Everything You Need to Know About Diastasis Recti

by Dr. Ryan Neinstein

My grandmother told me that if you know how to fix something that is broken you should fix it!

Now, I would be ludicrous to think that I could truly understand what it is like to go through the process of pregnancy; especially multiple times and with big babies. What I do know is this: if my core muscles were separated, I had a permanent bulge in my abdomen, and there was a safe and predictable way to fix it – I would!

Which brings us to muscle separation, also known as diastasis recti, or “mom pooch”.

So what is diastasis recti?

Diastasis recti is the separation of the stomach muscles but with no hole or hernia in the separation. When the muscles are together, your core is like a steel door (your insides lean against but nothing happens); when the muscles are separated the core is like a screen door and the insides bulges out.

Here is a 43 year old fit mom of 3 who came to see me because she had enough of the bulge:

Here she is after the repair with her tummy tuck!

How bad can diastasis recti get?

Everyone will respond differently but with more children and larger babies the damage can get severe.

Here is one of our patients who is absolutely thriving after a special repair:

Why do people get diastasis recti?

Multiple pregnancies and large babies tend to stretch the muscles and have a cumulative effect on keeping them stretched.

How many people get diastasis recti?

About 1/3 of women will have a persistent abdominal bulge a year after pregnancy.

Are there different types of diastasis recti?

Yes! If you think of the core muscles like a zipper starting in the pubic area  and going up to the ribs, the zipper can be unzipped half way or all the way.

Here are a few examples:

Can I fix my diastasis recti without surgery?

Physiotherapy and core strength training after babies will for sure help improve the form and function of the core muscles but they do not always completely correct it – especially if the muscles have severe  separation.

Take a look at one of our moms with severely separated muscles:

How do I fix my diastasis recti?

We fix the muscles as part of our mommy makeover procedure.
After we perform liposuction we sew the muscles together – this is like zippering up the muscles that were unzipped; we sew all the muscles that have separated back – this means sometimes we do one vector and sometimes multi-vector.

Fact: when you repair the muscles the skin becomes relatively longer, requiring the skin to be removed (tummy tuck); you end up having the bedding for a queen and the frame of a twin so we need to match it! This means you will need a tummy tuck to go along with the muscle repair.

What does a muscle repair feel like?

It feels as though you had your engine repaired, which is great because everything in your life is better when you have a functioning, intact core.  For the first week, there is however intense soreness.

To help it only feel like you did a million sit ups instead of 10 million,  we inject long acting numbing into the muscles. This injection has been an absolute game changer for the soreness – I have 5,000 moms who will tell you that its super super sore but beyond worth it.

Remember: patients who choose us are driven and high performing people, they are used to being persistent and persevering; the soreness is part of the process of getting to their goals!

Muscle Repair Pain Timeline

  • Day 1-2: “This nothing doc”, this is the time when the numbing is really working and you will have a mild soreness that helps reduce the soreness in the next phase.
  • Day 3-7: “Oh man, doc, what did you do run me over with, a truck?” This is when the muscles are tensing in their new shape and position.
  • What you probably don’t know but need to know is you will have more back pain at this phase because we ask you to sleep with pillows under your back and under your thighs. Lidocaine patches really help during this phase.
  • Week 2 through end of Week 3: “Its not that bad, I can move and groove” at this point supplements are in the rear view mirror; you are walking and standing upright, albeit slower than normal; you are starting to recognize a flatter more engaged tummy.

How will I feel after my diastasis recti is repaired?

These are what I hear when we fix peoples diastasis recti problems

  • “I feel like I have my core back”
  • “I don’t have to wear contraptions with tight dresses anymore”
  • “I don’t have to hold my breath to keep my stomach in anymore”
  • “I love doing planks, inversion, anything core at the gym because when I do the exercise I actually see it”

We let people start doing light exercise at 3-4 weeks but we ask you not to fully engage core for 8-12 weeks.

If you have questions about diastasis recti and procedures we offer to solve your problems so you don’t have to live your life with bulges and being uncomfortable, call us at 212-249-0949 for a consult with one of our surgeons or better yet email us your story, fears, goals, and amount of downtime you can realistically take to info@neinsteinplasticsurgery.com to start the pain relieving process

-Dr Neinstein