Should You Get Diastasis Recti Surgery?

More than half of postpartum people experience diastasis recti, also called diastasis recti abdominis. This gap in the abdominal muscles can result in a rounded stomach pooch. Diastasis recti usually heals itself with exercise, but in some cases, people might choose surgery.

If you're considering diastasis recti surgery, keep reading to learn about the procedure. We cover what to expect, benefits, the recovery process, and more.

What Is Diastasis Recti?

Diastasis recti happens when a gap forms in the center of your rectus abdominis muscles, which cover the front of your stomach. To be considered diastasis recti, the separation needs to be the width of two fingers (two centimeters) or greater.

People with this diastasis recti often notice a bulge down their abdomen; this might be most prominent when contacting the abdominal muscles. Other symptoms can include lower back pain, lack of core strength, urinary incontinence, and constipation. Pelvic organ prolapse or hernia might also happen in rare cases.

Diastasis recti is pretty common after pregnancy, thanks to hormonal changes and your expanding uterus, which pushes against the abdominal muscles. The condition usually improves with abdominal exercises. In severe cases, however, people might consider surgery to correct it.

When to Consider Diastasis Recti Surgery

If your diastasis recti is severe, or if it's not improving to your satisfaction after exercise, you may consider diastasis recti surgery. But only choose surgery if conservative treatment of therapeutic exercise and physical therapy has failed, says Ben Butts, PT, director of rehabilitation services and Performance Therapy at Providence Saint John's Health Center in Santa Monica, California.

You'll also need to figure out if your diastasis recti is truly problematic. Butts says the separation should be at least as wide as two centimeters, or two finger widths, for you to be a surgery candidate.

Also, consider if your diastasis recti is actually causing you pain. "Is your motivation for surgery purely cosmetic versus functional?" asks Butts. For example, surgery has been shown to fix issues like back pain and urinary incontinence.

That said, it's perfectly valid to have surgery for cosmetic reasons if that's your choice and you've discussed it with a reputable plastic surgeon. It's just important to be aware of how the surgery might help on a practical level as well. Make sure to look up diastasis recti surgery "before and after" photos so you know what to expect with results.

What to Expect With Diastasis Recti Surgery

Surgery for diastasis recti repair is substantial and should not be undertaken lightly. Technically, an operation that serves to repair diastasis recti is known as a tummy tuck or abdominoplasty, says Kevin Brenner, MD, FACS, a board-certified plastic and reconstructive surgeon based in Beverly Hills. "However, it's not a one-size-fits-all operation."

Some patients only need to have the muscle tightened, which can be done through an laparoscopic-assisted modified tummy tuck, he says. "Essentially, the muscle can be tightened from a bikini-line incision. This may require removal of a small amount of skin, but will not require an incision around the belly button."

Other diastasis recti surgeries are more involved. Patients with a significant amount of excess skin in addition to the diastasis may need a full tummy tuck, in which the muscle is tightened, extra skin is removed, and the belly button may be relocated to a new position within the abdominal skin. Ultimately, the right procedure is dictated by each individual's anatomy.

Recovering from Diastasis Recti Surgery

After diastasis recti surgery, you'll need to make arrangements for a significant recovery period. Expect to have limited mobility for one to two weeks post-operation before you start getting back to your normal routine (though you should still walk around). You may also have drains in your incisions; your surgeon will inform you about maintaining them.

Heavy lifting and core exercises will be restricted for about several weeks after surgery, and it will take time for the swelling to completely subside and for the scars to flatten, soften, and fade—about six months to a year.

Complications can happen after diastasis recti surgery, including the following:

• Infection
• Lasting ain
• Numbness
• Swelling
• Loss of skin
• Scarring
• Future for scar revision or surgery correction
  

Does Insurance Cover Diastasis Recti Repair?

You might hope—or even reasonably expect—that muscle repair would be a procedure covered by health insurance. But typically it's not, says Dr. Brenner. The reason? Repair of diastasis is considered an elective cosmetic procedure.

Unlike with a hernia (which is an actual hole or defect in the abdominal wall), there's no possibility of the intestines getting stuck inside and damaged, Dr. Brenner explains. In other words, if you can live with how you look, you can generally live with diastasis recti.

Should You Treat Diastasis Recti With Exercise Instead?

Experts agree that exercise can improve diastasis recti, and it should be the first course of action. Focus on movements that pull the abdominals in, like pelvic tilts, toe taps, heel slides, abdominal compressions, and single-leg stretches. You also can try an abdominal binder or support garment as an additional measure.

The key is to keep your belly pulled in and your core tightened, rather than letting it bulge out, as might happen in a traditional crunch or plank. If you see your belly rise up in a dome or mountain-like formation vertically along the midline of your abdomen, stop the movement. It could exacerbate the condition, says Dr. Brenner.

You may do these exercises on your own, with a physical therapist, or with the help of an at-home exercise program (like the Tupler Technique), which is specifically designed to help with diastasis recti.

"Make sure to give yourself adequate time with physical therapy," says Butts. "The body takes time to heal, and results are gradual." So remember that as eager as you are to see results, patience is the name of the game here.

The Bottom Line

If you have tried exercise and your diastasis recti doesn't seem to be improving, it might be worth talking to your health care provider about surgery. Consult with them to see what your options may be, especially if your diastasis recti is significantly impacting your quality of life.