VERNE MAREE freely admits that as her tummy has never been her best feature, she has sensibly given skin-tight Lycra and crop tops a wide berth. But what of the many mothers sadly robbed by rectus diastasis of the trim waist and flat tummy they were once so proud of? If that’s you, help is at hand.
After the birth of our two grandchildren, my daughter-in-law Carrie had a four finger wide diastasis, or gap between the right and left parts of the central tummy muscle. This made her a candidate for reparative surgery. Being Carrie, she instead embarked on a programme of thrice-weekly, physiotherapist-guided remedial Pilates.
Eight long months later, the gap had closed to one finger in width. Her advice? “Don’t ignore rectus diastasis (RD), or resign yourself to it as just another part of yourself lost to motherhood. It won’t magically go away.”
Ten years after childbirth, a friend of Carrie’s still has a hand-width gap, undoubtedly a surgical case. “After a meal, it looks like a vertical loaf of bread under her shirt,” says Carrie. “No one should have to live with that!”
What causes rectus diastasis?
Plastic surgeon Dr Marco Faria Correa agrees with her, adding that cases like these are common.
“Rectus” comes from the term rectus abdominus. This is the long, central muscle that runs from the chest to the pubis and is interconnected with the other core muscles. The linea alba is the tendon that connects them all. “Diastasis” simply means gap.
As your baby grows in the womb, it pushes out the abdominal wall and causes a stretching of the linea alba. But that’s not all. It stretches and elongates the entire muscle, which becomes long and flabby.
Think of it this way, says Dr Marco: At the gym, you stretch to elongate tight, short muscles. After nine months of gradually stretching your muscles to three or four times their original length, you need to shorten the muscles again. Exercise can help. But it absolutely has to be the correct exercise to be effective.
As he explains: “Exercises like crunches that contract the oblique and transversus muscles actually open up the gap. They further weaken your core and put a strain on your back. Contracting the central rectus muscle, however, closes the diastasis.”
Things to consider
Firstly, there is no exercise that can reconstruct the stretched connective tissue, or linea alba. This can only be corrected surgically.
Secondly, is your rectus diastasis affecting function and causing disability? A gap of even up to 7cm can present no problem, depending on how you’re functioning. That said, if you’re distressed by a bulging stomach that will not flatten no matter how much you work out, this may be enough reason to consider abdominoplasty, also known as a tummy tuck.
According to the literature, 100 percent of pregnant women experience a certain degree of stretching of the midline. Studies show that more than 60 percent will be left with a diastasis of 0.8cm to 1.0cm. What’s more, up to 48 percent will suffer symptoms – whether functional or cosmetic – and could be candidates for surgical repair.
Back pain and pelvic floor dysfunction
At least 38 percent of postpartum women experience one or both of these. Back pain is the most frequent, and that’s because rectus diastasis compromises the functioning of the core muscles that support spinal stability. That’s a strong medical reason to correct it.
Pelvic floor dysfunction is another debilitating symptom of rectus diastasis. The pelvic floor is a group of important muscles that are in turn connected to the core muscles. These are the major muscles that move, support and stabilise the spine. Natural childbirth, with the passing of the baby through the pelvis, is more likely to cause damage to the pelvic floor than a Caesarean section would be. The resultant pelvic floor weakness is associated with problems like incontinence – loss of proper control over urination – and also constipation. Neither of these is fun.
Some good news? The vast majority of studies show a tremendous improvement of back pain after an abdominoplasty or tummy tuck procedure. And nearly half those suffering from incontinence and constipation report an improvement in these areas, too.
Back in 1996, Dr Marco introduced minimally invasive endoscopic abdominoplasty to Singapore, and started using Da Vinci robotic plication. Still the gold standard for repairing rectus diastasis, its most evident advantages include:
- smaller incisions, often through existing Caesarean scars or the belly button; and
- quicker healing, with less chance of infection.
His approach will depend on your particular concerns. Someone with a functional or cosmetic problem, but with relatively smooth abdominal skin and no stretch marks, may be the right candidate for a minimally invasive tummy tuck. But if you have an excess of skin and unwanted skin folds, you may be a candidate for more extensive surgery.
Other procedures such as liposuction and breast enhancement, for example, can be done at the same time, often as part of a so-called “mummy makeover”. That’s so long as the operation doesn’t extend beyond six-to-seven hours, and depending on the patient’s health and overall condition.
Post-surgery – it’s a joint effort
Post-operative care involves learning to re-educate the core muscles, and this is an integral part of the treatment.
Says Dr Marco: “I want to be clear that you can’t solely count on me stitching your muscles together to give you a nice flat stomach. We get the best results with a combination of surgery to improve function, and you doing the right workout to strengthen weakened muscles and relearn how to use your core effectively. This is best done through Pilates and physio, working with an expert in the field.”
What’s more, he says, you have to wait for the right time to start physio: “After I’ve repaired a hernia or diastasis, we allow at least four months for collagen to heal the inner scar.” It’s not that you can’t do any exercise for four months, he adds – but you do have to choose the right movements.
A satisfying career
After decades in the field, it’s obvious that the energetic Dr Marco has a real enthusiasm for his work. What’s more, he revels in making a positive difference to the lives of his patients and continues to contribute to global conferences, both in person and online.
“I still find it immensely rewarding, I really enjoy the art of what I do, and I believe that my contribution to plastic surgery is recognised.”
This article first appeared in the December 2022 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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