Abdominal Diastasis

What it is

Abdominal diastasis is the separation of the rectus abdominis muscles at the midline, very common after pregnancy — when the wall stretches to accommodate the baby — and also with weight gain and age. It leaves the belly with a bulging appearance when straining or lifting, even in slim women, and can cause lower back pain, core weakness and discomfort. It is frequently associated with an umbilical hernia. Assessment measures the separation on physical examination and, when necessary, on ultrasound. In the first months after delivery, physical therapy with specific exercises is the treatment of choice. When the diastasis is large, persistent and symptomatic, surgical repair (muscle plication) may be indicated, alone or together with hernia repair, by laparoscopy or the open technique.

Most common symptoms

• Bulge along the midline of the belly when getting up or straining
• Belly that looks pushed out even at a healthy weight
• Weakness in the abdominal and core muscles
• Low back pain and postural changes
• Discomfort or a feeling of instability in the trunk
• Associated umbilical hernia
• Difficulty doing abdominal exercises

Causes and risk factors

• Stretching of the abdominal wall during pregnancy
• Multiple pregnancies, large babies or closely spaced pregnancies
• Weight gain and obesity
• Age and loss of tissue elasticity
• Repeated improper abdominal strain

How it is diagnosed

Diagnosis is made on physical exam: with the patient lying down and contracting her abdomen, the surgeon measures the separation between the rectus muscles, its extent above and below the navel, and whether a hernia is also present. Abdominal wall ultrasound measures the separation precisely and identifies small hernias when the exam leaves doubt. The evaluation also considers time since delivery, symptoms, weight and plans for future pregnancies, to guide the choice of treatment.

How we treat it at Femi Saúde

In the first months after delivery, the treatment of choice is physical therapy, with exercises specific to the core and pelvic floor, which usually reduce the separation and ease low back pain. When the diastasis is large, persists beyond that period and causes symptoms, the general surgery team at Femi Saúde may recommend surgical correction, plicating the rectus muscles along the midline, alone or together with repair of an umbilical hernia, by laparoscopy or open technique, with or without mesh, depending on the case. Surgery is usually planned once family planning is complete. The plan is individualized, combining physical therapy before and after the procedure.

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