Diastasis Recti Surgery

Diastasis recti, also known as rectus abdominis diastasis or rectus diastasis, is characterised by the complete or partial separation of the abdominal muscles leading to the formation of an abdominal gap.

This condition is caused by the stretching of the linea alba (the white connective tissue between the abdominal muscles) due to extreme inner-abdominal pressure during pregnancy or excessive and improper abdominal exercise.

Diastasis recti can be surgically corrected via abdominoplasty, this procedure is commonly known as a tummy tuck surgery.

Role Of Abdominal Muscles

The abdominal muscles (rectus abdominis), commonly referred to as the six-pack muscles, are a pair of vertical muscles held together by the linea alba. Abdominal muscles are a part of the body’s core muscles and are vital for posture, balance and movement.

Diastasis recti is the separation of the abdominal muscles, leading to the formation of an abnormally wide gap at the midline of the abdomen.

Causes And Risk Factors

Diastasis Recti In Women

During pregnancy, the stretching of the uterus applies significant inner-abdominal pressure, leading to the widening of the linea alba as the abdominal muscles are pushed apart. Following the delivery of the baby, the gap between the muscles usually subsides, but this is not the case for all women.

Diastasis recti is recognised as a prevalent postpartum body problem and studies estimate that diastasis recti persist in up to 50 percent of women even after pregnancy. Repeated stretching of the abdominal muscles and linea alba due to multiple pregnancies, or extreme stretching due to a large infant or twins, can also increase the risk of persistent post postpartum diastasis recti.

Diastasis Recti In Men

While diastasis recti is commonly observed in women due to its link to pregnancy, it can similarly affect men and is often misdiagnose as “belly fat” or a “beer belly”.

Obesity is a medical condition that affects both men and women and the increased presence of fat in the abdominal cavity can lead to abnormally high intra-abdominal pressure and the stretching of the linea alba.

Excessive and strenuous exercise routines involving the abdominal muscles such as crunches or sit ups, as well as improper handling of weight-lifting equipment can also contribute to the thinning and deterioration of the linea alba and increase the risk of diastasis recti.

Signs And Symptoms of Diastasis Recti

In patients suffering from diastasis recti, the gap between the abdominal muscles is abnormally wide. Some of the common signs of diastasis recti include:

Presence of a “ridge” that runs along the abdominal midline. The ridge is the most visible when attempting to sit up or when crunching the abdominal muscles
Presence of a “bulge” or a “belly pouch”
Presence of a gap between the six-pack muscles that is directly visible, or can be felt when the area between the six-pack muscles is gently pressed on
Poor or deteriorating body posture
Lower back pain
Constipation or urinary problems
Formation of a hernia in severe cases of diastasis recti

Diastasis recti can be diagnosed via physical examination, ultrasonography or a computed tomography (CT) scan of the abdomen.

Patients can also test themselves for diastasis recti by simply lying on their backs placing their fingers on the area between their six-pack muscles (their midline). Crunch the abdominal muscles slightly by tilting the head towards the abdomen and gently press the fingers down on the midline. If a gap of 2.7 cm or more can be felt between the six-pack muscles, it is likely that the patient suffers from diastasis recti.

For an accurate and definitive diagnosis, please consult a doctor to schedule a physical examination or an abdominal scan.

Medical Implications

Diastasis recti is a condition often associated with cosmetic beauty as it manifests as a “belly bulge” or as a ridge along the midline of the abdomen. However, diastasis recti correction surgery is not purely just a cosmetic procedure, it is a medical procedure that can improve a patient’s quality of life.

The separation of the abdominal muscles can result in the loss of core muscle strength and physical discomfort as the integrity of the abdominal muscles are affected. Patients may find it difficult to maintain proper back posture and may develop chronic back pain due to the lack of abdominal support. The pelvic floor muscles may also be affected, leading to constipation or urinary problems.

If left untreated, more severe cases of diastasis recti can eventually lead to the formation of a hernia if internal organs are able to push through the gap between the abdominal muscles.

Diastasis Recti Correction Surgery

Exercise and core muscle training can alleviate abdominal muscle separation, but for more severe cases, surgery may be used to correct diastasis recti.

Abdominoplasty, commonly known as tummy tuck surgery, is a surgical procedure that tightens lose muscle and skin around the abdominal region. Abdominoplasty can be divided into two categories: mini tummy tuck and full tummy tuck. For the purpose of diastasis recti correction surgery, a full tummy tuck is usually done.

Surgery Procedure

The entire length of the rectus abdominis is operated on during a full tummy tuck surgery. The surgery starts with the surgeon making an incision above the pubic area and along the pelvic line. A second incision is made around the navel, and a vertical incision is made to join the first and second incision sites. These three incisions allow for the navel to be separated from the abdominal skin and for the skin to be lifted off as flaps to expose the abdominal muscles.

Excess fat may be removed as required, and the gap between the abdominal muscles is surgically tightened via stitching. The skin flap is then pulled over the abdominal muscles and the excess skin at the base is trimmed away. Another incision will be made to allow for the navel to be repositioned at a normal level after the abdominal skin is tightened.

FAQs On Tummy Tuck

Is the procedure painful?

At The Clifford Surgery Clinic, the procedure will be performed under local or general anaesthesia to minimise discomfort. Following the procedure mild soreness, swelling and bruising around and on the operated area is to be expected, these symptoms should subside within a few weeks. Medication will be prescribed to the patient after the surgery to aid the healing process.

How long is the procedure?

Diastasis recti correction surgery (full tummy tuck surgery) is usually completed within 1 to 3 hours depending on the width of the abdominal gap and extent of correction needed. Patients may be required to remain in the clinic for a few hours following the surgery to allow for the anaesthesia to wear off and for the patient’s condition to be monitored.

Is there any down time after the surgery?

Diastasis recti correction surgery is a major outpatient surgical procedure involving multiple incisions being made on the abdomen and the stitching of the abdominal muscles. Patients are expected to take up to 10 days of outpatient medical leave from work following the surgery. Light activity and sedentary work may generally resume after 10 days, but the patient is advised to take up to 14 days medical leave from work if the patient is required to stand on their feet for extended periods of time at their workplace.

When can I see results?

Results are visible immediately after the surgery. However, it may take a few weeks for the best results to be visible as time is needed for post-surgery swelling/bruising to subside and for the abdomen to heal.

Will there be scarring?

As diastasis recti correction surgery is a surgical procedure, some scarring is expected. However, as the surgical incisions are made along the pelvic line, scars from the procedure are usually easily covered by undergarments or bathing suits.

Women who previously delivered a child via C-section surgery may opt for the incisions to be made at the same location to reduce the number of new scars formed after the surgery.

Are the results of abdominoplasty permanent?

Surgery results are generally long lasting if patients maintain their body weight post-surgery. Pregnancy can, however, cause the abdominal muscles to stretch apart again and reverse the results of the surgery.

Abdominoplasty is thus not recommended for patients who intend to get pregnant in the future as a repeat surgery is not recommended.

What should I take note of before the procedure?

• Ensure that you are well hydrated starting at least one week pre-surgery

• Smoking and consumption of tobacco should cease at least 6 weeks prior to the surgery

• Please inform your surgeon of any medication/supplements you are currently consuming during the pre-surgery consultation session. Consumption of certain medication/supplement (such a s blood thinners)s may need to stop prior to the surgery

• On the day of the surgery, please wear comfortable clothing and arrange for someone to transport you home after the surgery

What should I take note of after the procedure?

• Ensure that you are well hydrated after the surgery to prevent dehydration and to replace the fluids removed from your body during the surgery

• Please take at least 10 days of medical leave from work following the surgery. Light activities can generally resume after 10 days of rest

• Strenuous activities should be avoided for at least 6 weeks following the surgery

• Our plastic surgeon at Mount Elizabeth Novena Hospital will provide you with a fitted corset. The corset is to be worn for several weeks following the surgery to reduce swelling and bruising, as well as maintain the shape of the abdomen post correction surgery. The corset may be occasionally removed for cleaning, or while you shower.