Diastasis Repair and Umbilical Hernia Should I Have Surgery?

32 years old with 21 month old son. Birth vaginal with vacuum assistance. Been in physical therapy for 14 months for pelvic floor pain, urinary incontinence and diastasis recti. The separation in 2 cm 3 cm with small umbilical hernia. No improvement with pt. A plastic surgeon thought TT might make in continence and pelvic floor pain worse. My diastasis is not huge due to RA in my hips my physical therapist thinks possibly closing the diastasis would be helpful.

Doctor Answers 8

Fixing diastasis recti and fixing pain

Performing a tummy tuck for pain is a risky proposition as there is no guarantee that it will help.  In fact, tightening your muscles to correct the diastasis recti might make the pain worse.  A tummy tuck should be done for loose hanging skin of the belly and to tighten abdominal muscles to help improve the appearance of the belly area.

Repair of Diastasis Recti

I am sorry to hear about your painful condition.  I think it is best to break down your question into components.  You have urinary incontinence and pelvic floor pain.  I think that should be addressed with your gynecologist or urologist to see if a bladder resuspension may be helpful.  I believe that issue should be addressed first.  

The rectus diastasis and umbilical hernia repair can both be addressed during a tummy tuck which will bring your abdominal muscles back to a more stable and mechanically sound position.  I doubt that the tummy tuck will have any real impact on the pelvic floor pain or incontinence.  However, as mentioned above, I think those issues should be addressed first.

Good Luck to you.


Gilbert Lee, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 22 reviews

Post-pregnancy pain with rectus diastasis and urinary problems

Repair of the rectus diastasis and umbilical hernia are needed to restore normal anatomy and normal trunk muscle balance.  In my experience this has helped with urinary symptoms in some women, probably by improving abdominal muscle tone and muscle coordination with voiding.  Once your OB-GYN or urologist rules-out pelvic pathology I would highly recommend the abdominal repair.

It is important to see a Board Certified Plastic Surgeon who has  had a lot of experience with this surgery. Be sure to review a comprehensive portfolio of pre- and post-op pictures so you can gauge your surgeon's expertise and so you can get a good idea of the type of results that are reasonable to expect.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 45 reviews

Diastasis repair

It sounds to me that your symptoms are caused by more than just a rectus diastasis.  You have another issue going on that should be addressed by a urological gynecologist or urologist, especially to deal with the pelvic pain and incontinence.  A tummy tuck will not help.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Diastasis and pelvic floor weakness.

I would go with your physical therapist.

Plastic surgeons know little about the complex interactions between the trunk muscles, the pelvic musculature and core stability.

With a diastasis of your rectus muscles your core stability is compromised. With a compromised core stability your rehab exercises to improve your pelvic floor will be much less effective. 

Your plastic surgeon thinks repair of your diastasis will increase your intra abdominal pressure putting more pressure on your pelvic floor but this is a very simplistic way of looking at the problem. A repair means you will be able to exercise your pelvic floor and get pressure feedback from your trunk muscles letting you know how effective the pelvic floor contractions are

I think you would feel much more comfortable if your diastasis were repaired.

Douglas McManamny, MBBS, FRACS
Melbourne Plastic Surgeon
5.0 out of 5 stars 5 reviews

Diastasis Repair and Umbilical Hernia Should I Have Surgery

Hello and thanks for sharing your question

Sorry to hear about your complications. I too agree with your Plastic Surgeon. The diastasis needs fixing at some stage but not now.

Hope this helps

Naveen Somia, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 73 reviews

Muscle repair with tummy tuck

Hi Mari1983

Sounds like a tough delivery, especially on the background of your RA.

I would address your pelvic floor before the abdominal wall. The increase in pressure from closing the small diastasis may worsen your pelvic floor symptoms. I would see a gynaecologist that does pelvic floor procedures first. If you can get that issue stable for 6 months, the abdominoplasty will be useful.

Good Luck

Dr Gavin Sandercoe

Gavin Sandercoe, MBBS, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 8 reviews

Repair of diastasis recti is not your priority

I agree with the plastic surgeon you saw.  Repair of your diastasis is not your priority.  It sounds as though you had a very difficult labor and delivery, and the same kind of stretching force that your abdominal wall musculature endured is the same kind of force that your pelvic floor musculature endured.  This is probably causing your pelvic floor pain and urinary incontinence.  Those issues should be addressed first before undergoing elective abdominal wall contouring.  There is no reason to suspect that repairing your diastasis and small hernia will have a beneficial effect on your other symptoms, yet just as the other surgeon has suggested, there is plenty of reason to fear that it could worsen them.  Just from the increase in abdominal and pelvic pressure that accompanies tummy tuck alone, one would suspect this to be the case.  I am sorry to be the bearer of bad tidings, but you should address your other problems first before the tummy.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

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.