If you’ve noticed after that pregnancy that your tummy never regained it’s previous ‘flatness’ an abdominal condition known as diastasis recti might be to blame. This is the thing that can keep jeans fitting incorrectly even though you lost all the baby weight and you are the same size/weight as pre-pregnancy.
Some women find that their tummy still looks pregnant months after giving birth, and at the extreme, diastasis can be associated with abdominal pain and loss of core strength. Diastasis recti doesn’t just occur after pregnancy, it can affect men too. Often they notice their belly rise up in a dome or mountain-like formation vertically along the midline of the abdomen, which can resemble a hernia.
What is diastasis recti?
Put simply, diastasis recti is a gap between the rectus abdominis ‘six-pack’ muscles which running up and down the middle of your tummy. Normally the left and right six-pack muscles are connected together in the middle by a line of thick fibrous tissue. If this fibrous line stretches and widens it allows the left and right six pack muscles to separate and move to the sides. This is diastasis recti, and it causes weakness and bulging of the tummy. The thinned fibrous tissue in the middle can also bulge out in the gap between the two muscles.
Cause of diastasis recti
This problem is relatively common in women who have had children, but it also occurs in men. When you have children, pregnancy hormones soften the fibrous line between your six-pack muscles that allows the muscles to separate and make room for the growing baby.
The gap between the muscles gradually closes after childbirth as your hormone levels return to normal and the fibrous tissue regains its strength. However, in some women the gap doesn’t fully close. If it doesn’t close within three to six months, you can end up with a gap that won’t close without treatment.
Studies show that about 40 percent of women still have a diastasis at six months postpartum Pregnant women are not the only ones affected. Diastasis recti primarily occurs when there is increased internal abdominal pressure causing the muscles to separate. This happens during pregnancy, but also occurs in men and children particularly after surgery or injury. Even women who are extremely athletic (as well as men and children) may develop diastasis recti if they have an unstable core or train in a manner that increases abdominal pressure.
Why having a gap is a problem
Diastasis has effects on both your physical and emotional health. The fibrous tissue between the six-pack muscles becomes stretched, thin, and bulges outward in the middle of your tummy, usually in the area around your navel.
This causes an unusual appearance that might be mistaken for hernia, although not infrequently one or more small true hernias actually do develop through the weakened tissues. Separation of the six-pack muscles also means that the muscles of your abdominal wall, which normally hold in your internal organs and stabilize your core, become misaligned and cannot function properly.
The core muscles are weakened and can no longer hold everything in place, so you lose the flatness of your tummy, you get generalized bulging, and this sometimes makes you look still pregnant. Through losing core strength a diastasis can also lead to other problems including chronic low back pain, urinary incontinence, and constipation.
How do I know if I have diastasis recti?
With severe diastasis recti you may see a ridge protruding from your midline, which becomes more prominent when you’re straining, coughing or sitting up, and disappears when you lie down or relax your abdominal muscles.
You can perform this simple test to determine whether or not you have diastasis recti: Lie on your back, with your knees bent and your feet flat on the floor. Place your hand palm down on the middle of your tummy, with your fingers pointing toward your toes. Slowly lift your head, drawing your chin to your chest, which causes your six-pack muscles to contract. At the same time press down with your fingers, just above and below your navel (belly-button).
If you feel a gap more than two finger widths between the muscles as they contract, you have a diastasis.
What can I do about diastasis recti?
Once the fibrous tissue between your six-pack muscles gets stretched out, it can be difficult to rebuild your core strength and bring your muscles back together. Doing the right type of exercises can help mitigate some of the effects of diastasis, but traditional crunches, side twists, planks and other similar moves actually can make your condition worse. They tend to make those muscles tighter, pushing them further apart and stretching the fibrous tissue even more
so that it grows thinner and weaker. They can increase intra abdominal pressure and push your organs outwards against or through the gap. Specialised exercise programmes such a Mutu System, ‘Tupler Technique’ Fit2b involve a specific series of exercises that are effective at improving core strength and can help smaller separations.
Unfortunately with wider, established diastasis no amount of toning exercises will actually close the diastasis itself, because it just consists of over-stretched, thin, damaged fibrous tissue, and contains no muscle. If your diastasis has persisted more than 6 months following a pregnancy, it’s very unlikely to close on its own or with exercise. For symptomatic diastasis that causes you problems, surgery may be an option.
What does surgery involve?
Surgery to repair a diastasis recti often involves stitching the six-pack muscles back together along the midline. This often is part of a normal tummy tuck procedure, and is suitable for narrow diastasis.
Wider diastases, or where there is also a hernia, may need a different approach known as a Rives-Stoppa procedure. This moves the six pack muscles so that they come together in the midline, with a reinforcing mesh placed behind the muscles. This repair provides the most reliable and long lasting closure of a diastasis, but might involve open abdominal surgery through a larger incision.
As the specialist plastic surgeon for the regional Complex Abdominal Wall Reconstruction Service, I have vast experience and the most up to date reconstructive plastic surgery techniques to provide successful repair of diastasis recti. I have a focus getting the best cosmetic results, and typically perform diastasis repair through a cosmetic tummy tuck approach to give more discrete scars in the bikini line, and tighten and flatten the tummy skin at the same time.