Diastasis Recti After Childbirth: How to Get a Flat Belly Back

Why doesn't the belly return to its previous shape after childbirth or weight fluctuations? Why is it impossible to suck it in after a glass of water? Why does the belly treacherously protrude after eating, even small amounts? Why, despite doing ab exercises daily, is the belly still not flat? The answer is simple: it's DIASTASIS RECTI!

What is Diastasis Recti and the Causes of Its Appearance

One of the common reasons for seeking help regarding an unattractive, protruding belly is diastasis recti (abdominal diastasis). This is a condition where the abdominal muscles in a relaxed state "spread apart" to the sides and the belly protrudes forward, inflating like a drum. Diastasis is considered when abdominal muscles separate by 3 cm or more. Roughly speaking, if 2 fingers can fit between them.

The most common cause of diastasis recti is pregnancy. During pregnancy, the volume of the abdominal cavity increases, the abdominal muscles "spread apart," and excessive tension occurs. The tissues of the linea alba (white line of the abdomen) lose their elasticity, tears appear, and diastasis develops. After childbirth, during the first six months, diastasis decreases, but postpartum recovery doesn't always happen completely.^{clevelandclinic}

According to statistics, after the first pregnancy, the risk of developing diastasis is about 50%, after the second - 75-80%, after the third - more than 95%. This risk increases with multiple or polyhydramnios pregnancies, as well as in women over 35 years old.

How does diastasis recti manifest?

Two important aspects can be identified in how diastasis manifests:

• Medical or surgical. In general surgery, there's a concept of weak spots in the anterior abdominal wall, meaning places where hernias appear. The linea alba is exactly such a place. With diastasis present, this risk is multiplied many times over, since the linea alba becomes an even weaker spot. For this reason, the risk of linea alba hernias increases with diastasis. Accordingly, putting stress on the abs and lifting heavy objects becomes unsafe, as these factors provoke hernia formation.
• Aesthetic. With diastasis, the distance between muscles increases, and consequently, the abdominal circumference. Simply put, the belly starts protruding forward. This is especially noticeable after eating and drinking. In the morning, the belly is flat and toned, but after breakfast, it starts inflating.

Very often during consultations, patients can't even relax their belly on the first try because they're used to always keeping it tense and sucked in.

How to determine diastasis recti?

Important to know: self-diagnosis is an inaccurate method with a high percentage of both false-positive and false-negative results.

There are 2 simple reliable methods:

1. Examination by a surgeon. Preferably an experienced one, otherwise errors are also possible
2. Ultrasound of the anterior abdominal wall. Usually, ultrasound allows for fairly reliable determination of diastasis and, moreover, determination of its dimensions

So, we've understood what diastasis is. Let's talk about how to get rid of it.

Diastasis elimination

Fundamentally, there are 2 groups of methods for eliminating diastasis: non-surgical and surgical.

Non-surgical, meaning non-operative methods, include various exercises for abs and core muscles, breathing practices. Such methods are aimed at strengthening muscles, increasing their tone, and are relatively effective for small diastasis, up to 4 cm.

Important point! Incorrect or excessively heavy ab exercises can lead to worsening of the situation and appearance of linea alba hernias. Therefore, it's better to do this under the supervision of an understanding trainer or rehabilitation trainer.

If diastasis is larger than 4 cm, it can only be eliminated by surgical methods.

Who is indicated for surgical treatment of diastasis?

Surgical intervention is recommended for patients with the following indications:

• Diastasis size more than 4 cm
• Combination of diastasis with linea alba hernia
• Unsuccessful attempts at conservative treatment
• Significant discomfort and back pain due to biomechanical disruption

There are 2 methods of surgical diastasis elimination:

Using mesh and Repair with own tissues, meaning restoration of the disrupted anatomy of the muscular framework.

1. USING MESH. Such operations are usually performed by general surgeons. Laparoscopic access is made to the abdominal cavity and a mesh is installed over the diastasis area. This solves the problem of the weak spot in the anterior abdominal wall and eliminates the risk of hernia formation. This is a plus. Another plus of such surgery is that it's performed laparoscopically, meaning through small incision-punctures (1-1.5 cm) and practically leaves no scars. The minus is that the muscles don't return to the correct position and aesthetically the belly will still look like that of a pregnant woman.
2. SUTURING DIASTASIS WITH OWN TISSUES. Special sutures are applied that return the muscles to their original position, where they were before diastasis appeared. Both the diastasis is eliminated and the belly becomes flat and toned.

Previously, one method was used to eliminate diastasis - suturing it through a large incision at the bottom of the abdomen, as in abdominoplasty. Or it was sutured during abdominoplasty. This allowed elimination of diastasis but led to the appearance of a scar at the bottom of the abdomen, which wasn't always acceptable from an aesthetic point of view.
Considering the general vector of plastic surgery development toward minimizing access and reducing postoperative scars, there are now methods for suturing diastasis through small incisions or endoscopically, through punctures. And this is absolutely natural. Because plastic surgery implies an aesthetic result, and scars as a consequence of surgery contradict aesthetics.

It's believed that large incisions are needed for such diastasis suturing. But actually, this isn't true. Of course, diastasis can be sutured when performing abdominoplasty through incisions below. But this method leaves a considerable scar in the lower part of the abdomen, so it's not acceptable for all patients.

There are minimally invasive and inconspicuous methods of diastasis suturing:

1. Through an incision for mini-abdominoplasty. Usually it's made at the very bottom of the abdomen, doesn't exceed 10-12 cm, and leaves a thin strip that's invisible even without underwear.
2. Through mini-access in the navel. All sutures are hidden in the navel depression and are practically invisible. Diastasis can also be sutured both above and below the navel.

Such operations are almost always combined with liposculpturing, simultaneously removing fat deposits and creating athletic relief.