An overview of rectus abdominis diastasis

Diastasis recti, also known as diastasis rectus abdominis diastasis, is a condition where the rectus abdominis muscles separate during and after pregnancy. The rectus abdominis muscle is a pad vertical muscular structure in the front of the abdomen commonly referred as “six-pack abs,” divided into left and right sides by the linea alba which is connected tissue running down the middle. This means that your abdominal tone is less and you may experience lower back pain, there can be a central bulge on straight leg raising and also patients feel bloated even when they have no dietary and nutritional problems.

During pregnancy, the abdominals stretch, thinning and pulling apart the linea alba as the uterus expands. After delivery, the linea alba can heal and retract like a rubber band, bringing the abdominals back together. 

However, if the tissue loses elasticity from being overstretched, the gap in the abdominals will not fully close, resulting in diastasis recti. People with this condition may have a protruding belly, resembling a pregnant appearance even months or years after giving birth.

Rectus diastasis causes

Diastasis recti is primarily caused by the stretching and thinning of the linea alba tissue that separates the rectus abdominis muscles. This stretching and thinning can occur due to various factors, including 

1. Pregnancy: The growing uterus pressurise the abdominal muscles, stretching and thinning the linea alba (a thin band of connective tissue in front of your abdomen.).
2. Multiple pregnancies: Women who had multiple pregnancies are at a higher risk of developing diastasis recti due to repeated stretching and thinning of the linea alba.
3. Obesity: Being obese puts extra pressure on the abdominal muscles. As a result, it stretches and thins linea alba.
4. Heavy lifting: Repeated heavy lifting or incorrect lifting techniques can strain the abdominal muscles, leading to diastasis recti.
5. Ageing: As people age, the abdominal muscles naturally lose their strength and elasticity, making them more prone to separation.
6. Genetics: Some people may be genetically prone to developing diastasis recti.

How common is diastasis recti?

Diastasis recti, or rectus abdominis diastasis, is typically seen in postpartum women, but it can also affect men. Typically in men, they get a horizontal weakening of abdominal muscles rather than vertical weakening and in some cases, when men have this they need to have a correction horizontally as opposed to the common vertical correction we have seen in women who had pregnancies.

 The condition is more usual in the third trimester of pregnancy when the stomach bulges outwards due to the growing baby, which puts increased pressure on the abdominal wall. Although most people don’t notice diastasis recti until after delivery, it can start to develop during pregnancy.

Diastasis recti is highly prevalent in pregnant and postpartum women, affecting about 60% of them. It typically resolves within eight weeks of delivery if very mild, but about 40% of those affected still have it six months postpartum. Some post-pregnancy exercises with physiotherapy guidance can help to improve the strength of your abdominal musculature, but often, patients do require surgical intervention for this. 

How to know I have rectus abdominis diastasis?

The rectus diastasis symptoms can vary from person to person. Some common symptoms include:

1. A protrusion or bulge in the abdomen, especially when the person is sitting up or straining.
2. Weakness or instability in the core muscles.
3. Lower back pain or discomfort.
4. Poor posture.
5. Difficulty lifting objects or performing certain exercises.
6. Digestive issues, such as constipation or bloating.

If left untreated, it may increase the risk of hernias and urinary incontinence. In severe cases of diastasis recti, surgery may be necessary to repair the abdominal muscles.

Closing the gap: How to diagnose and treat diastasis recti

Diagnosing diastasis recti is typically done through a physical examination by a healthcare provider. During the exam, Dr Rory will assess the width and depth of the separation between the rectus muscles, as well as the strength of the core muscles.

Treatment for diastasis recti

The rectus diastasis treatment depends on the severity of the condition, which includes separation gap and other symptoms experienced by the patient. In mild cases, exercises that focus on strengthening the core muscles, such as pelvic tilts and abdominal bracing, may be sufficient to improve symptoms and reduce the size of the separation.

In more severe cases, surgery is recommended. Surgery is typically recommended when the separation is greater than 2.5 centimeters and where the patient is experiencing significant symptoms such as back pain or hernias. The surgery involves suturing the rectus abdominis muscles back together, with the permanent suture from the ribcage down to the pelvis and often is done in combination with some form of abdominoplasty either a mini abdominoplasty working on the separeted rectus abdominus muscles or a full abdominoplasty. 

Tummy tuck (Abdominoplasty) or mini tummy tuck surgery for fixing rectus abdominis diastasis.

During a mini tummy tuck procedure, the abdominal muscles are often tightened to address the widening that occurs due to diastasis recti. This is typically achieved using a permanent stitch that acts like a shoelace to vertically pull the muscles back together. The procedure is performed through an incision that runs low on the abdomen, usually hip to hip, depending on the laxity in the skin and excess fat.

In a mini abdominoplasty, in order to gain access to the separation of the muscles, often the belly button can be disconnected from behind, but this is best suited normally for patients with a high belly button in order that the belly button can be lowered when the excess skin is removed through the mini abdominoplasty.

A full abdominoplasty is typically recommended for patients who have experienced multiple pregnancies, significant weight loss, or excessive hanging skin and fat in the abdominal area. The procedure is also often recommended for patients with severe diastasis recti, with a gap in the muscles of more than 2 centimeters, and involves a scar around the belly button and along the scar of mini abdominoplasty and depending on the laxity of the skin of the abdominal wall, there can be a small vertical component like an inverted T along with the tummy tuck scar.

Dr Rory McGoldrick is a board-certified plastic surgeon with extensive experience in treating diastasis recti using a range of surgical and non-surgical techniques. Patients choose Dr Rory for his expertise, personalised care, and commitment to helping them achieve their desired body shape.