What is diastasis?
Diastasis Recti is a fancy way of talking about how your rectus muscles “the six pack” separate. This can be due to weight changes or pregnancy.
What are symptoms of diastasis?
When your belly muscles are separated, it affects core strength. Signs of muscle separation you can see:
- Urinary incontinence. Do you need to wear a pad when you run? Pee a little when you sneeze or cough? Get up in the middle of the night to pee?
- Low back pain.
- A bulging belly. This is frequently more noticeable after eating or at night, as your muscles loosen during the day.
- Difficulty with core exercises. Can you do a sit up? Do you shake like a leaf when holding the plank?
- Pelvic discomfort
- Persistent belly pooch even after weight loss. Some women look pregnant still years after having their babies. Many times, this is not due to fat- it is due to loose and separated rectus muscles. You may be back to your pre-pregnancy weight, but your clothes may not fit and your waistband is tight. Again this may be due to muscle separation following pregnancy or weight loss.
How does a tummy tuck work?
Tummy tucks are a great surgery. They work in three fundamental ways to address the changes which happen from weight loss or pregnancy.
- SKIN QUALITY. When you have stretched your skin, it is like a bathing suit. We all have a different quality of bathing suit. And then you stress it. How big did you get? How long? How many times? Are you in menopause? Tummy tucks cut out excess skin to tighten the skin. This tightens the abdominal skin and the upper thigh skin. (Yes! You often get a little bit of a thigh lift.)
- FAT. Everyone has some fat. When doing a tummy tuck, in my practice at Lauren Greenberg MD, I always do liposuction as part of my abdominoplasties. This usually involves removing fat with liposuction to sculpt the surrounding areas: love handles, pubic area (don’t ignore this area!), and inner thighs.
- MUSCLE SEPARATION. This is the diastasis recti. The more pregnancies you have, if you had twins, the bigger you got, the shorter you are (I do many tummy tucks on women who are 5’4″ or shorter as they don’t have room for the baby so it pushes the abdomen out, causing the muscles to separate), the more weight change you have the bigger the diastasis. When doing a tummy tuck we corset the muscles back together. I do this with permanent sutures, two layers, interrupted to give a strong lasting repair.
Study: Changes in Functional and Psych Symptoms after diastasis repair
This was a study to try to document the degree of changes after diastasis repair and abdominoplasty. This was published in the Aesthetic Surgery Journal, August 2025. “Perception of Changes in Functional Symptoms and Psychological Aspects Related to Rectus Muscle Diastasis in Women Who Have Undergone Reparative Abdominoplasty.” Some of this has been studied before. See my blogs on the subject. But more studies showing objective improvements are great. Abdominoplasties are NOT just cosmetic.
Study:
- 78 Women, prospective study. Evaluated 7 days before surgery, and then at 3 months and 12 months post surgery. The questionnaires had many questions (59+).
- Urinary symptoms, Low back pain, Femal Lower Urinary Tract Symptoms were evaluated. Voiding symptoms, filling symptoms, and incontinence symptoms.
- Psychologically, they looked at the Derriford Appearance Scale, and evaluated the patient’s discomfort
- Body Q was evaluated for body image. Satisfaction of appearance, appraisal of excess skin, and appearance related psychosocial distress.
- quality of life.
- Cosmetic appearance was evaluated by the patients and by a team of external surgeons as well- a team of 3 plastic surgeons, not connected with the operating surgeon or patient- looking at volume of the abdomen, lateral contour, excess skin, the belly button, and scars.
Findings?
- Statistically significant changes in urinary incontinence and back pain
- Patients and external surgeon team agreed on degree of improvement
- Patients had improvement in body image
- There was not a correlation with the diastasis recti width. This means that the improvement was seen for people with small separations and wide separations.
My thoughts
I LOVE TUMMY TUCKS. It is a big surgery. It has a big scar (which we minimize with scar treatments). It is painful (which we minimize with Exparel, a numbing injection I do into the rectus sheath at the time of surgery which lasts for days after surgery.). But tummy tucks fix what YOU cannot.
- When your muscles are separated, you cannot fix it with sit ups. I will corset the muscles together when I do the abdominoplasty
- When your skin is loose, you cannot do a laser, exercise, or cream to “tone it up.” The only way to tighten skin is to cut it out.
I have patients who drop pant sizes, don’t look pregnant anymore, don’t get up in the middle of the night to pee every night (so they sleep better! which helps brain health, weight, and other health issues), don’t have to wear pads when they run, can hit the golf ball farther, can do headstands in their yoga class again, have better more regular bowel movements. The list goes on and on.
Tummy tucks are not just cosmetic. They are truly reconstructive.
In this age of healthspan and longevity and aging better, reconstructing your abdomen after pregnancies or major weight loss will help you be active better and longer. I am a huge fan. See my page on abdominoplasty.
Medical Reference
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
