What Can I Do About My Rectus Diastasis?

While this is one of the most common questions I hear from mothers, let me begin by stepping back and describing what, exactly, a rectus diastasis is. Beneath your abdominal skin is some superficial, or “subcutaneous” abdominal fat. Below this lies your abdominal wall. The abdominal wall consists of a series of muscles bound together by tough connective tissue called “fascia.” The abdominal organs, surrounded by deep, or “visceral” fat can be found under the abdominal wall. The muscles in the midline, the core of the abdominal wall, are called the “rectus abdominis” muscles. These are long, thick muscles that run in a pair up and down the length of your abdomen and, when developed, give the appearance of a “six pack.”

During pregnancy, as the uterus grows to accommodate a developing baby, multiple anatomic changes occur to accommodate this expanding structure. Most relevant to this conversation, the rectus muscles, which run up and down the midline of the abdominal wall, can be pushed apart and separated from one another to allow the abdominal wall to stretch. A thin, weak vestige of connective tissue is left behind where the rectus muscles were pushed apart. Deep abdominal fat can push this week connective tissue outwards creating a bulge that is present even after pregnancy. This bulge is called a rectus diastasis or diastasis recti.

The good news about a rectus diastasis is that you do not need to do anything about it at all unless it is bothering you. Symptoms from a rectus diastasis can include core weakness, back pain, and pelvic floor dysfunction leading to incontinence. It can also cause the appearance of a lower abdominal wall bulge. If you do decide you want to correct your rectus diastasis, you may be able to achieve some symptomatic relief with targeted core exercises and specialized physical therapy – there is not clear data on the efficacy of these approaches, but some folks are reporting positive experiences. However, a severe diastasis can prohibit you from participating from a core regimen in a meaningful way.

Abdominoplasty (more on that here) offers a definitive treatment for rectus diastasis. In this procedure, the rectus abdominis muscles are identified. The central separation between these muscles is then outlined. Sutures are used to repair the diastasis and reattach the rectus abdominis muscles in the midline. This approach repairs the biomechanical basis for the symptoms of rectus diastasis and also repairs the lower abdominal bulge.

As always, please join the conversation in our Facebook group (www.facebook.com/groups/askaps) if you have any comments or questions about this or any other topic pertaining to plastic surgery!

Office of Darren M. Smith, MD

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