I have diastasis recti following pregnancy (2 1/2 years ago). It has worsened over time and I experience a soreness/pain in my abdomen that feels like bruising. I went to my PCP who sent me to see a general surgeon. She said I don't have a hernia, just go on a diet and do sit-ups. Needless to say I'm seeking a second opinion, this time from a plastic surgeon. Is it possible to have pain without a hernia or did the first surgeon just miss it in her very very brief examination?
Can Diastasis Recti Cause Pain Without a Hernia?
Doctor Answers 10
Rectus diastasis can be a cause of back pain and abdominal wall pain
It is absolutely possible to have discomfort in the abdominal wall from rectus diastasis without a true hernia. Separation of the rectus muscles in the midline can cause dysfunction of the whole abdominal wall. The fascia between the rectus muscles can stretch so that the muscles pull apart from each other and are no longer anchored together in the midline. When this is the case, the rectus muscles are not held out to the proper length and are not in the proper position to work well. Not only will this cause dysfunction of the recti, but all the other "core" abdominal muscles wrap around from the back and end in the outside border of the rectus. If the rectus is lying out to the side, none of these muscles is held to the proper length. Stress on the stretched fascia such as during exercise can cause pain. Inadequate core strength and stability from abdominal muscle malposition can also put strain on the back leading to back pain.
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Pain from Diastasis Recti
Separation of the rectus muscles, also called diastasis recti, is common with as a congenital condition, advancing age or after pregnancy. While the diastasis does not usually cause pain, it can cause discomfort and does cause contour deformities to the abdomen. During full abdominoplasty a plication or suturing is performed to repair the diastasis and improve the abdominal contour.
Need abdominal wall reconstruction to ease the pain
I have repaired abdominal walls for this problem in the past and solved issues related to pain and pressure in the lower abdomen, constipation and urinary issues. You can do all the exercise in the world but the fact that the abdominal wall has been stretched to such a point that it cannot recover is the issue.
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Diastasis recti cause pain without a hernia
Yes, it is possible to have pain with just a severe diastasis. But you still could have a hernia. Please go see a plastic surgeon and general surgeon to receive a firm diagnosis.
From MIAMI Dr. B
Symptomatic Diastasis Hernia
Diastasis Recti CAN be associated with heaviness and soreness even in the absence of a true ventral or umbilical hernia. But, sometimes BOTH can be present. While hernias are diagnosed much easier in thin individuals, feeling them in obese people may be a real challenge.
An imaging study MAY be useful if you were intent on campaigning to convince your insurer to pay for a hernia repair. In the vast majority of cases, insurance companies will not pay for repair of a diastasis.
You are wise in seeking out an experienced Plastic surgeon. A Plastic surgeon should be able to examine you more thoroughly and advise you on how to proceed.
Dr. P. Aldea
Hernias can be missed
Depending on how thick the fat pad is in this area, it can be easy to miss small hernias by examination alone. If you are thin, this is much less likely than if you are over weight. If you have had prior surgery on your abdomen, laparoscopy, gall bladder, etc, this also increases your risk of having a hernia. An ultrasound or CT scan may be warrented to check into this further.
Sit ups and crunches will not fix a diastasis. It is a great thing to do to strengthen your muscles and may flatten your belly, but if you are finished having children, then a diastasis repair may be reasonable.
Pain and diastasis
Diastasis is usually not associated with pain and one can easily miss a small umbilical hernia on a cursory exam especially if you are relatively over-weight as suggested by the recommendation to go on a diet. Exercising with a significant diastasis may only predisposed it to get worse due to the increased intra-abdominal pressure and the mal-alignment of the muscles. I would encourage a second opinion. Diastasis is a surgically-correctable condition.
Of course this does not mean the advice to diet and exercise should not be followed as well.
Pain with diastasis recti
Its not uncommon for primary care doctors and general surgeon to under-appreciate the present of loose abdominal muscle as not a "hernia" since some of the classic findings of a hernia are not readily noticed. The distinct edges of a hernia are not always palpated and this may lead for some to think that a hernia is not present. If your skin is in good condition, an endoscopic tummy tuck (endoscopic rectus diastasis repair) can be performed. This usually only involves a small incision near the pubic bone and one inside the belly button.
All the best,
Dr. Remus Repta
Rectus diastasis is generally painless
While nothing in medicine is ever absolute, it would be very uncommon to have pain from a rectus diastasis alone. You might benefit from a CT scan to rule out other possible causes.
Diastasis of the abdominal muscles is not associated with pain
Diastasis is a natural separation of the sit-up muscles which can be accentuated by pregnancy. The separation is not a true hernia and nothing can be pinched or trapped within in. It is very unlikely that the diastasis you have is the cause of your abdominal pain and insurance companies do not consider repair of a diastasis of 'medical necessity'. You may wish to look deeper into the pain issue with your primary care physician, as it is best to sort this issue out before you consider a tummy tuck with diastasis correction.
Best of luck,
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.