What is diastasis recti?
Diastasis recti — rectus abdominis diastasis — is the separation of the two rectus abdominis muscles to the sides, caused by stretching and thinning of the linea alba, the connective tissue that joins them along the midline of the abdomen.
Unlike a true hernia, there is no fascial defect (no hole) here: the tissue does not tear but stretches and weakens. For this reason, diastasis on its own is not at risk of becoming 'strangulated' like a hernia. It often coexists, however, with an umbilical or epigastric hernia, which matters for treatment.
How common is it?
It is very common, especially in women after pregnancy. Some degree of diastasis appears in more than half of women during pregnancy, as a normal adaptation to the enlarging uterus.
In most, the linea alba gradually recovers after childbirth. However, in about 1 in 3 women the diastasis persists even 12 months after delivery. It also occurs in men, usually in combination with visceral obesity and increased intra-abdominal pressure.
How does it present?
The most characteristic finding is a vertical bulge along the midline of the abdomen, which becomes more pronounced when the patient lifts the head or shoulders from a supine position (for example during a 'crunch' movement). The main symptoms are:
- A visible bulge or 'ridge' in the middle of the abdomen, more pronounced on exertion.
- A feeling of weakness or instability in the trunk — difficulty with movements requiring the core.
- Lower back pain, due to reduced trunk support.
- Pelvic-floor symptoms, such as urinary incontinence or a sensation of pelvic heaviness.
- An altered abdominal appearance, which many patients find significantly bothersome.
How is it diagnosed?
The diagnosis is primarily clinical. The surgeon assesses the distance between the rectus muscles (inter-recti distance, IRD), usually with the patient supine, gently lifting the head. A generally accepted diagnostic threshold is an IRD ≥ 2 cm.
- Clinical palpation of the linea alba at rest and during abdominal contraction.
- Abdominal wall ultrasound — accurately measures the IRD and rules out a coexisting hernia.
- CT or MRI — in complex cases, large diastases or for surgical planning.
- Assessment for a coexisting umbilical or epigastric hernia, which changes the treatment strategy.
Which factors increase the risk?
Diastasis results from prolonged or repeated increases in intra-abdominal pressure, combined with hormonal loosening of the connective tissue. Main factors:
- Pregnancy — especially multiple, consecutive or twin pregnancies.
- High birth weight (macrosomia) and higher maternal age.
- Obesity and visceral fat (the more common cause in men).
- Repeated heavy lifting or incorrect abdominal exercise.
- Chronic increases in intra-abdominal pressure (chronic cough, constipation).
- Connective-tissue predisposition / collagen quality.
Modern treatment options
Management is individualised according to the size of the diastasis, the severity of symptoms, any coexisting hernia and the patient's goals.
Physiotherapy & core rehabilitation
Targeted strengthening of the deep abdominal muscles and pelvic floor. It improves function, posture and symptoms and is the first step, especially in the first months after childbirth. It does not always 'close' the diastasis, but it restores core function.
Minimally invasive plication (± mesh)
Modern repair through small incisions: plication of the linea alba to re-approximate the muscles, with mesh reinforcement where needed. Ideal when a hernia coexists, as both are treated at the same time. Little post-operative pain and rapid recovery.
Open repair / abdominoplasty
In large diastases, significant excess skin or when a large hernia coexists, open repair with plication — alone or combined with abdominoplasty — offers a complete functional and aesthetic result.
Common patient questions
Will the diastasis close on its own after childbirth?
Very often it improves significantly within the first months. In about 1 in 3 women, however, it persists beyond the first year. In the early months, targeted physiotherapy and patience are advised; if the diastasis persists with symptoms, the surgical option is assessed.
Is diastasis recti dangerous?
On its own it is not dangerous and does not cause strangulation like a hernia, because there is no fascial defect. Assessment is needed, however, when an umbilical or epigastric hernia coexists, or when there is a bulge that hurts and does not reduce.
Do abdominal exercises help or make it worse?
Correct, guided strengthening of the deep abdominals and pelvic floor helps. Conversely, classic intense 'crunch' exercises may worsen the midline bulge. Guidance from a specialist physiotherapist is important.
When is surgery needed?
When the diastasis is significant and persistent, causes functional or aesthetic problems despite physiotherapy, or when a hernia coexists that must be repaired. Surgery re-approximates the muscles by plication of the linea alba, with mesh reinforcement where indicated.
Is the operation done together with hernia repair?
Yes, and this is important: when an umbilical or epigastric hernia coexists, the diastasis and the hernia should be treated at the same time. Repairing only the hernia and leaving the diastasis is associated with a higher risk of recurrence.