Diastasis recti is a topic that is, unfortunately, very near and dear to my heart. Or rather, my body. After four pregnancies, including two with complications, I have been left with pretty severe diastasis recti.

I have to be honest with you, diastasis recti is not fun at all. It’s difficult to deal with the fact that no matter how much I exercise or diet, I still look pregnant. It also causes physical discomfort. Because my diastasis recti is so severe, I have looked into what could help, including surgery to correct the condition.

If you’re not familiar with diastasis recti, let’s first take a look at what the condition actually is in women who have given birth.

Essentially, diastasis recti occurs when the two large parallel bands of muscles in the middle of the abdomen stay separated after pregnancy. The muscles will naturally separate during pregnancy as the uterus expands, but for some women the muscles become so stretched out or damaged that they never fully go back together.

This causes a bulge between the two separated bands of the abdomen. It’s not physically dangerous, but many times, that bulge is what’s referred to as a “mommy pooch,” because it’s so common in women who have given birth, especially if they’ve had multiple births.

Diastasis recti isn’t just about how a mother’s stomach looks, however. The condition can cause significant back pain and make it hard to lift heavy objects because of the lack of core strength. Occasionally, a portion of the intestines can bulge through the space between the muscles, which is called a hernia. Since a hernia could cause medical problems, this would be a reason to consider surgery.

Diastasis recti surgery is similar to a tummy tuck (abdominoplasty) since it involves surgically bringing the separated muscles back together. A tummy tuck also usually involves removing excess fat and skin in the area. Most women who decide to have diastasis recti surgery after having children have a tummy tuck procedure, not just a repair of the diastasis recti.

Not all women with diastasis recti will need surgery. Some women will have less severe diastasis recti, while others will have significant cases that can’t be corrected through any other means. According to the Mayo Clinic, surgery might be considered for women whose abdominal muscle weakness is interfering with their daily activities. Other than that, if women are “bothered by the bulge,” surgery might simply be for cosmetic reasons.

Even doctors can’t always agree on what necessitates surgery for women who have diastasis recti. For example, The American Society of Aesthetic Plastic Surgery offers differing opinions on what a woman with diastasis recti should do. One doctor recommended simple diet and exercise, while another suggested reconstructive surgery. However, most doctors agree that you can’t always fully fix diastasis recti without surgery.

I did speak to my doctor about my diastasis recti and she was able to refer me to visit a physical therapist, another option for treatment of diastasis recti. Physical therapists can teach exercises to help strengthen the abdominal muscles, and show you which exercises to avoid. They can also teach you correct techniques for posture, mobility, and lifting.

It’s hard sometimes to know exactly where to begin with getting help for your diastasis recti, and physical therapy for the condition may not be covered by your insurance. Some physical therapists may also not be familiar with how to best treat the condition in women who have given birth, so check with the physical therapy’s office to make sure the office can accommodate you.

While physical therapy and exercise may not fix your diastasis recti completely, learning the right exercises can help retrain your muscles and close the gap more than no treatment at all. There are also different online programs and tools like support belts, braces, and waist trainers that are designed to help hold the muscles back into position.

Many insurance companies consider diastasis recti to be a “cosmetic” procedure. It’s not always covered.

If you do decide to move forward with surgery for your diastasis recti, you should wait at least a year after your baby is born to allow your body to heal fully and all the muscles to get back into place. This also gives exercise and physical therapy time to work. You should wait at least a few months after your baby is done breast-feeding as well. The hormones of breast-feeding could interfere with your abdominal muscles.

The actual tummy tuck surgery only takes about three hours, but the recovery time is a bit longer. You will need to take special medications and may have drains in place for approximately two weeks after the surgery. Swelling can last for six weeks, so you will wear an abdominal binder for that time as well.

The Mayo Clinic explains that you will have to take care to not reopen the wound for about three months, which means being careful to not bend or lift anything improperly. It can take up to a year to fully recover and get the all-clear from your doctor at a follow-up appointment.

For me, it’s extremely difficult to decide if I should get surgery to repair my diastasis recti. On the pro side, I would regain self-confidence and be able to live life without worrying about what clothes fit me or make me look even more pregnant.

On the con side, it’s a lot to consider. Aside from the hefty price tag, there are the health risks of major surgery, the time it would take out of our family life for me to actually get the surgery and recover, and then the considerations of what would happen if I got pregnant again.

The bottom line is that there is no easy answer when it comes to repairing diastasis recti, but the first step is definitely to talk to you doctor.