperative and postoperative instructions carefully, attend all follow-up appointments, and communicate any concerns promptly. While complications are possible, they are relatively rare, and many individuals experience successful outcomes from this procedure. Visit the Risks Page for more information.
Does Medicare Cover Diastasis Recti Surgery?
If rectus diastasis is causing you abdominal discomfort, urinary incontinence, and/or lower back pain, the surgery will be eligible for cover 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/Abdominoplasty Surgery?
Further Reading – Medical Sources:
- https://www.frontiersin.org/articles/10.3389/fsurg.2019.00065/full
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715079/
- https://www.plasticsurgery.org/news/press-releases/more-than-just-a-cosmetic-procedure-tummy-tuck-reduces-back-pain-and-incontinence
- https://journals.lww.com/plasreconsurg/Fulltext/2018/03000/Abdominoplasty_Improves_Low_Back_Pain_and_Urinary.13.aspx
- http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1546-public
- https://www.nbt.nhs.uk/maternity-services/pregnancy/pregnancy-complications/divarication-abdominal-muscles
About Dr Craig Rubinstein
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Dr Craig Rubinstein FRACS (Fellow of the Royal Australasian College of Surgeons) is an experienced Melbourne Specialist Plastic Surgeon for breast and abdominoplasty surgery.
Dr Rubinstein offers women personalised abdominoplasty surgery and all forms of cosmetic breast surgery.
BOOK A CONSULTATION (03) 8849 1400
Next Steps in Your Surgical Journey
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About Your First Consultation
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What to Bring to Your Consultation
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- Ensure you also take a lot of notes and thoroughly examine the documents provided.
- Please be aware you may need to undress for a physical exam so wear simple clothes.