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

In most cases, diastasis recti isn’t a condition that requires medical correction, and therefore insurance probably won’t cover your procedure. However, if this bothers you, you can get it corrected by a board certified plastic surgeon. Diastasis recti correction is often performed as part of a tummy tuck.

What you are likely referring to is medically called Diastasis Recti.  This basically means there is a separation of the rectus muscles (six pack muscles).  This happens with significant weight gain and then weight loss as well as pregnancy.  Some patients are more prone to it than others.  It is not "medically necessary" to repair this unless there is an actual home in the separation or fascia which would cause a hernia.  This hernia surgery should be performed in a timely fashion.When there is a true separation or diastasis, commonly what is done is a plication.  This is when the surgeon brings the muscles back together to tighten up the abdominal area.  This is done at the same time as the excess skin removal.  This is what constitutes a tummy tuck procedure. Hope that helps.

After your baby is delivered, the stretched abdominal skin will shrink, and the rectus muscles, which have been stretched apart, will shrink back closer together. Supposedly. But as you've figured out, this doesn't happen equally well in all cases. 
For some women, the skin will never shrink back fully, and nor will the muscles. There's nothing 'wrong' with this at all. It's quite normal. Most women will get at least a touch of this after babies. The women who get a lot of it though, are those reading RealSelf!
It's not anyone's fault that they ended up with a lot of loose skin or separated muscles, it's mainly genetic and related to the elasticity of the soft tissues and skin. Twins doesn't help, and sometimes larger babies, more weight gain, older mums and having had multiple children can also contribute, but it's still mainly genetic. 
The crunch comes because some women don't feel normal, or don't think they look normal, anymore, even though technically, they are normal. 
These women with the unlucky genetics maybe need to consider having a tummy tuck, which involves both putting the muscles back side by side where they belong, and removing the skin which has not fully shrunk. 
Putting the muscles back together almost always fixes the herniated, or 'outie' belly button. It also helps get the 'core' muscles doing their job, which definitely helps with the '3 months pregnant' problem, and might also help with abdominal and lower back discomfort and abdominal bloating. 
I'd conclude answering your question by saying 'technically this surgery is never 100% necessary'. A calculated weighing up of the bad things about surgery vs the good things leads to a lot of women choosing to undergo it, and being glad they did, but it still wasn't 'necessary'. 

Best wishes, Mark.

Hello,

Thank you for your question. It is not generally considered to be medically necessary to repair a diastasis recti, however due to discomfort and appearance after childbirth, many women will have this repair included in an elective abdominoplasty procedure. 

All the best 

Hi Hroth, Thank you for your questions about when to repair your rectus diastasis.  The shortest answer is "Now"!.  The rectus abdominis muscles are a pair of vertical oriented abdominal wall muscles.  These muscles run parallel to each other and attach the pubic bone to the bottom of the sternum and the lower ribs.   Sometimes, a gap can form between these vertical muscles.  This gap is called rectus diastasis. Sometimes, the gap is small and sometimes the gap is big. Sometimes, if the gap is big, it can lead to a ventral abdominal hernia.  In your case, since you state it "feels uncomfortable" and appears that you look "three months pregnant", I would suggest that you have this diastase repaired. Rectus diastasis is usually repaired during a tummy tuck. The rectus abdominis muscles are sutured together with permanent sutures. This closes the gap between the rectus muscles and cures the rectus diastasis.  I hope that answers your questions regarding your split rectus abdominis muscles and ways to correct this diastasis. I would suggest you seek an experienced, board-certified plastic surgeon who has performed thousands of tummy tucks. If you having more questions regarding the surgical repair of rectus diastasis, please contact my office.  Sincerely Dr. Katzen.