Separation of the rectus abdominis muscles following childbirth
Cosmetic Surgery Dubai | 3 May 2019
Separation of the rectus abdominis muscles following childbirth is the most common reason for weakening of the abdominal wall. The condition impacts on body aesthetics and may be associated with stomach protrusion, hernia formation, lower back pain and impaired posture. Surgical treatment repositions and tightens the muscles, resulting in a stronger and flatter abdomen.
Diastasis recti is defined as a separation of the rectus abdominis muscles in the midline (linea alba). Up to 60 % of all women will experience muscle separation during the third trimester of pregnancy or the immediate postpartum period – a normal physiological event that usually reverts spontaneously.
Permanent diastasis is less frequent (10-15 %), most often occurring in women who have been pregnant three or more times or have carried large babies. The condition is thought to be caused by the accumulated effects of maternal hormones (which relax abdominal muscles and soften connective tissues) and the repeated biomechanical stretching of the abdominal wall.
Diastasis recti is evident around the navel (umbilicus) or the area above. The width of separation typically ranges between two to five centimetres and is easily felt whilst laying flat. As all muscles of the abdomen are connected in the fibrous midline, a widening of this area will diminish overall muscle-performance and core strength. A common concern is the inability to recover pre-pregnancy abdominal muscle tone, even with daily sit-ups and exercise. The weakened abdominal wall is prone to bulging while standing upright or in situations involving increased abdominal pressure. Hernias may develop but are usually asymptomatic.
Surgery aims to restore a healthy anatomy and strengthen the abdominal wall. As muscle separation usually occurs alongside other concerns such as skin laxity, the repair is generally performed as part of an abdominoplasty. During surgery, the rectus abdominis muscles are brought together while shortening and reinforcing the midline. This manoeuvre also repositions the corset-muscles in the flanks, improving both definition and waistline contours. Hernias are corrected as part of this procedure. Due to the physiological and hormonal changes in the postpartum period, I generally recommend that a patient waits for six to nine months after childbirth before undertaking surgical treatment.