What Is a Rectus Diastasis:
A diastasis occurs when the linea alba layers of the abdominal muscle have weakened, resulting in a separation of the abdominal muscles, and causing a visible bulge or pooch.
Diastasis recti or abdominal separation occurs commonly amongst two-thirds of pregnant women and can also occur in men.
During pregnancy, your muscles and connective tissues expand due to an influx of estrogen and relaxin hormones. As the baby grows and your abdominal muscles stretch to accommodate the growth, some separation in the rectus abdominis (“six-pack” muscle) is expected and normal.
A 1.5 to 2cm separation at the level of the umbilicus is considered normal after pregnancy.
A separation >2.7cm at the level of the umbilicus is considered a pathological diastasis of the rectus abdominis.
Diastasis Recti may be caused by:
Heavy babies, twins, triplets
Pressure on frontal abdominal muscle - rectus abdominis during pregnancy
Performing repetitive and incorrect exercises such as crunches/sit-ups
Signs and symptoms:
“Pooch” in the front of the tummy
Feeling of instability or “insides” falling out in the front
Low back pain
Pain with coughing/sneezing
How Do I Test If I Have a Rectus Diastasis?
Lying on your back with your feet bent, place a finger above your umbilicus
Gently lift your head off the pillow and feel to see if the finger sinks in or if a bulge develops, if it does, then you may have a diastasis.
Remember, only if it is > 2.7cm separation is it concerning, depending on your finger size, this may be 2 or 3 finger width.
Check this again below the umbilicus
Patients can contact Dr. Toomari for a formal evaluation.
Why does it matter:
Muscle imbalance that can impact:
Safe return to prior level of exercise, ie: running, tennis, weightlifting, etc.
Compensatory movement patterns that can later create more pain in other regions
Additional related issues such as urinary incontinence, pelvic girdle pain or instability, low back pain
What not to do:
Strain
Lifting: make sure you use correct lifting mechanics/squat form and exhale out before you lift
Toileting habits: use a Squatty-potty or stool to raise the feet to reduce straining during bowel movements
Movements that can worsen the abdominal separation (crunches/sit-ups, push-ups, press-ups, front planks)
What to do:
Start with foundational abdominal exercises, such as transverse abdominis recruitment or abdominal vacuums
Physical therapists don’t have one standard guideline on what moves will bring the belly muscles back into line.
Some research found success with the Tupler technique. It involves certain exercises done while wearing a belly splint, which protects and holds the ab muscles together.
Modify daily motions such as bending, lifting, and caring for infants to protect your abdominal wall
Core strengthening: training the correct abdominal muscles to work and all of the muscles to work together well to perform the exercises or activities that you want to be able to perform
When the connective tissue has healed, some Pilates or other exercises may help you strengthen and rely more on your transverse (deep core) belly muscles instead of the outer ones.
Not all Pilates or strengthening moves are good during pregnancy, though, so make sure you're working with a trainer who knows what "diastasis recti" means.
The best time to begin core strengthening is before you get a diastasis, when you don’t already have an abdominal separation.
Treatment
If your abdominal separation is not too big, you may decide to live with it. But you should bring those muscles back together before you have another pregnancy.
Your abdominal wall surgeon can measure how far apart your muscles are using finger widths, a measuring tape or instrument, or CT scan. Then they can see whether it's getting better or worse.
Many women can close their belly gap by learning gentle movements to use while the abs are supported. Ask your doctor for advice. They may refer you to a physical therapist.
If that rehab won’t work for you, maybe surgery will.
A traditional open operation to correct diastasis may be called "abdominoplasty" or "a tummy tuck." The plastic surgeon folds and sews together the weak central ridge from the outside of the muscle.
For a more novel minimally invasive approach, you may be eligible for Dr. Toomari's Robotic minimally invasive approach, which is surgery done with only small cuts instead of one large one.
What Are the Advantages of Robotically Assisted Laparoscopic Hernia Repair?
Robotic Assisted Laparoscopic Repair is a technique to fix the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh).
It may offer a quicker return to work and normal activities with a decreased pain for some patients.
Are You a Candidate for Robotically Assisted Laparoscopic Hernia Repair?
The procedure may not be best for some patients who have had previous abdominal surgery or underlying medical conditions.
Those patients that are not candidates for Laparoscopic Hernia Repair, may still be eligible for robotically assisted laparoscopic repair.
Only after a thorough examination can Dr. Toomari determine whether robotically assisted laparoscopic hernia repair is right for you.
What Preparation is Required?
Most operations are performed on an outpatient basis, and therefore the you will probably go home on the same day that the operation is performed.
Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
After Dr. Toomari reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
It is recommended that you shower the night before or morning of the operation.
If you have difficulties moving your bowels, an enema or similar preparation may be used after consulting with your surgeon.
After midnight the night before the operation, you should not eat or drink anything except medications that Dr. Toomari and/or his staff have told you are permissible to take with a sip of water the morning of surgery.
Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
Quit smoking and arrange for any help you may need at home.
How Is Robotically Assisted Laparoscopic Repair Performed?
Surgical procedures are done in one of two fashions.
The open approach is done from the outside usually by a plastic surgeon through a large incision in the lower area of the belly. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the muscle. The skin is then lifted off of the muscle and the belly button is detached from the skin. The plastic surgeon folds and sews together the weak central ridge from the outside of the muscle, and then pulls the skin tight and removes excess skin. Typically drains are placed in the skin after this surgery which you manage at home.
The robotic assisted laparoscopic diastasis recti repair. This approach is very similar to an umbilical or ventral hernia repair, with the added precision of using robotic technology. Dr. Toomari is able to sew together the left and right ab muscles, and close the diastasis gap. Some patients who are not candidates for laparoscopic hernia repair (e.g. those with very large hernias, complex hernias, previous laparoscopic hernia repair, or patients with history of prior prostatectomy or lower abdominal surgeries) may still be candidates for robotic hernia repair, and thus able to benefit from the advantages or minimally invasive surgery. In this approach, a 3D HD laparoscope (a robotic telescope) is inserted through an 8 mm cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Two additional 8 mm cannulas are inserted which allow Dr. Toomari to work "inside." The hernia is repaired from behind the abdominal wall. A piece of surgical mesh is placed under the hernia defect. This operation is usually performed with general anesthesia.
What Happens If The Operation Cannot Be Performed Or Completed By The Robotically Assisted Method?
In a small number of patients the robotic assisted method cannot be performed. Factors that may increase the possibility of choosing or converting to the standard "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, size of the hernia, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by Dr. Toomari either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
What Should I Expect After Robotically Assisted Laparoscopic Surgery?
Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
Once you are awake and able to walk and urinate, you will be sent home
With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.
You are encouraged to be up and about the day after surgery.
With robotically assisted laparoscopic hernia repair, you will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
Call and schedule a follow-up appointment within 2 weeks after you operation.
What Complications Can Occur?
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.
- There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the muscles of the abdominal wall. Some patients will develop a ridge of skin at the midline, which typically goes away in 4-6 months. Some patients may develop a fluid filled lump where they had a hernia, and the body will reabsorb that in time.
- Difficulty urinating after surgery is not unusual and may require a temporary catheter into the urinary bladder for as long as one week.
- Any time the abdominal wall is repaired, the defect can come back. This long-term recurrence rate is not yet known, but early results are favorable.
- Dr. Toomari, and your primary care provider will assess your health, and help you decide if the risks of robotic repair are acceptable.
When To Call Your Doctor
- Be sure to call your physician or Dr. Toomari if you develop any of the following:
- Persistent fever over 101 degrees F (39 C) Bleeding
- Increasing abdominal or groin swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Inability to urinate
- Chills
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids
- Persistent fever over 101 degrees F (39 C) Bleeding
RECTUS DIASTASIS patient information
RECTUS DIASTASIS / aka DIASTASIS RECTI / aka ABDOMINAL SEPARATION:
Diastasis recti is a common condition where the abdominal muscles separate, often due to pregnancy, obesity, or significant weight changes. Often called abdominal separation or a belly "pooch."
It's very common among pregnant women. About two-thirds of pregnant women have it, and can also occur in men.
Abdominal wall specialists such as Dr. Toomari use of the latest robotic technology to enhance overall core stability, improving posture, reducing back pain, and enhancing abdominal appearance.
If you have a rectus diastases, this page can help you understand what diastasis rect is and about it's treatment.
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Toomari Surgery