Diastasis of the abdominal muscles
when treatment is needed

What diastasis is, when it settles on its own, how it is treated with exercise and when an operation is needed.

“A belly like a pregnant woman’s”, a bulge in the middle when getting up from bed, a feeling of weakness in the abdomen — these are the common complaints in diastasis. It is often confused with a hernia or with “torn muscles”, but it is neither.

What diastasis is

The rectus abdominis muscles are two bands joined in the middle by a line of connective tissue. In diastasis this line stretches and thins, and the muscles move apart. It is not a tear. Most often it shows as a bulge or a hollow along the midline when the abdomen is tensed.

When it appears

• Pregnancy — almost all women have widening at the end of the third trimester, especially with more births.
• Obesity and marked changes in weight.
• Heavy lifting with poor technique.
• It also occurs in men.

Does it settle on its own

After birth a large part of the recovery happens in the first 8 weeks, and improvement is possible up to about 6 months. In some women — by the data, about a third — the widening remains even after one year.

Is it dangerous

By itself it is not dangerous. It can be associated with weakness of the abdomen, pain in the lower back and pelvis and a feeling of bloating, but the link is not the same in everyone. It differs from a hernia — in a hernia there is a defect in the muscle fascia and a risk of strangulation. The two can coexist, which is why an examination (and sometimes an ultrasound scan) is needed.

Treatment without surgery

• Work with a physiotherapist specialising in postnatal recovery — exercises for the deep abdominal muscles, the pelvic floor and breathing.
• Gradual loading. At first, exercises that cause a ridge to form in the middle (sit-ups, planks) are avoided until control is achieved.
• A supportive belt in the first weeks, as an addition.
• Weight control.

The aim is not always complete closure. Restoring function and tension in the midline is often more important.

When surgery is needed

• No improvement after at least 6–12 months of targeted treatment.
• Marked bulging that bothers you or gets in the way.
• An accompanying hernia.
• Excess skin and fat that leave the abdomen unsatisfactory without correction of the skin.

The operation tightens the midline with sutures (plication) and, if needed, uses a mesh for a hernia. It is most often combined with abdominoplasty when there is excess skin. Liposuction alone does not treat diastasis.

Recovery and recurrence

• Light activities soon after the operation; no heavy lifting and abdominal exercises for about 6 weeks.
• A new pregnancy and fluctuations in weight can bring the problem back — it is best for these plans to be completed before the operation.