Diastasis Recti Abdominus - for a Resident Addressing a Postpartum Patient

Diastasis Recti Abdominus

I'm partially writing this blog post for my wife who, after carrying and delivering our two wonderful children, has experienced a persistent, narrow gap along the linea alba of her rectus abdominis muscles.

Definition: 

Diastasis Recti Abdominis (DRA) is a separation along the linea alba of the rectus abdominis muscles. The image below shows a transverse section of the abdominal wall. In the center, the connective tissue band called the linea alba can be seen. In DRA, the rectus abdominis splits along this line. 



Etiology: 

DRA is most prevalent in postpartum women, occurring in 33-89% in the early postpartum period and persisting in approximately 30% of women at twelve months postpartum. (1)

DRA can also occur in men. Typically, it is associated with factors like advanced age, abdominal obesity, smoking, and physical inactivity. 


Pathophysiology: 

In pregnancy, hormones such as relaxin, progesterone, and estrogen relax connective tissue. This, combined with increased intra-abdominal pressure from an enlarging uterus can cause separation of the rectus abdominis muscles along the linea alba. 

In men, it most commonly results from a combination of factors. Abdominal adiposity increases intra-abdominal pressure and, when combined with weak abdominal muscles, leads to splitting along the linea alba.


Presentation / Clinical Evaluation:

The presentation of DRA can be divided into two categories: cosmetic and functional.

Functional:

  • Inefficient abdominal muscle contraction --> difficulty with daily activities
  • Lower back pain from lumbar spinal muscles overcompensating 
  • Pelvic and hip pain
  • Poor posture
  • Associated with pelvic floor dysfunction --> pelvic organ prolapse and urinary incontinence
Cosmetic:
  • Doming along the midline of the abdomen when contracting abdominal muscles

Diagnosis:
Ultrasound is most commonly used to diagnose DRA. There are several different diagnostic criteria, but 2cm of separation is typically the threshold used to make a diagnosis. MRI and CT may also be used. In studies, physical examination has been shown to correlate well with imaging studies. 

Treatment:

Conservative:

  • Exercise and physical therapy 
    • One study found that doing an intensive core stability training protocol in addition to standard abdominal exercises yielded better results
  • In addition to core stability exercises, it is important to perform pelvic floor exercises
  • Abdominal binders - limited evidence that they help when used in conjunction with exercise for greater than six months
  • Visceral manipulation therapy
  • Electromyography biofeedback-assisted core muscle strengthening exercises with kinesiology taping
  • Of note, most studies focus on reducing the separation of the abdominis rectus during six to twelve months postpartum as diastasis recti tends to improve significantly on its own during the first six months due to changing hormones and reduced mechanical stress
Surgical:
Surgical repair is often reserved for severe cases (>10 cm of separation) that do not improve with conservative methods

  • Open surgical repair with direct suturing
  • Use of mesh to reinforce
  • Laparoscopic, robot assisted

Prognosis:

Despite functional improvement with conservative measures, diastasis recti can persist in ~ 30% of postpartum women at thirty years after delivery when using 2 cm of separation as a threshold. (1) Exercise and physical therapy are generally effective for improving function, however, some level of cosmetic deformity often persists.


References:

1) Prevalence and Risk Factors of Diastasis Recti Abdominis in the Long-Term Postpartum: A Cross-Sectional Study. Scientific Reports. 2024. Lin S, Lu J, Wang L, et al.

2) Du Y, Huang M, Wang S, et al. Diastasis recti abdominis: A comprehensive review. Hernia. 2025;29(1):222. doi:10.1007/s10029-025-03417-5

Image Credit:

Netter FH. Rectus Sheath: Cross Section. In: Netter Reference [Internet]. Philadelphia: Elsevier; 2026. Available from: https://netterreference.com/content/netter_atlas_8e/index.php?task=plate&plateid=4325&source=search&sterm=abdominis&sort=num. Accessed 01/24/2026

https://estclinic.com.au/conditions/diastasis-recti/



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