At What Point is Surgery Necessary for Split Abdominal Muscles?

Diastasis recti is very common after having multiple pregnancies. It does not represent a "split in the muscle, but only a spread in the central area of the 2 abdominal muscles. A true split in the muscles is referred to as a hernia and it is common to have a small umbilical hernia (belly button hernia) in combination with a diastasis recti. You can elect to repair the umbilical hernia separately if it is large which can be covered with insurance. If the belly button hernia is small, a combined repair with a diastasis recti repair would be optimal. A diastasis repair can be done as a stand alone operation with the use of an endoscope with 2 small incisions. The repair involves two layers of internal stitches placed in the borders of the abdominal muscles which bring them together. This is called an abdominal wall plication. This can also be part of a tummy tuck (abdominoplasty) when there is excess skin on the abdomen too. 

I hope this helps.

Dr. Trussler

Hi @HRoth, Thanks for the Question!
During pregnancy, the abdominal muscles are spread apart and this can leave a "gap" that persists even after the baby is delivered. An Abdominoplasty, also known as a tummy tuck can tighten these loose abdominal muscles while simultaneously removing excess skin and fat. The end result is a beautifully slimmed body contour and abdominal profile. The scar remains concealed in the waistline of most low-cut swimsuits or underwear. 
 It's time to consider a tummy tuck if you are experiencing:
Loose, excess skin around the abdomenStretched or separated abdominal musclesStubborn fatty deposits in the abdominal area
The procedure is most commonly performed for women after they have had children. However it does not prevent future pregnancies. Pregnancy can cause the lower abdominal muscles to stretch out and become displaced from the midline, a concern that is often accompanied by excess subcutaneous (fatty) tissue. The lower abdomen is typically a fat storage area for women and was probably designed by nature to protect from famine, similar to the hump on a camel. These fat pockets are extremely resistant to diet and exercise.
Therefore, many tummy tuck patients are simply restoring their past figures from before children. This isn’t considered vanity; it’s a reclaiming of self or a healthy undoing of the past. Exercise will strengthen and firm separated abdominal muscles, but all the sit-ups in the world cannot tighten muscles if they have spread apart due to pregnancy. Older patients who have lost skin elasticity and developed mild areas of fullness can also benefit from abdominoplasty. 
Plastic Surgeons also perform tummy tucks in men and this has to be performed in a customized way to avoid feminizing the male torso.
Thanks,
Dr. Karan Chopra

Hello and thank you for the question!
Muscle separation it's common after pregnancy and significant weight variation and it represents a weak point in your "core" musculature.
A number of core oriented exercises can improve that, as well as wearing some tight garments during this time, but with limited effect. Try to speak to a physio that specialises in that. 
Then speaking to a Plastic Surgeon to discuss concern, impact on your life and options would be the next step. An ultrasound scan it's useful to define the separation and exclude hernias. And it looks like you might have one.
The surgical options have to be analysed in your particular situation, with your needs, concerns and risks. Whereas it might be the only solution, it might not be absolutely necessary if it's improving. It would take 9-12 months after your pregnancy to return to a stable situation again.
Take care and make sure you trust your surgeon!