What is Postpartum Diastasis Recti?

Question

Many women suffer from diastasis recti after pregnancy. It is a muscular surgical repair that is rarely covered by insurance for women, though it is often covered for men. It causes considerable physical discomfort for the women who suffer from it. Do you have any advocacy in that area?

Answer

Diastasis recti (DR) is where the abdominal muscles separate and cause the stomach to protrude. Close to 50% of women experience DR at six months after giving birth, and roughly a third of women experience it after one year postpartum [2]. Despite the prevalence of this condition, many women still know nothing about it and continue to believe the “pudgy” appearance of their abdomen is nothing more than excess weight as a result of pregnancy. Other causes of DR include lifting heavy weights, COPD, and playing wind instruments, as these all increase the pressure in the abdomen [1]. However, postpartum women are the majority of patients with DR [1].

Women are typically not screened for DR after giving birth, and if they are diagnosed, the most common treatment prescribed is a regimen of core exercises or physical therapy referral. However, exercise alone does not completely fix the problem and can leave a woman at risk of compromised stability and core function [2]. Unfortunately, DR has yet to be the subject of much treatment research, meaning that no strict guidelines exist for treating it [1]

Recent studies have found that DR can lead to [1]:

  • Upper and lower back pain
  • Abdominal pain
  • Pelvic girdle pain
  • incontinence of urine and stool
  • pelvic organ prolapse
  • muscle weakness

Surgery is the only option that will completely fix DR, but is usually not covered by insurance since it is considered to be cosmetic; the surgical procedure most commonly used to treat DR is also known as a “tummy tuck,” which is used to make the abdomen thinner and firmer by bringing the separated muscles together again, strengthening them [2]. The procedure is typically not covered for men or women unless deemed medically necessary [2]. The most common reason a DR surgical repair is covered by insurance is when it is paired with a hernia repair. If you have a severe enough separation with a hernia, you may be able to have part of your procedure covered by insurance, but your doctor will need to document thoroughly how your symptoms require surgery, typically after you've tried physical therapy for at least six weeks [2]. It is important to note that if you do decide to proceed with surgery, it is advised that women wait at least one year postpartum before they undergo the procedure to give their body time to recover after birth.

After thorough online research of existing disparities between insurance coverage of DR surgery for men and women, we could not find any mention of a gender disparity, nor could we find any research or data surrounding the claim. Nonetheless, we support additional research into DR and treatment options, which might show that pregnancy is a medically necessary reason for surgery.

Sources

[1] Blankensteijn, L. L., Hockx, M., Mullender, M., Bouman, M., & Melenhorst, W. B. (2023). Clinical significance of diastasis recti: Literature review and awareness amongst health care professionals. Journal of Plastic, Reconstructive & Aesthetic Surgery84439-446. https://doi.org/10.1016/j.bjps.2023.06.005

[2] Deem, M. (2023, October 16). Diastasis recti repair: What you need to know. Retrieved from Diastasis Recti Repair: When Do You Need Surgery? | RealSelf


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