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 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 the 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 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 mobilise the connective tissue and straight abdominal muscles. Targeted muscle and fascia training as well as adapting everyday behaviour 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 anaesthesia 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 amounts of excess skin) or up to the costal arch (for larger amounts of excess skin). Rectus diastasis is closed 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 amounts of 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 strain. Nevertheless, it should be avoided, especially to become pregnant again shortly after rectus diastasis surgery.
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. Above all, the doctor’s experience in the field of rectus diastasis surgery and abdominoplasty is what counts, so you should enquire carefully and ask about their expertise in the specialty.
As a private clinic, UNIQAESTHETICS® is happy to be one of your first ports of call here, as we have competent specialists with the necessary expertise in-house who are happy to advise and support our patients after pregnancy. Feel free to contact us at any time if you have any questions or are interested – we look forward to hearing from you!
