Diastasis Recti Repair: Exercise vs Surgery

There often seems to be two groups of thought on diastasis repair: those that advocate exercise or those that say healing is impossible without surgery.

I’ve had women message me privately saying my message of exercise may be harmful to other women with a diastasis recti. Doctors often recommend women for surgery after just one appointment. Physiotherapy is not a service offered to most postpartum women. I know of fitness trainers with diastasis repair programs that have hidden their own surgical repairs in order to sell their program.

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The thing is, it is not a matter of exercise versus surgery. One does not necessarily eliminate the need for the other. If you are treating a diastasis recti exercise is essential. There is no circumstance where exercise is not necessary. Surgery may also be necessary. However, you cannot know from the offset whether surgery is the path you need to take without taking the time to exercise first; to re-train your core, to rehabilitate you body and provide it with the tools to heal. Surgery addresses the result of the injury; the separated abs, by stitching the muscles together (FYI they were never one piece to begin with) but it does not address the cause of the injury. Until the cause is identified and addressed, healing is impossible.

Diastasis recti, although named for the separation of the rectus abdominus muscles, is a pressure management issue. It is a result of sustained unmanaged intra-abdominal pressure causing damage to the fascia and weakening the deep core muscles. It is this unmanaged pressure that leads to hernias, to slipped discs and to pelvic organ prolapse. If you don’t learn strategies to manage intra-abdominal pressure surgery will fail. 35% of hernia repairs fail within a year. Bladder suspension surgery to treat incontinence, although claiming to have an 80% success rate, often has to be repeated after 5 years. Mesh hernia and pelvic floor repairs are highly controversial and have a low success rate, with mesh vaginal repair recently been made illegal in several countries due to the unpleasant side effects.

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I’ve had conversations with women where I’ve stated that it can take up to one year to see results from a progressive, well planned diastasis repair exercise program, and I’ve been told that it’s too long. But the healing time for a tummy tuck is 3 months to a year, with many not being able to return to the activities they were doing prior to the tummy tuck for one whole year. A year is a year and recovery is recovery. It takes time. Exercise takes time but surgery certainly is not a short cut.

I think the problem is that the focus often is on flattening a woman’s belly, rather than on healing a woman’s core. The problem with focusing on the aesthetic is that fitness has become whatever is currently fashionable. Fitness and health are not interchangeable. I watched a reality T.V. show where a mother of 4 was training for a bikini completion and existing on dry chicken and vegetables, 6 days of weight training and endless cardio. Her friend commented on how “healthy” she was. Nothing about the extreme lifestyle of a professional competitor screams healthy. They are fit, yes, but healthy? not necessarily. I don’t mean to say competitors cannot be healthy, buy many of the techniques used to achieve that physique are for aesthetic reasons and not for health reasons. It is for that reason such a physique cannot be maintained and competitors have “off seasons”.

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I recently read a post where a woman talked about how before her tummy tuck her belly was flat in the morning but became more distended during the day as she ate. By the evening it would be protruding. The tummy tuck meant her belly never protruded. Diastasis recti can make bloat significant where the fascia has been stretched and, like an elastic pulled beyond its elasticity, does not retain tension well. However, stomachs were designed to expand. The world of social media and magazines has exposed us to so many posed and edited moments that we start to believe these moments are entire existences. The women on the covers of fitness magazines have often trained for weeks for that aesthetic, they have modified their diet, may be restricting water, are professionally made up, lit up, and photographed. The picture represents a millisecond. A moment in time. The cover does not represent an entire reality or what their bodies look like on a random Saturday evening after eating pizzas and drinking wine with their friends. Photo editing is rampant on social media, it is reality through a kaleidoscope.

What happens during a tummy tuck is that the fascia or muscles are sewn together. Naturally the abdominal muscles are not one single piece. They are two walls joined at the mid-line by fascia. This fascia is designed to stretch. It stretches during pregnancy to accommodate a growing fetus, and it stretches after eating to accommodate your meals and digestion. A tummy that has had abdominoplasty will not expand like a tummy that has not because it doesn’t have the capacity to expand in the same way. Muscles don’t have the same give as fascia. It is for this reason that doctors recommend women have tummy tucks only after they are done child bearing. The growing uterus would damage the surgery by pulling muscles apart to allow for expansion. Your tummy is designed to expand. Your fascia is designed to stretch, and the fact that it does should not be seen as problematic.

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This is not a blog against surgery. A tummy tuck for diastasis repair is sometimes necessary. It is necessary where the fascia has been damaged beyond repair and cannot gain the contractile strength it once had even after exercise, and dietary manipulations. Exercise and dietary choices do have the capacity to help repair and heal the fascia but sometimes it is not enough. But I truly believe you cannot make this decision until you have tried rehabilitative exercise for at least one year. There are not two sides to how to approach diastasis repair. Exercise is a necessary tool. Exercise is important. Surgery may also be necessary, but it is never your only option. It can never be your only option because surgery will fail without exercise.

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If you need help healing your diastasis recti, check out my 12-week core retraining program, Abs After Baby. It is a step by step progressive full body exercise program with a focus on the recruitment of the deep core muscles needed to heal a diastasis recti. The program comes with a digital full colour guide along with video links to the exercises with demonstrations and movement breakdown. Included is access to a private Facebook group where  videos can be posted for remote personal training (review of form and technique). There’s help every step of the way to get your abs, core and pelvic floor strength back after babies.

Mummy Fitness Abs After Baby

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