Diastasis recti (DR) is a common condition where the large muscles of the abdomen separate, frequently occurring in women following pregnancy. This separation can create a visible bulge and often compromises the functional strength of the core. While physical therapy is the initial approach for most people, surgery remains the definitive option for severe cases that do not respond to conservative measures.
Understanding Diastasis Recti
Diastasis recti is characterized by the widening of the linea alba, the strip of connective tissue that runs down the midline and connects the right and left sides of the rectus abdominis muscles. This is a stretching and thinning of the central fascia, not a tear in the muscle itself. The primary cause is increased intra-abdominal pressure, most notably from late-stage pregnancy, which forces the abdominal wall to expand.
The condition results in a noticeable protrusion or “pooch” in the midsection, which can become more prominent when the abdominal muscles are contracted, such as when sitting up. Common symptoms include chronic lower back pain due to weakened core support and difficulties in maintaining proper posture. Diastasis recti can also contribute to pelvic floor dysfunction, potentially leading to issues like urinary incontinence.
Determining Surgical Candidacy
Surgery is typically reserved for individuals whose separation is significant and who experience functional impairment that has not improved with non-surgical treatments like specialized physical therapy. A separation of the rectus muscles measuring two centimeters or more is often considered a diastasis, but many surgeons suggest a width of five centimeters or greater before surgical intervention is strongly recommended. This threshold indicates a more severe structural compromise of the abdominal wall.
Women should have completed childbearing, as a subsequent pregnancy could undo the surgical repair. Patients must also be at a stable and healthy weight before the procedure, since significant weight fluctuations can negatively impact long-term results. While surgery provides a flatter appearance, the presence of functional issues—such as chronic pain, an associated hernia, or core instability—often solidifies the medical necessity for the repair.
How the Procedure is Performed
The central goal of diastasis recti surgery is to repair the weakened linea alba by bringing the separated rectus abdominis muscles back together, a technique known as rectus plication. The procedure is performed under general anesthesia. Plication involves placing a series of strong, permanent or slowly absorbable sutures in a continuous or layered fashion to cinch the two muscle halves together along the midline.
The surgical approach is chosen based on the patient’s individual needs, primarily whether they have excess skin or fat that also needs to be addressed. The traditional open repair is commonly performed as part of an abdominoplasty, or “tummy tuck,” using a horizontal incision low on the abdomen. This approach allows the surgeon to lift the skin and fat to directly access and plicate the anterior rectus sheath, while also removing any loose skin.
Alternatively, for patients who do not have excess skin, minimally invasive techniques such as laparoscopic or endoscopic repair are available. These methods involve small keyhole incisions and the use of specialized instruments to perform the plication of the posterior rectus sheath. In some complex cases, particularly those involving a large separation or recurrent diastasis, a synthetic mesh may be used to provide additional long-term reinforcement to the repair.
Recovery and Post-Operative Care
Recovery varies based on the extent of the repair and the surgical technique used. Most patients can anticipate a hospital stay of one to two days following a more extensive open procedure. The initial recovery phase, requiring limited activity and avoidance of straining, typically lasts between two and four weeks.
Managing post-operative pain with prescribed medication is an important part of the immediate care plan. A compression garment is routinely worn for approximately four to six weeks to help minimize swelling and provide continuous support to the newly repaired abdominal wall. Patients are strictly advised to avoid any heavy lifting, pushing, or strenuous exercise for six to eight weeks to prevent placing stress on the plication sutures.
While full internal healing and the final aesthetic result may take three to six months, most people can gradually return to their normal daily activities within the first month. Patients must monitor their surgical site for signs of potential complications, such as infection or the accumulation of fluid, known as a seroma. Following the surgeon’s specific instructions is paramount for ensuring a smooth recovery and achieving the optimal functional outcome.