The Iskandar Complex Hernia Center offers complex hernia surgery and advanced abdominal procedures with unparalleled compassion and renowned expertise, so you can enjoy a dramatically improved quality of life.
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The Iskandar Complex Hernia Center
2460 I-35E Suite 215-B
Waxahachie, TX 75165
Phone: (469) 800-9832
DIASTASIS RECTI: ABDOMINAL SEPARATION FAQS
By Dr. Mazen Iskandar
Diastasis recti is a separation of the abdomins muscles that typically occurs in pregnant and postpartum women but can also be present in men. The rectus abdominis muscles (six-pack ab muscles) stretch during pregnancy. The separation can make a person’s belly stick out or bulge months or years postpartum
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What is diastasis recti?
Is Diastasis Recti a type of hernia?
How common is Diastasis Recti Abdominis?
What are the associated Diastasis Recti symptoms?
How is Diastasis Recti diagnosed?
Does Diastasis Recti require surgery?
How is Diastasis Recti surgery done?
How successful is Diastasis Recti surgery?
Is surgery more effective than physical therapy?
What exercise can help Diastasis Recti?
What exercise should I avoid with Diastasis Recti?
Can Diastasis Recti be prevented?
Don’t Guess. Get Checked.
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What is diastasis recti?
Diastasis recti (also called diastasis rectus abdominis, rectus abdominis diastasis, or diastasis) is a separation between the right and left rectus abdominis muscles. The condition most often arises in the second or third trimester of pregnancy.
However, the condition is not confined to pregnancy. Newborns and men can also be affected by the condition. It can occur as a result of wear and tear, obesity and genetic predisposition.
Along the front of your stomach, the rectus abdominis runs vertically. It is separated into left and right sides by a longitudinal band of connective tissue called the linea alba. The abdominal wall is stretched when the uterus swells and pushes on internal organs during pregnancy, and the linea alba thins and pulls apart. As this band of connective tissue is pushed outward, it becomes wider.
Once you have delivered your baby, the linea alba might mend and rejoin. It is extremely elastic and retract backs (like a rubber band). When tissue loses its flexibility as a result of stretching, the abdominal gap does not close as completely as it should. This is referred to as diastasis recti.
If you have diastasis, your stomach may protrude below or above the belly button, giving the appearance of being pregnant long after delivery.
Is Diastasis Recti a type of hernia?
A recti diastasis looks like but is not a hernia as there is no tear or defect in the abdominal muscles, merely a stretching. However, a coexisting hernia can also be present. A coexisting ventral hernia and a rectus diastasis is a complex and significant clinical problem, as well.
The Iskandar Center specializes in complex hernia repair with coexisting conditions. If you have a coexisting hernia, please reach out to us for a consultation.
You deserve renowned expertise and unparalleled compassion.
How common is Diastasis Recti Abdominis?
It’s common among pregnant and post-partum women. About two-thirds of pregnant women have it.
Having more than one child increases the likelihood of this condition, especially if the pregnancies are close together in time.
What are the associated Diastasis Recti symptoms?
The main symptom of diastasis recti is a vertical bulge that appears above the belly button when one does a crunch or gets up from lying or sitting down.
Other symptoms that may be less distinguishable, but can signal abdominal separation include:
constipation
lower back pain (lumbar)
urinary incontinence fecal incontinence
difficulty breathing
discomfort in body movements
a weakened core
These symptoms can lead to a negative body image and impaired quality of life.
How is Diastasis Recti diagnosed?
The main diagnostic tool is a good physical exam by an experienced surgeon looking also for associated hernias. A CT scan could be performed to confirm and grade the rectus muscle separation. Recently, ultrasound has been shown to provide accurate information regarding the separation’s extent without using radiation or incurring additional costs. Separation is measured in the abdomen at five locations above and below the belly button. A separation of more than 3 cm is considered abnormal. Additionally, imaging can reveal the presence of a genuine hole in the wall, commonly referred to as a hernia.
Does Diastasis Recti require surgery?
Most patients with diastasis recti have no pain and are treated with core strengthening exercises.
Surgery is warranted in patients who have diastasic recti with an associated hernia or those who desire it for cosmetic reasons or if there is a significant weakness in the function of the abdominal wall. A concomitant hernia repair with reattachment of the muscles can be done in a minimally invasive or open fashion depending on the case and the presence or absence of excess skin.
How is Diastasis Recti surgery done?
When physical therapy fails to diminish the aberrant expansion of the linea alba and symptoms are severe, surgery may be considered. Surgery is typically explored 6–12 months after delivery, as the diastasis may resolve naturally during this time frame. Open, laparoscopic, and robot-assisted surgery are all surgical possibilities. Regardless of surgical type, each includes a plication of the rectus fascia. Plication is the act or process of folding. Typically, the front/anterior rectus fascia is plicated during the open approach, whereas the rear/posterior rectus fascia is plicated during laparoscopic and robot-aided approaches.
Plication can be carried out with or without the addition of mesh reinforcement. When a hernia repair is also needed, surgical mesh is employed.
The procedure carries some similarities to a tummy tuck surgical method.
How successful is Diastasis Recti surgery?
The success rate for laparoscopic surgery is high, as most studies report a 0% recurrence rate 6 months after laparoscopic surgery. A laparoscopic technique is commonly used when diastasis and ventral hernia coexists but the method can also be used when only treating an abdominal rectus diastasis.
Is surgery more effective than physical therapy?
A study comparing surgery with physiotherapy concluded that improvements in the two surgical treatment groups were significantly greater compared with the improvements in the physiotherapy group. Surgery patients reported decreased pain and a better quality of life.
What exercise can help Diastasis Recti?
Side-lying exercises, deep chest breathing, and modifications to daily movements and posture can possibly improve non-severe diastasis recti.
A physical therapist experienced in abdominal wall separation can ensure you perform the proper exercises correctly to avoid further separation.
What exercise should I avoid with Diastasis Recti?
Exercises that are commonly prescribed by athletic trainers can lead to further separation of rectus abdominis muscles. These include commonly the recommended crunches, sit-ups, push-ups, press-ups, and front flanks.
Check with a physician before beginning any exercise program if you have any symptoms of abdominal muscle separation.
Can Diastasis Recti be prevented?
Doing the proper strengthening exercises before and during pregnancy can help. Rather than performing traditional abdominal exercises on your back, focus on pelvic mobility exercises such as pelvic tilts, pelvic circles, and bridges during pregnancy. When combined with proper breathing, these exercises help to strengthen the connection between the abdominal and pelvic floor muscles.
A physical therapist can ensure you perform the exercises correctly.
DON’T GUESS. GET CHECKED.
If you think you have diastasis recti symptoms, it is highly advised for you to seek out a medical assessment by a qualified physician. If surgery is needed to repair your diastasis recti abdominis or if you suspect you have a basic or complex hernia in conjunction with the condition, Dr. Iskandar would be happy to provide a consultation. As a leading complex hernia surgeon and abdominal wall surgeon, he can offer you a sound medical opinion on the best treatment options.
RESOURCES
Diastasis Recti Dallas Diastasis RectiDiastasis Recti Dallas Diastasis Recti PhysiotherapyDiastasis Recti Dallas Diastasis Recti Before And AfterDiastasis Recti Dallas Diastasis Recti Physical TherapyROBOTIC SUBCUTANEOUS ONLY REPAIR (SCOLA) FOR UMBILICAL HERNIA WITH DIASTASIS RECTI
This is a video of the robotic subcutaneous-only repair or SCOLA repair for umbilical hernia with diastasis recti. This is a procedure that’s appropriate for patients with small hernias and diastasis who do not have excess skin that needs to be removed. And this would be an alternative to an abdominoplasty or tummy tuck, and it is essentially the same procedure without the removal of excess skin.
This procedure is done using three small incisions in the lower abdomen, and as you can see here, we are creating flaps between the muscle and the subcutaneous tissue. Here, you can see the umbilical hernia visible. Bipolar cautery is used to control any perforators and the fascia is visible at the bottom.
Here, we are now dissecting around the hernia. As you can see here, there’s an umbilical hernia containing preperitoneal fat that is being reduced and the hernia contents are dissected away from the umbilical stalk. The umbilical stalk is disconnected from the fascia and dissection continues towards the upper abdomen. Here you can see the umbilical defect.
After completion of the dissection, this is the space that is dissected and you can see here the diastasis, you can see the gap between the right and left muscles. We are using here marking pen to delineate or identify the edges of the fascia or the muscle on both sides with the diastasis in between. This will aid us in our plication.
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The diastasis here is about four centimeters. We then use a permanent, non-absorbable suture to plicate the diastasis, taking bites between the right and left muscle. We take stitches starting from the subxiphoid area all the way down, taking good bites, and we try to take as many bites as possible before trying to cinch the suture to distribute the tension. As you can see, a nice ridge is forming between the left and right side.
Then we sequentially pull the stitches to tighten the plication, heading down towards the umbilicus and below the umbilicus. Two sutures here are used, and then we lock the sutures and divide them. Here we are measuring the space to see how big it is and to plan for a mesh. This could be done with or without mesh depending on the size of the hernia. Here we elected to use mesh.
We placed medium-weight micropores fully properly in mesh and fixated it at six or seven locations. Then we are tucking the umbilicus back to the fascia, to restore normal anatomy. Following that step, a JP drain is placed into the subcutaneous tissue as it is expected that these patients may form fluid collections, and this drain is typically removed in the office two weeks after surgery. And this is the final result. Thank you for watching.