Rectus diastasis is a widening of the connective tissue between the two rectus abdominal muscles. It commonly develops during pregnancy as the abdominal wall stretches, but it can also occur after significant weight change. The condition may create a central ridge or dome and affect the way the abdomen looks or functions. It is not a true hernia, although both conditions can be present together.
Common symptoms
The most visible sign is a midline bulge that appears when sitting up, lifting the head or performing abdominal exercise. Some women describe weakness, reduced core control, lower-back discomfort or difficulty returning to previous activity. The width of the separation does not always match the severity of symptoms, so treatment should be based on function and individual concerns rather than measurement alone.
How is it different from a hernia?
Rectus diastasis involves stretching and thinning of the midline tissue without a true hole. A hernia is a focal defect through which fat or bowel can protrude. Diastasis does not usually carry the same risk of bowel obstruction or strangulation, but a small umbilical or epigastric hernia may coexist and require separate consideration.
Assessment
Clinical examination is often sufficient. Your surgeon or physiotherapist may assess the width and tension of the midline during movement, breathing and muscle contraction. Ultrasound or CT may be useful when a hernia is suspected, symptoms are unexplained or surgery is being planned. Pregnancy history, future family plans, previous operations and personal goals are all relevant.
Non-surgical treatment
Specialist physiotherapy is commonly the first approach. Rehabilitation may focus on breathing, posture, pressure management and progressive strengthening rather than repeated traditional abdominal exercises. This can improve function and confidence, although it may not completely close a wide structural separation. Weight management and treatment of chronic cough or constipation may also reduce abdominal pressure.
When is surgery considered?
Surgery may be discussed when significant separation persists despite rehabilitation and causes functional or contour concerns. The abdominal muscles are brought towards the midline, sometimes alongside hernia repair or removal of excess skin. Risks include bleeding, infection, fluid collection, altered sensation, scarring, blood clots and recurrence or widening after future pregnancy.
Frequently asked questions
Is rectus diastasis dangerous? It is not usually dangerous and does not normally trap the bowel, but a coexisting hernia should be identified.
Can physiotherapy fix it? Physiotherapy can improve strength and control, but structural closure is not guaranteed.
Can it return after surgery? Further pregnancy, major weight change and tissue factors can stretch the repair.