Diastasis Recti Surgery: Preparation and Recovery

When you have diastasis recti, surgery is sometimes necessary. Diastasis recti, also called rectus abdominis diastasis (RAD), is a condition where the muscles of your abdomen have come apart. The muscles can separate when someone is pregnant or for other reasons.

Diastasis recti surgery can be done on its own or as part of a "tummy tuck" procedure.

This article will go over what you need to know about diastasis recti surgery. You will learn why it is done, what to expect, and what the recovery from diastasis recti surgery will be like.

What Is Diastasis Recti?

Diastasis recti or rectus abdominis diastasis (RAD) is a condition where a gap forms down the center of the muscles of your abdomen. It can cause a bulge that runs down the middle of the stomach. If an adult has a separation between the abdominal muscles that's a width of two fingers (two centimeters) or more, it is considered diastasis recti.

These muscles naturally come apart in the later stages of pregnancy, so people may have the condition after they’ve been pregnant. RAD can also happen in newborns and older people.

Having RAD raises your risk of getting a hernia, having trouble controlling your urine (incontinence), and having low back pain.

Who Needs Surgery for Diastasis Recti?

Diastasis recti can get better on its own—for example, it might improve in the weeks and months after you are done being pregnant. Sometimes, doing abdominal exercises to strengthen the muscles can also improve diastasis recti somewhat.

However, if it does not get better and is causing quality of life issues, you may need to have surgery to fix diastasis recti. A surgeon can close the space and reconnect the muscles by itself or as part of an abdominoplasty (“tummy tuck”).

If you are experiencing negative effects physically and mentally because of the condition, having a procedure to fix it might be beneficial. Some issues that surgery may correct or improve include:

• Weakened pelvic floor contributing to urinary leakage or constipation
• Lower back pain that makes it painful to lift, twist, and move
• Hernias that may have developed because of weak muscles in your abdomen
• Cosmetic issues related to the bulge in the abdomen

Contraindications

If you are breastfeeding, most surgeons will want you to wait a couple of months after weaning your baby before having diastasis recti surgery.

If you're planning to become pregnant again, remember that pregnancy separates the muscles in your abdomen. You should wait until you are done having kids to have surgery to fix RAD.

Most surgeons will want you to wait at least six to nine months after giving birth to have surgery to fix diastasis recti.

You need to give your body time to recover from childbirth. You also need to give your hormone levels a chance to return to what they were before you were pregnant.

Potential Risks

There are potential risks of diastasis recti surgery. The risks largely depend on the kind of surgery you have.

For example, some surgeries to fix RAD are done with just a few small cuts (laparoscopic surgery). During the procedure, the surgeon uses a camera to see inside your belly. 

Other surgeries, like a tummy tuck, are done with more cuts or bigger cuts (incisions).

Every surgery comes with risks, including:

• Surgical wound infections
• Fluid and/or blood collecting in the surgical wound
• Surgical wound coming apart before it's healed (dehiscence)
• Numbness or lasting pain
• Skin loss
• Scarring
• Swelling that does not go away
• Changes to skin that affect the appearance belly button (including losing the belly button)
• A belly that looks uneven or lopsided (asymmetrical)
• The need for more surgery in the future (e.g., for repairs or corrections)

If you are thinking about having diastasis recti surgery, talk to a board-certified plastic surgeon. Make sure you understand the risks of having surgery because they might be different for you than they would be for someone else.

A surgeon may show you "before and after" photos so you can see how they fixed diastasis recti for other people.

Purpose of Diastasis Recti Surgery

In most cases, surgery is the only way to repair diastasis recti.

However, you should know that RAD surgery may not be covered by insurance because it’s considered an elective procedure. That means that it can be scheduled ahead of time because it is not an emergency.

If you have RAD, it changes how your belly looks. If you have it fixed, diastasis recti surgery can also be considered a cosmetic procedure.

While surgery can improve the appearance of your abdomen, that's not the only reason people have a procedure. Many people have surgery to help with back pain and incontinence.

People with RAD can also get hernias, which is when part of an organ or tissue pokes through the muscle in your abdomen. Hernias are uncomfortable and can make it harder to go about your daily activities. 

Hernias happen when the muscles in your abdomen are weak or torn, so having surgery to fix muscles that have separated from RAD can be helpful.

There are alternatives to RAD surgery, including body contouring procedures like liposuction. 

While these procedures take fat from the abdomen, they do not fix separated muscles or get rid of excess skin.

Doing exercises that strengthen your core muscles can also be helpful, both physically and in terms of improving how your belly looks. However, exercises will not repair diastasis recti.

How to Prepare

Here's what you'll need to do to get ready for diastasis recti surgery.

Location

Most RAD surgeries are outpatient surgeries or "day surgery" because you do not have to stay overnight in a hospital.

Your surgery will be scheduled at a place that does outpatient surgeries. 

Older adults, newborns, and people with certain medical conditions may need to be admitted to the hospital (inpatient surgery) to have diastasis recti fixed.

What to Wear

On the day of your surgery, wear loose, comfortable clothes. You want to wear something that will be easy to change out of. Here are a few pointers:

• Pick a top that opens easily in the front. Do not wear a shirt that you would have to pull over your head. A hoodie or a button-up shirt would also work.
• For bottoms and shoes, drawstring pants and slip-on shoes are easy and comfortable.
• Choose items that are easy to wash or that you do not mind getting dirty. After your surgery, there might be bleeding from where you were cut. Even though the cuts will have bandages on them, your clothes could still get stained.

Food and Drink

You will have to follow some rules the day or so before your surgery. One important instruction your surgeon will give you is to not eat or drink for a certain amount of time before your surgery (fasting).

Usually, you will need to stop eating at least eight hours before you have to be at the hospital. You might be able to keep drinking clear liquids, like water, until about two hours before your surgery.

Medications

Your provider may ask you to stop taking some of your medications before your surgery. This is because some medications can thin your blood and make it easier for you to bleed.

There are many prescription medications that can thin your blood. However, many over-the-counter (OTC) medicines, supplements, and herbal remedies can have the same effect. Aspirin is a common example of an OTC medicine you should not take before you have surgery.

What to Bring

You need to make several preparations for the day of surgery. First, you will need to have someone come with you who can drive you home after your surgery.

You also need to bring some documents on the day of your surgery, including:

• Personal identification (like a driver's license)
• Health insurance information (if you have it)
• Any paperwork that your surgeon's office asked you to fill out

There are also some things that you should leave at home. Do bring valuable items or a lot of cash with you. Leave your favorite jewelry or watch at home. 

If you bring your phone or tablet with you, give it to the person who has come with you when you're getting ready for surgery.

Pre-Op Lifestyle Changes

Being as healthy as possible before your surgery will help you get through the procedure and make recovery easier. 

If you're having RAD surgery, your surgeon might talk to you about why it's important to be at a weight that supports your health.

If you lose or gain a lot of weight after you have a procedure like a tummy tuck, it can make the skin of your abdomen stretch out.

Your provider will support you in eating a nutritious diet and getting regular exercise before your surgery. 

However, you might want to avoid doing exercises that put pressure on your abdomen. For example, doing crunches can make diastasis recti worse.

There are also some exercise programs meant to help people with diastasis recti. You might be able to work with a physical therapist to strengthen your abdominal muscles before your surgery.

What to Expect on the Day of Surgery

When the time comes to have your RAD surgery, here's what you can expect.

Before the Surgery

Your surgeon will tell you what to do the night before and the morning of your surgery. 

For example, they may have you wash your body with antibacterial soap to help prevent infections.

Follow the instructions your surgeon gives you carefully. If you have questions, call their office.

You should feel comfortable bringing up your concerns or asking questions in the days and weeks leading up to your surgery. On the day of the procedure, you won't have very long to talk to your surgeon.

Plan ahead to make sure that you will get to the place where you are having surgery on time. 

When you arrive, you will change into a hospital gown. You might be given a bag to put your clothes and personal items in. The person who has come with you can look after it for you.

A surgical assistant or nurse will check in to see how you are doing. They will take your vital signs (for example, your temperature and your blood pressure). If you're not feeling well or have had a fever, make sure you let them know.

You will be under general anesthesia for your surgery. The medicine makes you unconscious—like being asleep, but much deeper. You will also get medicine that makes it so you can't move during the surgery. You won't feel any pain or remember the surgery when you wake up.

The provider who is in charge of giving anesthesia (anesthesiologist) will come to talk to you. They will have you look at a document that tells you about your rights as a patient (waiver). Every patient has to read and sign it before they can have surgery.

Once the paperwork is done, the anesthesiologist will give you some medicine to help you relax. Then, you'll be ready to go to the operating room.

During the Surgery

Once you have been given anesthesia, your surgery can start. Your surgeon will either do the procedure with a big cut (open) or a few smaller cuts and a camera (laparoscopic).

If your operation includes a tummy tuck, your surgeon will start by making a cut going side to side between your pubic bone and belly button.

Next, they will lift up the skin and use stitches to pull the abdominal muscles back together and put them in the right position. If you have a hernia, your surgeon will fix it.

Once they finish the repairs, your surgeon will trim the excess skin by pulling down the remaining skin to stitch it together (suturing).

Since the skin has been moved around, your surgeon will need to make you a new belly button.

When they're done, they close the wound with adhesives, clips, tapes, or more stitches.

If you're having a laparoscopy ("keyhole" surgery) your surgeon makes a few small cuts in your abdomen. They put tools and a camera inside the cuts to look around and make repairs.

Laparoscopic surgery is not as major as open surgery. It's also called "minimally invasive" because you do not need to have as many cuts. However, you'll still need plenty of time to heal after.

After the Surgery

You'll usually be able to go home a few hours after you get out of surgery. However, if you had any problems during the procedure or if you have certain health conditions, you may need to stay in the hospital overnight so your medical team can keep an eye on you.

You will have bandages on your wounds and drains on your body to let the extra fluid come out as you start to heal. 

You will be shown how to keep the drains clean. It's very important that you follow the instructions carefully.

You will also be sent home with something to wear around your middle that puts pressure on it (compression garment). It provides support and can help the swelling go down.

You will check in with your provider next, within a day or two. They may take the compression garment off to see how you are healing. 

From there, you will have to take the garment off and on yourself for about a week. You might need someone to help you if it's uncomfortable.

Recovery

Most people can go back to work within two to four weeks of having diastasis recti surgery.

If you do a lot of heavy lifting at your job, you may need to wait a month. If you start lifting heavy objects too soon, it can affect your healing.

Healing

You can expect some pain in your abdominal muscles for a few weeks after RAD surgery. It may hurt when you cough or laugh and your movements might be limited. Your surgeon may have prescribed pain medication to help you through your recovery.

You will also have some swelling after your surgery. You might notice some small changes in your weight, but it is not fat—your body is holding on to water in the early stages of recovery.

Since diastasis recti surgery is on your muscles, they'll probably be sore for a while. Your abdomen may feel taut for a week or so, especially if the surgeon tightened your skin. You might also have some trouble standing up straight, and it may hurt when you cough or laugh.

As you are healing, you need to avoid straining your muscles. You also need to prevent the cuts in your belly from getting infected. Your provider will give you instructions on how to do this and you need to follow them carefully.

You won't be able to get your abdomen wet. That means no bath, shower, or swimming until your surgeon tells you it’s safe to do so. If you get the cuts wet before they are healed, it can cause an infection or affect their healing.

Coping With Recovery

Your provider will give you medication to help with the pain. You'll need to rest as much as possible and may need to take naps or go to bed earlier than usual.

That said, keep moving around. In the first week of healing, walking around your house will get your blood flowing and help with healing. However, you won't be ready to jump back into a workout routine for a while.

Try to stay busy so you're not tempted to push yourself too much before you're ready. It will also help if you have some loved ones close by who can help you with things like shopping for groceries and laundry. 

Since you won't be able to do the heavy lifting yourself, having someone to help you will be important as you're recovering.

Possible Future Surgeries

The results from diastasis recti surgery will last forever (permanent). Once you have the surgery, your abdominal muscles should stay in the right place and the gap you had should not come back.

However, it's possible that the surgery will not turn out how you wanted it to. Even if your surgeon was experienced and you did not have complications, you might not end up with the results you wanted.

If you've been healing for a few months and you are not happy with how your belly looks (for example, the skin is uneven), you might need to have another surgery to fix it (revision). 

Lifestyle Changes After Surgery

Surgery for RAD will fix your abdominal muscles but you need to take some steps to make sure the changes stick. 

One of the most important things is keeping your weight stable. If you gain a lot of weight or get pregnant, the fixes your surgeon made might not hold.

Having a lifestyle that includes nutritious eating and regular exercise will help the results of your surgery last.

Once you're healed, you will have some scars on your abdomen. 

The scars will fade with time, but there are steps you can take to help them heal. For example, keep your skin protected from the sun. If you get a sunburn on a scar, it might not fade as well.

Summary

Diastasis recti surgery fixes muscles in your abdomen that have come apart. The separation can lead to other health problems like hernias. You might also feel self-conscious about how your abdomen looks.

People have diastasis recti surgery for a variety of reasons, including supporting their body physically, fixing hernias, and improving their self-image.

If you're thinking about having RAD surgery, choose an experienced surgeon that you trust. They will talk to you about the risks and benefits of having diastasis recti surgery and decide whether it’s right for you. 

After your surgery, follow your provider’s instructions about taking care of your body while you are getting better.

If you heal up but still do not like how your belly looks, you can talk to your surgeon again. They might be able to do another procedure to fix it.