For patients suffering from the consequences of rectus diastasis due to pregnancy, surgery is increasingly becoming an option. Our Medical Director Dr. med. Tino Schulz talked to Becky from the blog bemomandfit.de about the diagnosis of rectus diastasis, possible treatments, surgical procedures, risks and benefits.
How does rectus diastasis develop?
Although men can be affected in the same way as women, rectus diastasis often occurs as a result of pregnancy, as the straight abdominal muscles of the pregnant woman move apart during this time, creating a muscle gap . This cannot and should not be prevented, as it is physically necessary. The rectus diastasis should return to its original state in the puerperium and during the recovery period. If it does not, it can cause discomfort that restricts the quality of life.
How wide is the rectus sheath and when does rectus diastasis begin?
One speaks of a rectus diastasis if this cleft, also called rectus sheath, is wider than 2.7 cm.
When should rectus diastasis be treated after pregnancy?
First of all, a rectus diastasis that does not return to its original state during the recovery phase is not something that needs to be treated per se. However, new mothers often feel the desire to get ‘their’ body back after pregnancy and therefore want to close their rectus diastasis.
If the rectus diastasis has not yet clearly receded after a few months after delivery, we believe it is advisable to actively do something about it, because for many people a rectus diastasis after pregnancy is not just a question of aesthetics, but also reduces the holding and supporting function of the abdominal muscles and generally makes them more susceptible to injury.
What symptoms does rectus diastasis cause?
Rectus diastasis can be present without any symptoms. However, untreated rectus diastasis often leads to the following symptoms:
- Muscular weakness in the trunk area
- Back pain
- Bulging belly that does not shrink with exercise and a healthy diet
- Digestive problems
Conventional treatment approaches for rectus diastasis after pregnancy
If rectus diastasis does not change as a result of targeted rest and regression, there are some conventional methods that can improve the condition in some cases. It is particularly important to train the deep, transverse abdominal muscle (M. transversus abdominis) and to relieve the weakened connective tissue.
Physiotherapy approaches and special programmes such as Tupler® training serve to strengthen the deep abdominal muscles and also mobilize the connective tissue and straight abdominal muscles. Targeted muscle and fascia training as well as adapting everyday behavior are essential, but unfortunately conventional methods alone often do not achieve the desired results.
The overall picture of rectus diastasis is often accompanied by excess skin and a bulging abdomen, which causes many women physical and psychological distress. Excess skin can be improved by slowly losing weight, consistent training, (lipo)massages, lymphatic drainage, mesotherapy and other measures. However, these methods have their limits, which are often quickly reached. Although a fat-away injection can melt small fat deposits, it is not recommended for this indication. The same applies to liposuction: Although this operation can remove excess fat, the excess skin, as well as the rectus diastasis, remain unchanged by this procedure.
Rectus diastasis surgery: Back to a feel-good body
Nowadays, rectus diastasis surgery is often combined with an abdominoplasty. This makes sense as the abdominal wall is exposed during both operations and the best result can be achieved through combined treatment. A combined operation often makes sense, as only one procedure under anesthesia is necessary and the financial savings are also convincing. Combinations of different procedures – especially after pregnancies – are becoming increasingly popular and are popularly known as ‘mommy makeovers’.
Depending on the excess skin, the operation involves a transverse incision above the pubic mound and the detachment of the skin and soft tissue mantle up to the navel (for small excess skin) or up to the costal arch (for larger excess skin). Rectus diastasis is performed by suturing the separated muscle bellies directly together so that the connective tissue gap is reduced by a fascial suture. If necessary, a mesh can be sewn in using an onlay technique for additional stability.
Minimally invasive methods such as the MILOS technique, which can be performed on rectus diastases up to a width of 5 cm, are also conceivable for small excess skin. Patients can look forward to a barely visible scar, but it is not possible to remove the excess skin with this method and the removal of the rectus diastasis can result in an additional skin fold.
Can a rectus diastasis reopen after surgery?
We recommend performing rectus diastasis surgery at a time when you have completed your family planning. It is very rare for a surgically closed rectus diastasis to reopen and this requires a great deal of effort. Nevertheless, it should be avoided, especially shortly after rectus diastasis surgery, to become pregnant again.
Cost coverage of rectus diastasis surgery – When does the health insurance company pay?
Health insurance companies will only cover the costs of rectus diastasis surgery if the patient is symptomatic, i.e. if they have symptoms. An application for cost coverage is submitted together with a specialist, which the health insurance company can approve or reject. In the case of a tummy tuck and corrections for purely aesthetic reasons, the operation is performed on a self-pay basis.
How you can effectively close a rectus diastasis
The methods mentioned above (e.g. targeted training of the abdominal muscles) should not simply replace an operation, but should rather be seen as additional support to reduce the rectus diastasis before the operation. Which surgical method is best depends heavily on the individual patient and is therefore discussed in a detailed, personal consultation with a specialist. One of the most important factors is choosing a doctor you trust. In general, general and visceral surgeons as well as plastic surgeons can be considered. However, the doctor’s experience in the field of rectus diastasis surgery and abdominoplasty is the most important factor, so you should ask about their expertise in the specialty.
As a private clinic, UNIQAESTHETICS® is happy to be one of your first port of call here, as we not only have competent specialists with the necessary expertise in-house, but also a competent patient advisor in the form of Tupler Trained Professional® trainer and mommy fitness blogger Becky from bemomandfit.de, who is happy to advise and support our patients after pregnancy. In her blog post on the topic of rectus diastasis, our Dr. med. Tino Schulz answered the questions of her community. You can read more about this interesting topic there and feel free to contact us at any time if you have any questions or are interested. You are welcome to book a consultation with our specialist via our online appointment tool . We look forward to hearing from you!
By the way: In episode 2 of our podcast BE UNIQ®which you can find on all popular podcast platforms, you can find out more about the Mommy Makeover and surgical options after pregnancy in an interesting interview.
