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Home " Bloated belly... when Nature prevails over the Surgeon

Bloated belly... when Nature prevails over the Surgeon

Bloated belly after rectus diastasis surgery... a nightmare for patients, a sorrow for which the surgeon can do nothing.

But why after diastasis surgery should the bloated belly? For a surgical error? For inadequate technique?

The answer in both cases is no (but to think so is human): the cause is to be found in the same pathophysiology of diastasis.

In diastasis of the rectus, as is well known, the abdominal muscles, and in particular the rectus abdominis muscles, work according to altered contraction vectors, and sometimes do not work at all. This inevitably causes what always happens when a muscle does not work: muscle fibres degeneratecan be replaced by, for example, adipose tissue (which obviously has no ability to contract) and decreases innervation by nerve fibres. It is as if a part of the muscle is dead, or at least in a deep coma.

The diastasis operation (R.E.P.A. like any other operation) reconstructs the geometry of the contraction vectors of the muscle: but there it stops; if the muscle is not there, or if it is there but has lost the ability to contract, there is nothing to be done.

bloated belly, diastasis of the rectus abdominis, meteorism, R.E.P.A,

If the muscle does not contract, it has no tone: therefore the capacity of the abdominal thrust decreases, and if the patient has problems with meteorism (which can also be, but not onlydue to diastasis) here appears the phenomenon of bloated belly.

And how the muscles contract we realise in the operating theatre.

In the following video, you can enjoy one of the final parts of the speech by R.E.P.A. (Endoscopic Pre Aponeurotic Repair of Rectus Diastasis). After realigning the muscles to the midline of the abdominal wall, we always check that the work has been done well, we stimulate muscle contraction with small electric shocks administered with the hook, one of the most important instruments in endoscopic surgery. If the muscle is there, it contracts vigorously; otherwise, it contracts very little or not at all. The realignment has been performed correctly, the diastasis is closed but, alas, muscles, exhausted by years of pathology, no longer respond. In the case of the video, the muscles of the lower part of the wall still contract, albeit slightly; in other cases, no muscle contraction is observed despite electrical stimulation.

These patients must inevitably expect the appearance (or re-appearance, as it is one of the characteristics of diastasis...) of a bloated belly in the postoperative period?

Of course not. The sense of post-surgical physiotherapy (which we first introduced by instructing our patients to perform cycles of hypopressive gymnastics under the guidance of a experienced physiotherapist) is precisely to try to revive 'dull' muscles. Hypopressive gymnastics, a particular type of propioceptive gymnastics unfortunately almost unknown in Italy, when performed under the constant supervision of a physiotherapist who knows what he is talking about, is extraordinary (but not miraculous, obviously... you go as far as Nature allows you to go!) in restoring the muscle's ability to contract and the patient's awareness of having that muscle. But requires commitment and appropriate application by patients.

In conclusion, the synergy between surgery and physiotherapy is crucial in the truly multidisciplinary treatment of diastasis of the rectus. But, as we can see, there are many postoperative variables: not least, the ability of the physiotherapist e the application of patientsboth of which are essential if you really want to avoid the unpleasant phenomenon of bloated belly.

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