Diastasis has always been considered a purely aesthetic problem, being treated as such, but it is time for a paradigm shift given that it entails physical disorders that elevate it to the category of pathology.
Diastasis is an excessive separation between the rectus abdominis muscles of at least 3 cm, which leaves the central area of the wall weakened and gives a lumpy sensation that can be confused with a hernia. It frequently coexists with an umbilical hernia.
What is its prevalence and what symptoms does it produce?
Around 70%, increasing with age and obesity, although it does not usually cause symptoms and does not need to be treated. When it produces symptoms, they are: difficulty getting up, chronic lower back pain, abdominal bloating, constipation or urinary incontinence. Symptomatic diastasis usually occurs after childbirth, and must be assessed in a different and individualized way.
How is diastasis established during pregnancy?
During pregnancy, the rapid increase in volume of the abdomen produces a stretching of the tissues to the detriment of their elasticity, in addition to an elongation and loss of strength of the entire abdominal girdle, formed by the rectus anterior, lateral and lumbar muscles, as well as the pelvic floor muscles, which together we call the core. When one or more of these elements fail, symptoms may appear and the problem must be corrected.
How is it treated?
The ideal approach to obtain an optimal functional result includes treating the core, which is why I apply a complete program that I have called the ECR Program (Training, Surgery and Rehabilitation). First, we began a training plan led by a core/pelvic floor physical therapist for 6 months. This phase requires consistency to perform the exercises every day. Sometimes this alone can correct the symptoms. Once this phase is completed, if the problem persists, it is time to talk about surgery and we have two ways to approach it: The first is abdominoplasty, indicated when there is excess skin, which combines the correction of the diastasis with the removal of excess skin, which means an extensive scar in the lower abdomen.
The second is laparoscopic rectus plication or REPA, being the most aesthetic option since three small incisions are made that are hidden, but only applicable if there is no excess skin. An extended modality in search of an optimal aesthetic result includes liposuction in the same procedure. Finally, the program is completed with six months of rehabilitation to finish strengthening the muscles and learn what exercises we should avoid.
When to consult for a diastasis?
Never before six months after delivery nor if another pregnancy is desired, and always consult with a specialist abdominal wall surgeon.
