3 Killiney Road, Winsland House 1, #09-08, Singapore 239519

Muscle Divarication Repair

DRAM repair

Recti Surgery

INFORMATION

Pregnancy exerts pressure on the belly, which in turn causes the muscle in front of it to lose its shape. There may be a protrusion around the belly button. This is called diastasis of the rectus abdominis muscles (DRAM), diastasis recti abdominis, abdominal separation, recti divarication or, simply, diastasis recti. “Recti” is derived from “recti abdominis” or “rectus abdominis” which refers to the group of muscles sitting in your belly. They keep the contents of the stomach together. “Diastasis” stands for separation.

In other words, the name means separation of the abdominal wall muscle or your core muscles. The condition affects around two-thirds of women on a global scale and leads to abdominal discomfort and impaired quality of life. When this happens, often, the stomach muscles will not go back to their original state after birthing. Instead, abdominal rectus diastasis may worsen, leaving the person with a belly sticking out, and losing it would be a difficult task.

As the muscle tears, the uterus, bowels and other organs have only a thin band of connective tissue in front to hold them in place. This is when vaginal delivery gets difficult too.

Divarication of Recti Surgery

Divarication of recti (also known as mummy tummy diastasis recti) is a condition affecting the abdominal muscles in pregnant women and sometimes men. There is an abnormal distance between the muscles in the belly. Abdominal muscle separation after pregnancy is common too. A lot of times, it does not respond to any exercise programs or other conservative treatment and has to be fixed surgically. The procedure to do that is called muscle divarication repair, and it can enhance one’s quality of life.

How to get the tummy muscles back together?

When the recti muscles of the stomach are torn apart, getting everything back in place and making the tummy smaller might be a bit of a task. Hence, muscle divarication repair can be done. It is also referred to as mummy tummy, rectus diastasis repair, diastasis recti repair, diastasis recti surgery, and DRAM repair.

Who is more likely to get rectus divarication?

Women who have more than one child and also those who get pregnant after the age of 35 are at a higher risk of developing abdominal rectus diastasis. Hence, if you have suffered from an umbilical hernia before, this makes you more vulnerable to abdominal muscle separation, in which you are going to need reconstructive surgery.

What causes abdominal muscle separation?

Rectus abdominis diastasis can result from the following:

  • Imbalance of the muscles
  • Poor core strength
  • Significant stretching of the abdominal wall (during pregnancy)
  • Restrictions within the diaphragm
  • Going overboard with core exercises during workouts
  • Reduced fitness
  • Lack of proper coordination of abdominal muscles

About DRAM repair (recti repair surgery)

The cosmetic procedure that can fix rectus diastasis is individual. There are various techniques for DRAM repair, but three main categories can be distinguished so far: hernia repair techniques, plication techniques for DRAM repair, and techniques that address small midline hernias.

Single-layer plication for DRAM repair is one of the most efficient methods to fix the problem, but as every case is different, other types of plication techniques with interrupted sutures or continuous sutures may be more suitable. The surgeon chooses an approach based on the female patient’s medical history.

This procedure is similar to abdominoplasty surgery (tummy tuck surgery) and has a high success rate. What is different is that a tummy tuck procedure usually involves the removal of abdominal skin and fat to create a tighter stomach.

The surgeon gets access to the affected area using absorbable stitches. They make a suprapubic incision or a horizontal incision along the bikini line, just below the belly button and above the pubic bone. During muscle divarication repair, the stomach muscles that are separated will be sewn back together with absorbable sutures (interrupted sutures or continuous sutures, etc.) From here, the muscles that have been sewn together will continue to join one another naturally over time.

Once the divaricated muscles are repaired, any remaining excess skin and belly fat can be removed so that the stomach doesn’t stick out anymore. This surgical treatment significantly improves the quality of life. About six weeks after abdominal wall reconstruction, patients can go back to normal activity.

What to expect from the surgical procedure that stitches together the rectus abdominal muscle?

DRAM repair is done under general anaesthesia. Scars are expected from muscle repair, but the plastic surgeon will use surgical techniques to ensure it is hidden as much as possible, and the scarring will be able to heal on its own over time.

With respect to recovery, the first weeks after surgery of diastasis recti, it is normal to experience mild pain and abdominal discomfort around the incisions, especially when laughing, coughing, and lifting heavy objects (which you shouldn’t do). There will be swelling and tightness. In the beginning, you will find it difficult to stand up straight, but this will change over time, and you will start to feel better day by day.

To ensure that your healing phase goes smoothly:

  1. Avoid straining your muscles.
  2. Don’t forget to keep your bandages clean and follow your surgeon’s instructions.
  3. Don’t worry. You will be given pain medication to manage the discomfort following laparoscopic repair of the ab muscles.

It is also recommended that you take short walks around the house to improve blood circulation and enhance healing. That said, do not overexert yourself and make sure to allow enough time to rest your body.

Who is suitable for the muscle repair procedure that addresses abdominal rectus diastasis?

Pregnant women who experience divarication of recti can have muscle repair a couple of months postpartum. The condition does affect men too and is often left misdiagnosed as weight gain or beer belly.

Now, postpartum women suffering from diastasis recti that lack concomitant ventral hernia should consider physiotherapy as the first line of treatment before undergoing surgery. Sometimes abdominal muscle separation can resolve with conservatory treatment with a combination of abdominal exercises and aerobic exercises that also involves pelvic floor muscles. This can close the gap.

A physician can measure the width of the linea alba and the abnormal distance between your stomach muscles with an ultrasound, medical instrument, measuring tape or using finger widths. This will help them see whether the divarication of recti is getting better or not.

If you notice that you still have separated rectus muscles 12 months after childbirth and that it’s getting worse, you should discuss the surgical approach with your doctor. He or she will provide you with an overview of treatment options that are suitable for you, depending on how bad your case of symptomatic rectus diastasis is.

A laparoscopic approach is a minimally-invasive approach that allows for faster healing. It’s much better than open surgery, as it uses tiny cuts instead of large openings. However, if the patient presents with hernia, an open repair of DRAM may be recommended.

Why is it important to undergo diastasis recti repair treatment?

As mentioned earlier, some forms of inter-recti distance can cause significantly impaired quality of life, and this is reason enough to undergo treatment at some point after giving birth. That being said, the decision should be made after a physical exam and consultation with a trained specialist are carried out.

If left untreated, the recti separation distance will only get wider, causing further trouble. This might give rise to back pain, abdominal discomfort, bad posture leading to more pain and discomfort in the whole body, and inability to do the heavy lifting. The condition will also prevent you from some physical activity, such as yoga poses, oblique curls, crunches, sit-ups, and more.

What could minimise the risk of recurrence is a personalised recovery program implemented into one’s day-to-day life several months post-abdominal wall reconstruction. In many cases, hernias prove to be a risk factor for recurrence; hence, they should be taken care of in due time. The recurrence rate after surgical repair is low, about 16%.

How can physical therapists help with this diastasis recti?

A physical therapist will want to check out the alignment of the stomach muscles and other surrounding tissues to see if everything is working smoothly. Sometimes pressure in the ribcage could impact the nearby nerves and strike an imbalance. A tight diaphragm affects not only one’s breathing but also the stomach muscles.

With a special ultrasound device, the specialist can get a peek at muscle contraction and how someone is using their muscles. This way, the right type of exercise can be recommended that will help to strengthen the muscles and linea alba so that the balance is restored and patient discomfort eliminated. They can suggest using a corset or elastic tubular bandage to support the muscles during physical activity.

If the problem is more advanced, the only option would be a laparoscopic surgery or other surgical techniques for muscle repair. And, this is where plastic surgeons step in.

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    Shens Clinic

    Shens Clinic, 3 Killiney Road, Winsland House 1, 
    #09-08, Singapore 239519
    Shens Clinic, 3 Killiney Road, Winsland House 1, #09-08, Singapore 239519

    Monday – Friday: 09:00am – 06:00pm
    Saturday: 09:00am – 02:00pm
    Sun and PH: Closed

    (Strictly by appointment only)

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