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Notice the vertical indentation in the center of this woman’s abdomen. Even very slim, fit women can suffer from diastasis recti post-pregnancy—and may benefit from a tummy tuck to repair the condition.
It’s no secret that pregnancy changes your body, and some changes are more welcome than others. One post-pregnancy effect that for most women firmly lands in the “not welcome” category is diastasis recti, or a separation of the abdominal muscles that can lead to a myriad of problems from a protruding belly to chronic back pain.
Despite the fact that diastasis recti is very common after pregnancy, the condition isn’t widely discussed. In fact, many of my Denver tummy tuck patients who come seeking help to correct a bulging belly don’t know about diastasis recti until I point it out during their consultations.
What is diastasis recti?
The rectus abdominus muscles, which run side by side from the ribs down to the pubic area, are held together by a band of connective tissue (fascia). During pregnancy, the fascia naturally thins and stretches, allowing the muscles to spread apart to make room for the growing baby. For some women, the fascia gradually contracts back to normal in the months after giving birth. However, in many cases it is too weak to contract and stays stretched, causing the ab muscles to remain separated. This is diastasis recti.
Aesthetically, diastasis recti presents as a bulging or protruding belly—a “mummy tummy” or “post-baby pooch.” Many women with the condition feel that they still look pregnant, even years after having their last child.
Diastasis recti is not just a cosmetic issue. The abdominal muscles, which normally work together, can weaken significantly once they are stretched apart, leading to problems such as lower back pain, stress incontinence, digestive disorders, and hernia.
How do I tell if I have diastasis recti?
Your doctor can diagnose diastasis recti with a physical exam, but in the meantime you can try this at home: lie on your back with your knees bent and feet on the floor. Press on your tummy gently with your fingers just above the belly button, and lift your chin towards your chest. Feel for the edges of your ab muscles. If you can fit two or more fingers in between the muscles, you likely have some degree of diastasis recti.
Other signs you have diastasis recti include:
- You still look pregnant a year or more after giving birth or losing significant weight
- You have a protruding belly despite reaching a healthy weight with diet and exercise
- Your belly bulge becomes more noticeable when you engage your abs (i.e., sitting up)
- You have chronic lower back and/or hip pain and/or constipation (always see your doctor about any unexplained changes in your body)
Will a diastasis recti go away on its own?
Yes, sometimes. If you’ve had a baby within the past 6 to 12 months, be patient! It takes time for the body to readjust. A diastasis is more likely to close on its own if you had minimal weight gain during pregnancy, or if this was your first pregnancy. However, if you are at a healthy body weight, you’ve been battling a bulging belly for a year or longer, and diet and exercise have not helped, it may be time to consider surgery.
Treating diastasis recti with tummy tuck surgery
A tummy tuck is specifically designed to tighten the abdominal wall inside and out. By placing permanent internal sutures in the fascia to close the separation, a plastic surgeon can repair a diastasis recti to restore a firmer, flatter abdominal shape. This often also alleviates secondary issues such as back pain, hernia or stress incontinence.
While some surgeons offer laparoscopic procedures to solely repair diastasis recti, I strongly recommend a full tummy tuck for several reasons:
- Most post-pregnancy patients with diastasis recti also have excess, sagging skin, which is removed during a tummy tuck.
- Closing a diastasis recti reduces abdominal circumference, which can create more loose skin. Repairing a diastasis recti with a tummy tuck allows a plastic surgeon to remove the optimal amount of skin based on what’s left after the muscles are tightened.
- A board certified plastic surgeon is specifically trained and qualified to consider the aesthetic outcome, not only the medical outcome. This includes belly button reshaping to ensure a natural abdominal contour as well as careful scar placement to ensure you can conceal scars after your procedure.
- Many patients end up having a tummy tuck to improve results of a diastasis recti repair alone. Having a tummy tuck in the first place would avoid a second surgery.
Choosing your tummy tuck surgeon
If you are bothered by a protruding belly and you suspect a diastasis recti, talking to an experienced, board certified plastic surgeon can help you better understand the issue and your options to address your concerns. When interviewing potential surgeons, make sure they are highly experienced in tummy tuck surgery specifically for diastasis repair. Also, ask what they do to ensure a safe surgery and beautiful results, as tummy tucks are one of the more involved plastic surgery procedures.
To give you an idea of what can make a difference between a “good” tummy tuck and a superb tummy tuck, here are some of the techniques I incorporate for my patients in Denver:
- Total tummy contouring. A “plain tummy tuck” that only focuses on the front can result in a flat but boxy abdomen. I incorporate VASER assisted liposuction as needed to sculpt the sides, hips, and back to give a gorgeous shape to the entire midsection.
- Drain-free tummy tucks. Traditional tummy tuck techniques can result in fluid buildup in between the skin and muscle layer, which can require a patient to wear external drains for several weeks. I utilize progressive suturing to strategically close this space, eliminating the need for drains.
- BOTOX injections during surgery. Yes, BOTOX! Injecting BOTOX into the newly repaired muscles helps to prevent muscle spasms as they heal. This greatly enhances patient comfort during recovery.
Can you fix diastasis recti with exercise?
A tummy tuck is the most effective way to treat diastasis recti, but not everyone is ready for surgery; perhaps you plan to have more children in the future, for instance. There are certain exercises that, when performed correctly, can help a mild diastasis improve. However, many common exercises, including crunches and planks, can actually pull your ab muscles further apart, making matters worse. If you want to pursue the exercise route, it is best to work with an experienced physical therapist to ensure you correctly perform appropriate exercises and avoid any that could exacerbate the condition.
Want to learn more about options to restore a firmer, flatter belly? Contact us.
Tummy tucks are one of my favorite procedures to perform, as it can make such a dramatic difference in a patient’s comfort and self-confidence, as well as their appearance. If you would like to learn more about options to achieve a firm, toned abdomen, I invite you to contact my office to schedule a personal consultation. I look forward to meeting you!