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Body Science & Metabolic Disorders International Medical Center
Attending Physician Yen-Chou Chen

25-year-old Doreen Ching from Malaysia was pregnant with quintuplet at the age of 20 and she decided to give birth to all children. Doreen endured hardship during her pregnancy and she almost had hemorrhagic shock during a caesarean section for labor because of placenta accretes into the uterine wall. She had serious loose postpartum belly and diastasis recti of the entire abdomen. She was very depressed by the severe stretch marks. 

CMUH Body Science & Metabolic Disorders International Medical Center – Attending Physician Yen-Chou Chen indicated that patient Doreen not only suffered from postpartum excess skin and stretch marks but also weak abdominal muscles, severely protruding tummy and lower back pain. The examination shows that Doreen suffered from severe diastasis recti that led to the excruciating lower back pain, so she decided to take the surgery in Taiwan. The other day, physician Yen-Chou Chen conducted abdominal surgery on Doreen and discovered in the surgery that the diastasis recti of Doreen reached 5cm while her abdominal fascia was severely loosened. Physician Chen removed 560 grams of skin and conducted navel deformation with musculus rectus abdominis stitching in 15cm. On the 5th day after the surgery, Doreen's lower back pain was substantially relieved and she will take the plane back to Malaysia today. 

Physician Yen-Chou Chen suggested that the pressure inside the abdomen eventually increases during the pregnancy process. The linear alba of rectus abdominis muscle is a connective tissue and such tissue could not sustain the uprising tension from pregnancy and will become thin and eventually separated. Hence the linear alba of rectus abdominis muscle will produce a great gap and eventually lead to postpartum diastasis recti. 

Physician Yen-Chou Chen expressed that the risk factors of diastasis recti include: Multifetal, multiple birth, excess amniotic fluid, big fetus, excess weight increase during pregnancy, and genetics. The prevalence rate falls between 60~100% according to the reports released by different countries. The main symptoms include the disability of retraction by the abdominal core muscles that lead to protruding tummy. The patient will still look like pregnant with the intestines accumulated in lower abdomen, which also leads to indigestion and constipation. Over the long run, the disease will affect the poses, body bending, humpback and lower back pain. The main diagnosis practice for diastasis recti is to check the separation width with calipers during the physical examination or apply ultrasound or CT as supplementary examination. 

Physician Yen-Chou Chen mentioned that in general, diastasis recti under 2 cm is normal and puerpera of natural birth engage in rehabilitation exercise of abdominal core muscles one month after labor and Caesarean section puerpera 1 and half month after labor, in order to shorten the recovery period. Most patients will eventually recover in 8 weeks postpartum but few will recover in 6 months after giving birth. Those puerpera still suffering from diastasis recti and other complications will need to consider for surgery. Patients without excess skin can only be treated with musculus rectus abdominis stitching while patients with excess skin complicated with navel deformation will require removal of excess skin and navel deformation, in order to optimize treatment effect and symptom alleviation.