the explanation of the plastic surgeon

In an impassioned post on Instagram la flower designer Naomi Bocchi he said he suffers from a particular medical condition called diastasis recti, which emerged following the birth of her two children. The girlfriend of the former Roma footballer Francesco Totti she specified that it is a malaise “not understood by families or by society” discovered thanks to specific Facebook groups, in which women tell their experiences and give each other support. But what exactly is it abdominal diastasis? We asked the Doctor Marco Iera, plastic surgeon at the IRCCS San Raffaele Hospital in Milan. Here’s what he told us.

Doctor Iera, first of all we kindly ask you to explain to us what diastasis recti is

Abdominal diastasis refers to an enlargement or excessive separation of the rectus abdominis muscles in the central part. We have these two rectus abdominis muscles, one on each side, that are joined along the midline. In technical terms it is called linea alba. After delivery, there is usually an enlargement or excessive separation of these muscles. Let’s say that in the initial position they are held together by the linea alba, which is nothing more than a thin fabric that unites them. During childbirth this line weakens, becomes thinner and therefore the muscles tend to separate. Based on how far these muscles move away from the central line there is also a classification of diastasis, which is defined by three degrees of severity: mild, moderate and severe. The mild degree occurs when this distance of the right and left rectus abdominis muscles is less than 3 centimeters; the moderate degree when it is between 3 and 5 centimeters; the severe degree when it is greater than 5 centimetres.

How many women does it affect?

Statistics show that about 30 percent of women suffer from it after giving birth.

Are there any other causes for this condition?

The main reason is certainly pregnancy, since first of all a muscle contraction movement is carried out by the woman which causes this separation. And then there is the same internal pressure due to the growth of the fetus which favors the separation of the muscles. But it’s not just pregnancy that causes diastasis recti. In humans, for example, there is significant weight gain, an obesity. It is also favored by laxity of the muscles, due to physiological aging – over time the muscles become lax – or by other types of problems. Or from major operations in which tissues are weakened, such as in patients undergoing bariatric surgery.

What are the symptoms of diastasis recti?

Let’s say we could talk about consequences and symptoms. The most visible consequences are not only aesthetic, but above all functional. Aesthetics, which mainly affect women, are the impossibility of having a flat stomach. Abdominal globularity. But the most important thing is the functional consequences. If these muscles enlarge, the organs below them no longer have a restraining device. For which the musculature loses its normal function of containment and maintenance in the viscera, therefore the viscera can protudere (leak) outwards, thus giving rise to abdominal hernias of various degrees and in the most serious cases even to an incisional hernia. All of this turns into symptoms such as swelling, especially after meals, abdominal pain, difficulty digesting and in the most serious cases even urinary incontinence.

How do you intervene to treat abdominal diastasis?

First of all, a diagnosis must be made, which is carried out through a specialist visit and an ultrasound of the abdominal wall. In severe cases with an abdominal wall resonance. Once the diagnosis has been made, intervention is based on the degree of diastasis, which as indicated is classified into three degrees: mild, moderate and severe. In mild or moderate cases we intervene with abdominoplasty and plastic surgery of the rectus-abdominal muscles. The muscles join through points to this central line, the linea alba. The anatomy is brought back to its natural state. Normally, excess skin is also removed, which is always created in women after pregnancy. In severe cases, therefore very, very serious, when the muscles are not very elastic and very weakened, there is no possibility of joining them along the linea alba. For which a biocompatible mesh is used which somewhat replaces the musculature. It’s kind of like a patch placed there on the muscles, which acts as a restraining tool. The operation lasts more or less 3 hours and requires at least one night’s hospitalization and a week’s rest. After a month you can resume sporting activity.

How many women and how many men undergo this surgery annually?

There are no real statistics, there are no data. What I can say is that this is an underestimated problem. Little is said about it. You don’t even know who to turn to, basically. Many say they didn’t even know the plastic surgeon treated diastasis recti. In addition to the aesthetic and functional consequences, it should be remembered that there are also psychological problems.