By Robert Kessler, MD — Plastic Surgeon, Newport Beach, CA
The main muscles of the abdominal wall are the rectus abdominis muscles. They run from the rib cage to the pubic bone and define the contour of the abdomen. They’re segmental, and in thin, athletic individuals they show through the skin as the classic “six-pack.”
How the Muscles Are Held in Place
These muscles meet at the center of the abdominal wall and are surrounded by a tissue layer called the rectus fascia — a fibrous structure that holds them in place and maintains the integrity of the abdominal cavity. Their central location not only anchors the abdomen but helps maintain balance with the opposing muscles of the back.
What Happens During Pregnancy
As the abdominal wall expands, the rectus muscles move away from the midline. The muscle can stretch, but it’s the fascia — the strength layer — that does most of the stretching, and it’s weakened in the process and doesn’t return to its original position. The muscles remain separated, most noticeably above the belly button. No amount of exercise will restore them to the midline; building strength is always beneficial, but the rounded appearance can’t be resolved through exercise alone. The fascia must be surgically tightened to bring the muscles back into alignment.
Diastasis Is Not a Hernia
Diastasis recti must be differentiated from a hernia. A hernia is a weakness in the abdominal wall — the rectus fascia — that lets abdominal contents push through and sit beneath the skin. In rectus diastasis, the fascia is thin but intact, so there’s no danger of the complications seen with hernias.
Surgical Repair
Surgical repair of a diastasis recti is a routine part of an abdominoplasty (tummy tuck). When the abdominal skin is elevated, the borders of the rectus muscle are obvious through the fascia, and sutures bring the muscles back into appropriate alignment for optimal function and appearance.
If you’re working through recovery before considering any procedure, recovery garments and gentle compression can support the abdominal wall day to day. Jenn can walk you through what’s happening and what helps.