Rectus diastasis, or diastasis recti, is a condition where the rectus abdominis muscles are no longer located next to each other as they run up and down the abdomen from the breastbone (xyphoid) to the pubic bone (symphysis pubis). The word “diastasis” comes from the Greek word meaning “to separate”. The diastasis is easiest to see when the patient does sit-ups and notices a linear bulge running up the center of the abdomen. The most common cause in women is pregnancy. Heavier men can develop this condition in their upper abdomen as well.
Rectus diastasis by itself has no risk, because the inner aspect of the abdominal wall is smooth. This means that bowel cannot find its way into a hernia and potentially strangulate. However, the diastasis can be associated with umbilical or epigastric hernias, discomfort of the abdominal wall to touch, poor balance, and a sense of a loss of a functional “core”. This loss of core strength can explain back pain that occurs in some patients with severe rectus diastasis.
Pregnancy induced rectus diastasis can cause a significant shape change to the abdominal wall, even for very slender patients. Because the tissue between the muscles has been permanently stretched, no amount of exercise will restore the shape of the abdomen. Rectus diastasis is repaired through the surgical technique of an abdominoplasty, or tummy tuck. The skin is lifted near the pubic hair, and elevated to the level of the xiphoid. The muscles are tightened in the midline where the tissue had been stretched by pregnancy. Permanent stitches are often used. In the most severe cases, mesh is used to reinforce the central repair area, and this is called a “mesh abdominoplasty”.
Males have their own unique pattern of rectus diastasis, noticed as a midline bulge located between the xiphoid and the umbilicus. When men have significant pain or associated hernias, a mesh repair can be performed, but typically with a long, vertical scar.
The condition of a rectus diastasis can hurt, and many years ago the repair of the stomach muscles was covered under many insurance plans. This is not the case anymore. The repair of a rectus diastasis is considered cosmetic surgery, and is not a covered expense by insurance plans.
Some women are just as concerned about the FUNCTIONAL issues of having a rectus diastasis as they are about the cosmetic issues. When the rectus muscles are no longer attached to each other in the midline, they no longer contract effectively. The upper arms and trunk do work, and need to push off against a pressurized abdomen. With rectus diastasis, a lack of coordinated muscle contraction and the expanded size of the abdominal cavity works against effectively raising intraabdominal pressure. With going up stairs, exercise, or other acts of daily living, a rectus diastasis causes other parts of the body such as the back to work harder. Repair of the rectus diastasis, therefore, often gives patients better use of the torso, and often improves mild lower back pain if it is present.
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Dr. Gregory Dumanian is a renowned plastic surgeon who has more than 20 years of experience in aesthetic and reconstructive procedures. In addition to performing abdominal wall repair, he is a renowned breast reconstruction, hand surgery and microsurgery provider. To learn more or to schedule a consultation, contact his practice at (312) 694-2428.