Diastasis is defined as an abnormal separation of parts normally joined together. Diastasis recti can be confusing for patients as well as physicians as they both present as a bulge in the abdomen. While a hernia is an actual hole in the abdominal wall, diastasis is weakening or stretching of the connective tissue between the muscles, called fascia.
What causes diastasis recti?
There are two main causes of diastasis recti: pregnancy and weight gain. The two main subgroups experiencing diastasis are post-partum women and overweight middle aged men.
During pregnancy, hormones cause the abdominal wall to become more compliant to allow room for the expanding uterus. While the abdominal wall somewhat returns to normal, sometimes some laxity or weakness remains. Exercise and core strengthening can help correct this, but typically will not resolve it completely.
As we gain weight, we also increase adipose or fatty tissue inside the abdominal cavity. This stretches the abdominal wall and puts more tension on the fascia, which compensates by stretching.
What are the symptoms of diastasis recti?
In training, I was taught that diastasis was something that didn’t cause problems or symptoms. That it was purely cosmetic. In reality, we have learned that in addition to cosmesis and appearance, diastasis can commonly cause lower back pain or urinary symptoms. These symptoms may improve with plication of the diastasis.
the problem with diastasis
Because diastasis recti has historically been considered as cosmetic, it is not covered by insurance. Hernia surgeons have previously not always addressed diastasis. Repairing the diastasis may require out of pocket expenses.
What are the surgical options for diastasis recti?
There are several different options for repairing diastasis recti or what’s called plication. A one size fits all approach does not account for certain scenarios. Three main subtypes of patients that may need plication of their diastasis are:
- Multifocal incisional hernias with diastasis recti. This normally occurs after a laparotomy with someone who already had diastasis recti. This is usually treated with robotic retromuscular repair with plication of the diastsis from the posterior side (inside the abdominal cavity).
- Postpartum diastasis with excessive skin. This is usually best treated by a plastic surgeon with a traditional tummy tuck or abdominoplasty. The benefit of this is tighter skin and ability to combine excision of fat. The tradeoff for this is a fairly long scar from hip to hip below the waist line.
- Postpartum diastasis with or without a hernia without excessive skin is best treated with a subcutaneous laparoscopic plication. This is sometimes referred to as REPA or SCOLA. This provides the same repair as a tummy tuck through three small incisions below the waist line.
Abdominal core health quality collaborative
It is often said that no surgeon truly knows his own hernia recurrence rate. How do you know what you are doing is working if you’re not keeping track?
The Americas Hernia Society aims to fix just that with the Abdominal Core Health Quality Collaborative or ACHQC. The quality collaborative is a database created by hernia surgeons that enables them to keep track of their performance, patient outcomes and complications. It also allows us to come together to pool our data to add significance and meaning to the numbers.
It is not research and nothing we do is experimental. It is merely a tool to make good surgeons better.
Participating in the ACHQC is completely optional with no obligation. There is no requirement to participate in order to have your hernia repaired.