ASK AVERY: Can the Separation of My Stomach Muscles be Repaired?

Stomach muscle separation or diastasis rectus abdominis is a medical condition that can occur after significant weight loss and as a result of the uterus expanding during pregnancy. The abdomen has two large bands of muscles that run vertically down the midline of the body (the six-pack muscles). With the help of the pregnancy hormone relaxin, these muscles separate during pregnancy to allow for the baby’s growth. For some women they remain separated after postpartum healing has been completed, causing a bulge in the middle of the abdomen. Women who have experienced this condition can be concerned about the appearance of their abdomen.

The list of problems that can arise as a consequence of the muscle separation is also of great concern to these women. The altered position of the abdominal wall muscles as a result of diastasis recti can contribute to lower back pain and difficulty lifting heavy objects; a loss of pelvic stability; and pelvic floor dysfunction, such as urine leakage. Abdominal tissue or intestines can also push through the space resulting in a hernia.

What are the options for treatment? This condition will not resolve with a healthy diet and exercise. Some women try non-surgical treatments. For an experienced professional opinion about non-surgical treatment options, I contacted Physiotherapists Cassandra Zane and Anthony Ingram from Grandstand Physio in Merewether. According to Cassandra and Anthony:

"The use of corrective exercise in the management of DRAM (Diastasis of the Rectus Abdominus Muscle) is controversial, with little evidence to suggest that exercise can prevent its occurrence, nor improve its resolution. Once it is apparent, however, activity should be adjusted to minimise further separation as you return to exercise. Your return to exercise should be graded and utilise an inside-to-outside approach. Specifically, emphasis should be placed on improving the tone of the transverse abdominus and pelvic floor muscles to better support the rectus abdominus muscle as it ‘heals’. Any exercise that does activate the rectus abdominus should involve drawing the abdomen towards the spine, and any exercise that causes the abdominal muscle to bulge outward avoided."

In addition to functional symptoms that can occur, there may be loose skin that also fails to ‘recover’ from being stretched. Rectus divarication repair is most often performed as part of an abdominoplasty procedure. An incision is made that runs along the lower abdomen very close to where a C-section scar wound sits but extends from hip to hip. The skin and fat of the abdomen are lifted off the abdominal wall up to and then beyond the level of the umbilicus (belly button), and then often all the way to the rib cartilages centrally where the abdominal muscles attach. Lifting the skin off the abdominal wall exposes the thick white covering known as fascia that encases the red muscle tissue. It is the tough white fascia that is used to bring the separated muscles back together with a series of sutures, which may be dissolving or permanent. It is not uncommon to have small umbilical or a para-umbilical hernia associated with muscle separation, and these can be repaired at the same time by suturing and tightening the tissue layer that covers the muscles. In an abdominoplasty, excess skin is then removed below the belly button. In cases where there is no excess skin but only separated muscle, the incision can be kept a little narrower along the lower abdomen.

Following surgery there will be some bruising and swelling, and a feeling of tightness in the abdomen from the internal sutures. Return to work and light exercise can vary from 2 to 4 weeks, with this time off being factored into your decision to have surgery and when. Recovery is an opportunity to take some time out from the busyness of life and rest. Let your family and friends support you in your recovery, whether that’s picking up the kids, making some meals, and definitely with any heavy lifting.

Grandstand Physio PH 4963 1887, full contact details can be found at www.grandstand.clinic - if you have any questions you would like Dr Avery to answer, please email info@averyplasticsurgery.com.au.