Published by Dr MIguel Fernadez Calderón: 28/04/2023
Pregnancy, overweight and poor posture are some situations that can trigger the separation of the abdominal muscles. This condition is known as diastasis rectus abdominis and it is not only an aesthetic problem, but also a functional one. In Sculpture Clinic we explain the surgical and non-surgical solutions to this problem.
What is diastasis recti?
The separation of the rectus abdominis muscles is known as abdominal diastasis. This alteration weakens the abdominal wall and causes a bulge to appear in this area when the person stands or performs abdominal press movements.
The rectus abdominis are two muscles found in the center of the body and are joined by the linea alba. Their function, along with the rest of the abdominal muscles, is to support the body and facilitate movement. They are also responsible for protecting the internal organs.
The separation of these muscles affects aesthetics because the abdomen appears larger. But this is not the only problem, as it can cause urinary incontinence, prolapse, back and pelvic pain.
Types according to location and severity
Depending on the area that affects the separation of the muscles, diastasis recti can be supraumbilical, when it is located above the navel.
It can also appear below the navel. In this case we are talking about an infraumbilical diastasis. Finally, it is called total diastasis if it affects the entire midline.
Another way to classify diastasis is according to its severity, which responds to the separation between the rectus abdominis muscles.
If the distance between the rectus muscles is between one and two centimeters, it is considered a mild diastasis. The separation between two and five centimeters is moderate. But when the separation of the muscles exceeds five centimeters, it is a severe case.
It is important to understand the type of diastasis to determine the correct treatment.
Causes and Risk Factors
Abdominal diastasis is related to increased intra-abdominal pressure, which causes the muscles to separate. This condition can affect both men and women and may be related to pregnancy, obesity, among other factors.
Pregnancy and postpartum
Pregnancy is one of the most common causes, as the abdomen expands to make room for the growing fetus. This pressure on the abdomen can lead to separation of the muscles.
On the other hand, pregnancy hormones, such as relaxin, also contribute to the loosening of connective tissues, thus facilitating diastasis. In multiple pregnancies, the risk is higher.
Pregnancy and childbirth can bring changes to a woman's body such as abdominal diastasis and changes in the vaginal lips. The latter can be corrected by labiaplasty.
Obesity and weight changes
People with obesity are also prone to diastasis recti. This is because significant weight fluctuations weaken the abdominal muscles.
Similarly, the pressure exerted by excess abdominal fat can affect the elasticity of the connective tissues.
Inadequate exercise and excessive physical exertion
There are other risk factors that can cause this alteration. Among them are the excess of exercises that involve repetitive movements of flexion or torsion of the trunk.
Other risk factors related to diastasis are sedentary lifestyle and intestinal inflammation. It can also appear as a consequence of some surgeries.
Symptoms and Diagnosis
Diastasis recti does not always present obvious symptoms. Some people may even have it without knowing it. However, there are cases in which it can cause discomfort, in addition to the associated aesthetic problems.
Visible signs and associated discomfort
People with diastasis recti usually have a bulge in the midline of the abdomen. This bulge is more evident when the abdominal muscles are strained, for example, when getting out of bed or exercising.
In addition to the bulge, other discomforts that may occur are low back pain, difficulty in physical activities, poor posture or urinary incontinence.
Self-assessment and clinical trials
The diagnosis of abdominal diastasis is made by a physical examination that can be performed by a physical therapist. Ultrasound scans are also requested to see if there is a separation between the muscles and to determine exactly how many centimeters it is.
A person may suspect this condition when his or her abdomen is flabby and bulging, and it is possible to do a self-assessment.
To do this you should lie on your back on a solid surface, bend your knees to rest your feet on the floor and do an abdominal. When executing this movement you should palpate the area above the navel with your fingertips. This will let you know if there is a separation of the muscles.
After the self-examination it is necessary to visit a specialist to receive a professional diagnosis and treatment.
Non-surgical solutions
If the separation between the rectus muscles is less than two centimeters, it can be treated with exercises and physiotherapy.
Specific exercises for treating diastasis recti
The physical therapist is in charge of guiding the patient on the core strengthening exercises to be done. In this case, traditional crunches are not performed, so it is important to follow the therapist's instructions.
During the therapies, hypopressive abdominals are performed and the transversus abdominis muscle is worked. Pelvic floor exercises are also recommended.
Don't forget that a specialist is the one who will tell you which stretching and mobility exercises you can do, as well as strengthening exercises.
Physical therapy and rehabilitation programs
As we explained, it is necessary to visit a physiotherapist to diagnose and apply the corresponding treatment. If the diastasis recti is mild, it is possible to solve it by means of a program adjusted to the patient's conditions.
On the other hand, it is recommended to go through this process even before undergoing surgery to correct diastasis.
The results with these treatments can be seen in a year, even longer, and depend on each patient. The therapies must be accompanied by a good diet.
Use of abdominal bands and girdles: pros and cons
Girdles act as an adjunct to the treatment of abdominal diastasis and help prevent discomfort. However, they do not solve the problem by themselves. In addition, not just any type of girdle can be used. It will be the specialist who will indicate which type of girdle to use and for how long.
The advantages of girdles are:
- They prevent back pain.
- They prevent organs from moving out of place.
- Helps compress the abdomen.
As for the disadvantages:
- Not just any girdle can be used.
- Avoid overuse.
Surgical solutions
In cases where rectus abdominis diastasis is severe, surgery is used to put the muscles back in place. Surgical treatment is recommended when the separation is greater than three centimeters and when physical therapy has not worked.
Ideal candidates for diastasis recti surgery
Surgery to correct rectus abdominis diastasis is not necessary in all cases. Surgery is applied in cases where the separation is very severe.
Other factors are also taken into account, such as whether the patient suffers from back pain and other discomforts.
There are occasions in which diastasis is associated with a hernia, which can be umbilical, inguinal or abdominal. In these cases surgery is also used.
Types of surgeries to treat diastasis rectus abdominis
Surgical treatments aim to repair the midline with sutures. In this way, the muscles are put back in place.
Plicatura of rectus
Rectus abdominis plication consists of joining the muscles together with sutures. This is done through an incision made near the navel. Depending on the patient's condition, a mesh may or may not be used to help strengthen the area.
It can also be done by endoscopy, which is a less invasive surgery.
Abdominoplasty
Rectus abdominis diastasis is also corrected by abdominoplasty when the patient has excess skin in the abdomen.
This surgery is done with an incision in the lower abdomen, through which the surgeon has access to the muscles. He will be in charge of taking both muscles to their place and make the plication. Likewise, he may or may not place a mesh.
After joining the muscles proceed to tighten the skin and cut the excess. When the abdominoplasty is performed, the navel is also repositioned.
Consult Sculpture Clinic' s abdominoplasty treatment if you think this is the solution to your problem.
It is possible to combine abdominoplasty with liposuction to remove fat and improve body contour.
Risks and complications of surgery for diastasis recti surgeries
Every operation has risks and surgery to correct diastasis recti is no exception. These include the appearance of hematomas, seromas, infections, pain or problems related to anesthesia.
Choosing the right surgeon and following the instructions given before and after the operation helps to reduce risks.
Postoperative recovery: advice and care
During recovery the patient must follow the surgeon's instructions to the letter. The postoperative period may last four weeks in which the patient must rest physically. This time will be for the skin and the muscles to adjust.
The first week you will need to take the medications prescribed by your doctor to prevent infection and control discomfort. You will probably feel some pain.
You should sleep on your back, with your back raised to avoid stretching your abdomen completely.
The patient will return to his activities little by little, but should not make great physical efforts.
After the operation you will have to wear a girdle for abdominal diastasis. At first all day, and then as directed by the surgeon.
Long-term results of surgical and non-surgical solutions
Correcting diastasis recti will result in an improved appearance for the patient. The body contour will improve as the muscles are reattached and strengthened. This will also result in improved self-esteem.
If the correction is done by abdominoplasty, the excess skin will also be removed, which means a profound change in the patient's image.
But diastasis recti is not only an aesthetic problem, but also a functional one. So, after surgery, it is expected that the discomfort, back pain, incontinence and other symptoms that the patient has had will disappear.
Prevention of diastasis rectus abdominis
- Do exercises to strengthen the transversus abdominis muscle.
- Always maintain good posture while standing or sitting.
- When you are sitting you can place a pillow on your back to improve your position.
- Avoid a sedentary lifestyle and exercise; however, physical activity must be controlled.
- Do not carry heavy weights or objects, especially during pregnancy.
Conclusions: choosing the right solution for each case
Abdominal diastasis may be caused by different reasons and different degrees of severity. It is a condition that should be diagnosed and treated by a specialist.
According to the patient's situation it will be determined if it can be solved by surgical treatments, such as abdominoplasty, or by physiotherapist therapies. Listen to the specialist and follow his indications.
If you suspect that you suffer from diastasis recti, go for a check-up to start treatment as soon as possible.
