Big diastasis: an announced chronicle

“Big diastasis recti abdominis is not a phenomenon showing up all of a sudden.” 

Dr. Alessio Caggiati specializes in plastic and aesthetic surgery. He has performed more than 10,000 surgeries and has large experience treating big diastasis recti, a phenomenon that leads to an important distancing between the rectus abdominis.
Caggiati explains: “Big diastasis recti abdominis is a progressive phenomenon that takes place over the course of a few years.” This major distancing of the two sections of rectus abdominis results from an initial small sagging of the abdominal fascia, which is either neglected or undiagnosed.

Causes of big diastasis recti abdominis

This pathology can be caused by two factors: one of a genetic nature and the other of a paraphysiological nature. “In the first case, there is an alteration in the composition of the abdominal fascia —explains the doctor— due to a lack of amino acids.” 

The second case, on the other hand, occurs during pregnancy when the abdominal wall is subjected to significant stress and the abdominal fascia can experience some temporary sagging. 

“Another trigger —continues Caggiati— is the abuse of physical activity during the last trimester of pregnancy.” In the first phase, in fact, it is recommended to work out because there is no stress on the abdominal wall. Yet, at the end of pregnancy, vigorous workouts should be avoided since there is already a wall stress due to the fetus’ growing volume.

“Suffering from diastasis recti after childbirth—explains the doctor— is absolutely normal. The diagnosis, in fact, takes place at least after a year.” 

Limiting big diastasis recti abdominis in pregnancy

During this period, various solutions can be undertaken to try to recover from diastasis. In case they don’t work, it is then possible to consider surgery. The operation can last a few hours if other aesthetic procedures are also performed. After the surgery, we recommend a total rest period of at least 15 days and returning to normal life after 3 months.
“I am against discharging the patient immediately —explains the surgeon— even if the regression of the symptoms is fast enough.” It is recommendable to spend the night in the hospital so that the patient can be monitored. Complications may not be handled properly at home. For example, post-operative bleeding may occur, caused by a pressure change due to multiple factors. 

The use of post-surgical garments is also essential for patient rehabilitation because they contribute to a more long-lasting result after surgery.
“When we reduce the circumference by many centimeters —adds Caggiati—, there is an increase in pressure in the abdomen, and the patient may experience difficulty in breathing.” In this case, it is ideal to wear the garment even before the surgery to promote thoracic (and not abdominal) breathing so that the patient can get used to the change.

How big diastasis recti abdominis start

“There are no specific symptoms —explains the surgeon— and they are comparable, both in terms of incidence and frequency, to women who have given birth.” For example, urinary disorders can occur because when the rectus abdominis muscle no longer works in parallel, the bladder’s function of contraction is lost.

Big diastasis recti abdominis also affects upright posture. Balance problems occur due to a misalignment between the rectus abdominis and the muscles along the spine. Due to diastasis recti, muscles are made less efficient and this can cause an imbalance between the two muscles.

Diastasis recti is a pathology that does not have well-defined symptoms and that often stays undiagnosed. “From a scientific point of view —explains the surgeon—, there is no classification of diastasis recti.” 

It is necessary to take into account the clinical aspect of the disease, its evolution and the impact it has on surgery. The classification must be in relation to the risks and benefits, because not all patients need surgery.
In fact, the less severe the diastasis recti, the less intervention is required.