Let's say you're a mom.
Now let's say you have chronic lower back pain or pelvic pain. Perhaps you notice a cone or dome-shaped bulge popping out of your abdomen every time you pick up your kid, sit up in bed, or workout. Maybe you feel or see a gap in the middle of your belly. Maybe you have a mommy pooch that's just stubborn AF.
I don't care if you're one week, one month, one year, or one decade postpartum—if any of the above issues sound familiar, you may be experiencing diastasis recti.
Need a quick primer? Diastasis recti, aka DR or ab separation, happens when your "six-pack" muscles on the front of your stomach separate. These muscles—called your rectus abdominis—are connected in the middle by a long fibrous band called the linea alba, which runs from your sternum to your pubic bone. During pregnancy, the linea alba gets stretched out thanks to little homegirl or homeboy growing in your belly (plus all the hormone-mediated changes that lead to increased tissue laxity).
At least some degree of ab separation is normal in up to 100% of pregnancies—yup, pretty much all of 'em. But what's NOT considered "normal" is for ab separation to persist long after baby arrives. Unfortunately, as many as 60% of women still struggle with diastasis recti at six months postpartum and another 30% will still have it a year later.
What's a gal to do? After all, a condition like this can seriously disrupt a woman's quality of life, self-confidence, and daily activities. For the frustrated mama, a "tummy tuck" surgery may seem like the only—dare I say "easiest"—option.
I'm here to tell you it's not—at least not without doing some hardcore CORE rehabilitation first.
Should You Get Surgery (aka a "Tummy Tuck") for Diastasis Recti? Let's Look to the Research
Here's a general rule most medical professionals agree with:
Except for extreme or aberrant cases, surgical intervention should be considered a LAST RESORT. For an issue like ab separation, conservative options like exercise and physical therapy need to be explored, honestly attempted, and exhausted before consulting with a surgeon.
What I mean by this—and what the research shows us—is that diastasis surgery is not a "quick fix." Sure, a good surgeon and his or her team can correct your gap and bring those six-pack muscles back together. But here's the thing:
With DR, there's more to it than just the ab separation. Almost all women with prolonged ab separation also have significant core unit dysfunction that goes far deeper than the superficial muscles and tissues.
Surgery. Will. Not. Fix. This.
Think about it: it's not as if a growing baby only affects the linea alba. All the parts of your core unit—including your deep abdominal muscles, ribcage, pelvic floor, diaphragm, glutes, hip flexors, spine, and pelvis—can become directly or indirectly altered by the changing biomechanics that a pregnancy imposes on you. These structures and tissues don't operate independently of each other but work together as a neuromuscularly coordinated chain of command. And if one part of the chain gets wonky, the whole unit is likely to become dysfunctional—especially when we consider that many of us go into our pregnancies with pre-existing core dysfunction anyway due to years of slouching and poor posture!
The problem isn't just that surgery can't fix the major core dysfunction associated with ab separation. Like any operation, diastasis recti surgery also comes with risks including bleeding, infections, and post-operative pain. To make matters worse, you'll have to deal with weightlifting restrictions and activity limitations during your recovery period, which can last anywhere from to 4 to 6 weeks or more. During this time, you won't be able to do core strengthening exercises—which means you'll be missing out on the chance to rehab those abs!
BUT WAIT, THERE'S MORE. A common complication associated with abdominal surgeries are adhesions, which affect more than 9 out of 10 people who undergo open abdomen procedures. Abdominal adhesions are restrictive bands of internal scar tissue that can delay healing, impair lymphatic drainage, damage your gut health, and exacerbate your mommy pooch. Adhesions are NOT your friend, mama, and they should be avoided at all costs.
Lastly, because diastasis recti surgery doesn't adequately address underlying core dysfunction, you may be at risk for recurring ab separation or chronic core dysfunction, which could mean a long struggle with back pain, stress incontinence, painful sex, the mommy pooch, body image difficulties, and all other sorts of crap you don't deserve to deal with.
Oh yeah, one last thing I forgot to mention: your insurance won't cover this. Unless it can be justified as a "medical necessity" due to something like a hernia, diastasis recti surgery is considered a cosmetic procedure. This means you'll be shelling out about $9,000-$17,000 for a surgery that will only partially fix your problem at best and lead to added complications at worst.
Healing Ab Separation—And Then Some: My Evidence-Backed Approach
I don't mean to crap on surgeons. I also don't mean to shame anyone who's thinking about undergoing this surgery. It really may be indicated in some cases. One 2016 study published in PRS Global Open found that people who's DR causes abdominal pain after sitting for more than 30 minutes or pain that limits their ability to participate in sports were more likely to benefit from surgery. You and your doctor may also decide that surgery is needed if conservative options honestly aren't helping.
Here's my overall point:
Diastasis recti can suck. It really can. Unhealed ab separation affects your physical appearance, confidence, and overall quality of life. But surgery is rarely necessary. And even if it IS necessary, surgery still won't be able to address your underlying core dysfunction.
This is why I recommend comprehensive ab rehabilitation for ALL postpartum women. To be honest (and you know I'm honest), I think it should be considered part of the prenatal/postnatal standard of care. Not just kegels. Not just "ab" exercises. I'm talking about deep core stability movements plus other techniques explicitly designed to optimize posture, alignment, activation, and strength—what I call the four pillars of core health.
My approach to healing ab separation is backed by evidence, including a recent 2019 randomized controlled trialpublished in the Journal of Musculoskeletal and Neuronal Interactions. Researchers found that deep core stability exercises yielded statistically significant improvements in DR and quality of life (yay!). Importantly, my approach is also simple. It's comprehensive and requires some commitment on your part, but it's not overly complicated or time-consuming. Plus, by nailing these exercises, you may be able to minimize the extent of ab separation during a future pregnancy and heal up more quickly postpartum.
I'm here to take the guesswork out of it for you. I give you the tools to heal your core AND ab separation, you just do the work. Beats anesthesia and stitches, right?
Are You Ready to Heal Your Ab Separation?
My comprehensive 12 Week Post Pregnancy Ab Rehab Program (complete with coaching by moi!) takes you on a step-by-step journey to optimize your core function, heal your ab separation, feel better, and look better. It's a $99 investment in your health—vs a $9,000+ bet on an invasive procedure that may not give you the full results you want.
Psst—many of the exercises in my Ab Rehab programs aren't just for postpartum women! Men can experience diastasis recti, too—so if you've got a fella in your life who's dealing with the DR feel free to send 'em my way. :)