Diastasis Recti Treatment: Muscle Tightening with a Tummy Tuck

By Jerome Edelstein, MD

Tummy Tuck Photo
DIASTASIS RECTIDiastasis recti is a condition that is common in women who have had one or more pregnancies. It involves the separation of the left and right side of the rectus abdominis muscle (a muscle that covers the front surface of the stomach area).

The growth of a uterus during pregnancy creates so much pressure on the internal abdomen that the rectus muscles stretch, migrating outwards and separating in the centre. Often, women who have been pregnant multiple times will develop diastasis recti due to repeated stretching of these muscles.

The condition is characterized by a ridge-like presence that runs from the bottom of the breastbone to the middle of the stomach area (near the belly button), and can continue down towards the pubic area. It increases with muscle strain (for example, during a crunch) and is evident around the navel (umbilicus) or the area above. The width of muscle separation is usually between two to five centimetres and can be felt while lying flat.

Although Diastasis recti is usually described as muscle separation, the main issue involves a tough band of tissue, called fascia, that holds the muscles together. This tissue, when stretched, is similar to garbage bag material, that is, it can shrink back a little, but is usually permanently stretched. This is the reason that even if you do a tremendous amount of abdominal exercises, you will not get rid of Diastasis recti. The problem really involves the fascia, not the actual muscle.

Diastasis recti is thought to be the result of the accumulated effects of maternal hormones (which relax the abdominal muscles and soften connective tissues) and the repeated, biomechanical abdominal wall stretching that occurs during pregnancy. It has also been linked to dramatic weight gain.HOW COMMON IS DIASTASIS RECTI?Up to 60 percent of all pregnant women experience some extent of muscle separation in their third trimester or in the immediate postpartum period. This is natural and usually resolves itself spontaneously. The permanent form of diastasis is far less frequent (affecting 10 to 15 percent of women) and is usually found in women who have been pregnant three or more times or have carried larger babies.

Women who are older than 25, have a multiple pregnancy, repeated pregnancies or deliver a baby with a high birth weight are more likely to develop diastasis recti. Aggressive abdominal exercise during the first trimester may also contribute to its development.
PHYSICAL PROBLEMSAll of the abdominal muscles are connected (in the fibrous midline), meaning that the widening that occurs with diastasis recti can lead to diminished core strength and a reduction in overall muscle performance. Many women are most concerned with the interference it plays in regaining pre-pregnancy stomach muscle tone. Despite performing daily core strengthening exercises (eg. sit-ups and planks), diastasis recti does prevent muscle improvement. The weakened abdominal wall also tends to noticeably bulge. In extreme cases a pseudohernia may develop, most noticeable by the abdominal contents becoming visible through a significant protrusion during sit-ups.

Aside from the toll diastasis recti may take on a patient’s appearance and self-esteem, the condition can also lead to physical problems. Without surgical repositioning and tightening, diastasis recti can lead to the formation of hernias, impaired posture, lower back pain and stomach protrusion.
TREATMENT THROUGH ABDOMINOPLASTY – A MOMMY TUMMY TUCK!If diastasis is present, we use permanent stitches to bring the muscles back together, returning the muscles to their proper anatomic location so that they are able to function in their most biomechanically correct position. If the abdominal wall remains lax after the muscles have been stitched, we tighten the lateral aspects of the wall using corset sutures — a technique that also reduces the patient’s waist size and improves body definition.

Talk to our board certified Plastic Surgeon, some of the best tummy tuck surgeons in Canada, at (416) 256-5614.