At What Point is Surgery Necessary for Split Abdominal Muscles?

after my last c-section i noticed my stomach always sticks out to the point where i look about 3 months pregnant. As it turns out, my muscles are split from the top of my stomach to my incision scar. It is really uncomfortable and my insides feel sore at times. It also seems like i may have a herniated belly button. At what point is it necessary to have surgery to fix this?

Doctor Answers 9

Abdominal muscle split or spread? Diastasis recti and the treatment options

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

Austin Plastic Surgeon
4.9 out of 5 stars 44 reviews

Corrections Can Be Made In Conjunction With Tummy Tuck

Diastasis of the rectus muscles is a common occurrence following multiple pregnancies. During pregnancy the abdominal wall becomes stretched by the rapid expansion of the intra-abdominal contents. In many cases, this results in separation of the two muscles in the midline with the formation of a diastasis. This separation extends from the pubic bone to the rib cage and is especially noticeable when the abdominal muscles are flexed. Flexion typically results in a midline bulge that extends from the pubis to the rib cage.
It’s unusual for patients to have abdominal pain when they have a rectus diastasis. Surgical correction is usually performed in combination with abdominoplasty for aesthetic reasons. In your case, the pain that you describe may be related to an umbilical hernia. When intra-abdominal contents herniate through a small abdominal wall deflect, pain is a common finding. Under these circumstances, umbilical hernia repair is indicated.
It’s important to consult a surgeon who has experience treating conditions of the abdominal wall. This surgeon should be able to evaluate and treat umbilical hernias. If you’re also concerned with the appearance of your abdomen, umbilical hernia repair and correction of your diastasis can be performed in combination with abdominoplasty surgery.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Surgery Necessary for Split Abdominal Muscles

If you mean by the word "necessary" insurance coverage, than it could be a covered benefit. It really depends upon the severity of the split, in other words causing a hernia or painful, and the health insurance plan you may have. If you meant as a necessary cosmetic surgery than that is very personal. More up to you and your wishes. Seek in person opinions from boarded plastic surgeons. Best of luck. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Diastasis recti

Thank you for your question.  Diastasis recti, or separation of the abdominal muscles in the midline, is very common following pregnancy, as is umbilical hernia.  Both can be easily corrected at the time of tummy tuck surgery.  If indeed you are having pain from either one, it would be wise to consider a surgical consultation sooner than later.  

Surgery for split abdominal muscles

The separation that you are describing is called a diastases recti. It is very common in women following pregnancy. The intra-abdominal expansion resulting from pregnancy separates the two rectus muscles causing the separation Usually repair of a diastases recti not considered a medical necessity. Occasionally it can cause some discomfort and often it contributes to ranges in abdominal contouring. If the appearance of your abdominal wall bothers you enough it is reasonable to consider a repair. If there is associated loose skin a full tummy tuck would be the best choice.In the performance of a full abdominoplasty, an incision is made from one hip to the other. The incision is carried through the skin and fat layer and stops at the muscle layer. At this level the skin and fat layer is elevated off of the underlying muscle layer. This elevation is continued up to the belly button. An incision is then made around the belly button to keep it in it's normal location allowing the skin and fat layer to continue to be elevated up to the rib margin. Very often tightening of the muscle layer is then accomplished before removing the excess skin. The loose skin and fat layer is then pulled down snugly and the excess skin and fat is then removed. The belly button has not been moved or removed. It is still in it's normal location underneath the skin and fat layer. An incision is made over the belly button and it is pulled up to the surface and re-stitched in it's original location.

My simple and illustrated video may help you--learn more about tummy tucks and other body contouring procedures.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 112 reviews

Hernia versus Diastasis Repair with Tummy Tuck

An incarcerated hernia is an absolute indication for repair. However, a diastasis is NOT an indication for repair and is considered cosmetic

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Elective vs Emergency Diasatsis Repair

Most of the time, a diastasis of the rectus muscles is not a medical issue.  It may be unpleaseant in terms of appearance and possible discomfort, but rarely is it medically indicated.  However, in some cases,the pressure of the intraabdominal contents pushing on the weakened abdominal wall can cause it to thin out so much where it could become a true hernia.  The best thing to do would be to see a surgeon and let them feel your abdomen and possibly image it with a CT scan to get a better understanding of your abdominal wall.  I hope this helps.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 73 reviews

There is no must

This is cosmetic surgery, yes it helps a bit with the abdominal protrusion, but no one must have it -- it is elective and will help improve the way you look.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Emergency VS. Elective VS. Necessary VS. Unnecessary Surgery - Made Easy

Regarding: " At What Point is Surgery Necessary for Split Abdominal Muscles?
after my last c-section i noticed my stomach always sticks out to the point where i look about 3 months pregnant. As it turns out, my muscles are split from the top of my stomach to my incision scar. It is really uncomfortable and my insides feel sore at times. It also seems like i may have a herniated belly button. At what point is it necessary to have surgery to fix this

A FEW Definitions:
EMERGENCY Surgery - A highly volatile dangerous surgical condition requiring immediate remedial action (such as ruptured appendix, bleeding aneurysm etc)
The opposite of Emergency is ELECTIVE
ELECTIVE Surgery = A surgical condition where the operation cane be scheduled to a date and time convenient for the patient, surgeon and the OR staff.

AMONG the types of procedures which are elective can be those which improve life and function (Hysterectomy, Mastectomy, some hernia repairs, colon resections, joint replacements, facial reconstruction, breast reconstruction, cleft lip or palate repair) OR operations which improve appearance but do NOT improve function nor save lives (IE Cosmetic Surgery).

EVERY woman who has had a full term pregnancy has stretched her tummy muscles. Every woman who had more than a single pregnancy has definite split tummy muscle and a split (Diastasis). In other words, if normal is "constituting a norm, standard, pattern, level, or type" - then it is normal for women of a certain age to have split tummy muscles.

For this reason, all medical insurance companies in the US are united in their refusal to pay for Cosmetic Surgery (IE "unnecessary" surgery) which includes Tummy Tuck Surgery.

If you want your tummy flattened and get your before babies body back, only better, you will have to pay for it out of pocket.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 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.