Space between muscles
Lie on your back, bend your legs, raise your shoulders a little and feel the middle of the abdomen above and below the navel with the pads of your fingers: how many fingers fit between the edges of the muscles.
CONDITION / TORSO AND ABDOMEN
Diastasis rectus abdominis.
Diastasis rectus abdominis — separation of two rectus muscles along the midline of the abdomen, often after pregnancy. It is not a hernia: exercises with a physical therapist are tried first, and surgery is considered when symptoms persist or there is a hernia nearby.
CONCEPTUAL VISUALIZATION- What it is
- A separation of the rectus abdominis muscles of more than 2 cm is defined by the European Hernia Society.
- Is it a hernia?
- No: the white line between the muscles stretches, but the organs do not pass through it. A hernia may be nearby.
- How common
- In a study of 300 women who gave birth for the first time, 60% were 6 weeks postpartum and 32.6% 12 months later.
- What is the first
- Exercises with a physical therapist; surgery is considered if symptoms persist.
01 / WHAT IS ITWhat is
What is
diastasis recti muscles.
The rectus abdominis muscles are two vertical bands of muscles connected in the middle by a white line. During pregnancy, the growing uterus pushes them apart: the muscles lengthen and weaken, and the white line thins and stretches. This is diastasis, or separation of rectus muscles.
Spreading during pregnancy is common, according to the NHS it's usually around 2 fingers. In most cases, the gap returns to normal by 8 weeks postpartum, but not in all: in a Norwegian study of 300 women who gave birth for the first time, 60% had diastasis (from 2 toes) at 6 weeks postpartum and 32.6% at 12 months.
The European Hernia Society defines diastasis as a separation of the rectus muscles of more than 2 cm.
A diastasis is not a hernia: it does not allow organs to protrude through it, and it does not carry the same risk as a true hernia. But nearby, on the white line or near the navel, there may be a hernia - then the treatment is different.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
diastasis presents.
Diastasis can be checked independently. The most important complaints, according to the EHS guidelines, are body weakness and abdominal appearance.
Bulging in the middle
The stomach protrudes in the middle line, especially when straining.
Body weakness
Feeling unsteady or weak in the core muscles is one of the top two complaints in the EHS guidelines.
Abdominal view
Dissatisfaction with the appearance of the abdomen is the second main complaint according to the same guidelines.
Pain in the back
A review of 12 studies (2,242 participants) found no association of diastasis with low back and pelvic pain, but wider diastasis may be associated with more severe low back pain. The quality of research is weak.
Bulging near the navel
A separate protrusion near the navel or on the white line, which increases when coughing and decreases when lying down, may be a hernia, not a diastasis.
Umbilical hernia03 / REASONSWhy do they diverge?
Why do they diverge?
rectus muscles.
Diastasis is associated with pregnancy, but it also occurs in men.
pregnancy
The growing uterus stretches the rectus muscles, lengthens and weakens them.
Stretched white line
The connective tissue between the muscles thins and stretches, so the muscles do not converge towards the middle.
Heavy lifting
In a Norwegian study of 300 women, those who lifted heavy 20 times a week or more had diastasis recti more often (odds ratio 2.18).
Other factors
For other risk factors compared in the same study, no difference was found between women with and without diastasis.
Not only after childbirth
Among the 11,658 patients with diastasis and hernia who underwent surgery and entered the Herniamed registry, 68.7% were men.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Diastasis itself is a planned situation: it usually does not require emergency care. Urgent help may be needed if there is a hernia nearby and it is pinched. Then don't drive to the hospital alone.
103 immediately if there is a hernia nearby (protrusion near the navel or on the white line) and:
- very strong pain in the abdomen or in the protrusion that does not go away;
- nausea, you vomit or cannot keep food down;
- the protrusion is swollen more than usual, and the skin above it has changed color;
- no gas and no stool.
When to see a doctor:
On the same day: to the surgeon, if there is a hernia near the diastasis (protrusion near the navel or on the white line) and it started to hurt, the abdomen swelled or the temperature rose to 38 °C or higher. Planned: if, after 8 weeks after giving birth, the gap between the muscles is still noticeable, the abdomen hurts or pulls, or you notice a separate bulge near the belly button, contact your doctor: he will refer you to a physical therapist and, if necessary, to a surgeon.
05 / DIAGNOSTICSHow to determine
How to determine
diastasis
- Conversation
When was the birth and how many were there, what worries me - body weakness, back pain, appearance of the abdomen, urinary incontinence; which exercises have already been tried.
- Review
The doctor will feel the space between the muscles above the belly button, at the level of the belly button and below it while you are lying with your head elevated, and look for a hernia.
- Ultrasound or CT scan
In order to accurately measure the width of the diastasis and not to miss the hernia, the consensus of surgeons recommends imaging methods - ultrasound or CT.
- Classification
The width of the separation, whether there have been pregnancies and whether there is a concomitant hernia — this depends on the plan.
06 / TREATMENTHow we treat
How we treat
diastasis
First - exercises. Surgery is considered when symptoms remain after exercise or there is a hernia nearby. The quality of research on diastasis is limited, so most recommendations are weak and individualized.
01
Exercise first
Physical therapy is the first step.
- What do you advise?
- The Italian Consensus of Hernia Surgeons calls targeted exercise the first step in treatment; EHS guidelines—that physical therapy should be tried before surgery.
- What exercises give
- In a meta-analysis of 9 randomized studies (450 women after childbirth), the gap between the muscles decreased by an average of 8 mm, more if the exercises were started in the first 3 months. But activity limitation scores (on the Oswestry scale) did not improve.
- Data are contradictory
- In another meta-analysis, transversus abdominis exercises did not change the width of the diastasis compared with minimal or no intervention. The authors believe that exercise may alleviate symptoms, but correct the anatomy to a limited extent.
- Pelvic floor
- Postpartum pelvic floor exercises reduced the odds of urinary incontinence by 37% (meta-analysis, moderate confidence).
- What to avoid first
- According to the NHS, in the beginning it is better to avoid curls, planks and shock loads, do not strain on the toilet and do not lift heavy; it is important to monitor posture.
- Bandage
- In a meta-analysis of 13 randomized trials, exercise reduced the gap below the umbilicus better than bracing or no intervention; above the navel, their effect is unclear.
02
Surgery
When symptoms remain or there is a hernia.
- When considered
- The Italian consensus calls the threshold for surgery a difference of more than 2.5 cm to relieve symptoms. Decisions are made together with the patient, taking into account her situation.
- Without hernia
- EHS guidelines recommend stitching the white line (plastic or plication); the consensus is to do it minimally invasively.
- With a hernia
- If there is a hernia nearby, the diastasis is treated along with it with mesh: the consensus recommends mesh for a defect of more than 1 cm and placement outside the abdominal cavity.
- The result
- In a Swedish study of 60 women whose symptoms did not go away after training, one year after suturing the white line, none of the diastasis recurred, and 98% said their body function was better. Complaints about urination and urinary incontinence (according to the questionnaire) decreased in 47%, but increased in 13%.
- Operation or exercises
- In a randomized trial of 86 patients, one year after surgery, pain and quality of life improved equally with mesh and sutures; the pain remained in the training-only group. This is one small study, and the exercises are advised to start first.
- Risks
- In a review of 24 articles (931 patients), diastasis recurred in 5%, seroma occurred in 7%, numbness of the abdominal skin in 6%, wound infection in 2%, and chronic pain in 4%. The review did not reveal the advantages of mesh over seams.
03
Abdominoplasty
If there is excess skin.
- when
- If excess skin remains after pregnancy, muscle stitching can be combined with removal of excess skin - abdominoplasty.
- What to expect
- A 2011 review warns: diastasis correction is mostly aesthetic, because diastasis does not carry the risk of a real hernia. Among the complications, the review names hematomas, small areas of skin necrosis, wound infection and dehiscence, pain, nerve damage, and repeated muscle dehiscence — its frequency, according to the review, can reach 40%.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Diastasis of the rectus muscles at the Doctor Valikhnovskyi Surgical Institute is treated in the direction of abdominal wall reconstruction. First — exercises with a physical therapist; the surgeon assesses whether surgery is needed, and if so — which type.
CLINIC SERVICE
Slender belly
Abdominal wall with umbilical, postoperative and large hernias and diastasis — mostly minimally invasive.
View service
What we do for this condition
- Exercises with a physical therapist — the first stage — several months of physical therapy before deciding on surgery.
- White line stitching — the rectus muscles are brought together by suturing the linea alba between them.
- Abdominoplasty — if necessary, along with suturing the muscles, excess skin is removed.
- Mesh behind the muscles — if there is a nearby hernia, a mesh is added and placed behind the rectus muscles.
- Endoscopic and robotic surgery — when combined with a hernia, large incisions are often replaced with several punctures; the method is chosen based on the size of the hernia.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the abdomen from the front and side, and if available, an ultrasound of the abdominal wall.
- ConsultationExamination, measurement of the gap between muscles, search for hernia; discussion about childbirth, symptoms, and exercises already tried.
- ExercisesIf surgery is not needed yet — an exercise program with a physical therapist and a follow-up examination.
- SurgeryIf symptoms persist or there is a hernia — suturing of the linea alba, with mesh or abdominoplasty if necessary.
- RecoveryHeavy loads and abdominal exercises — only after surgeon's approval.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Will diastasis pass by itself after childbirth?
Often the interval is reduced: according to the NHS, usually up to 8 weeks after birth. But not always - in a Norwegian study of 300 women, 32.6% had diastasis after a year. If the gap is still noticeable after 8 weeks, see your doctor.
Is diastasis a hernia?
No. With diastasis, the white line between the muscles is stretched, but the organs do not pass through it. The hernia may be nearby, for example near the navel, then the treatment is different, often with a mesh.
Will exercise help?
First of all, exercises are recommended. In a meta-analysis of 9 randomized trials, the gap was reduced by an average of 8 mm, while another meta-analysis found no difference. Exercise can relieve symptoms; if symptoms persist, consider surgery.
What exercises to avoid?
According to the NHS, in the beginning it is better to avoid curls, planks and impact loads, not to strain and not to lift heavy. Specific exercises are selected by a physical therapist.
When is surgery necessary?
When symptoms remain after exercise — body weakness, pain, dissatisfaction with the appearance of the abdomen — or there is a hernia. The Italian consensus calls the threshold more than 2.5 cm. Decisions are made together with the surgeon.
Will a bandage help?
In a meta-analysis of 13 randomized trials, exercise reduced the gap below the umbilicus better than a bandage.
Stomach ache — is it dangerous?
Diastasis itself usually does not require emergency care. But if there is a hernia nearby (protrusion near the navel) and it hurts very much, and the pain does not go away, you feel nauseous or vomit, the skin above the protrusion has changed color, or gases do not pass and there is no stool, call 103. If the protrusion just started to hurt, go to the surgeon the same day.
Sources
17 sources · EHS guidelines, consensus, meta-analyses, studies, and NHSshowCollapse
- European Hernia Society guidelines on management of rectus diastasisBritish Journal of Surgery, 2021doi:10.1093/bjs/znab128 ↗
- The Italian national consensus conference on the diagnosis and treatment of Rectus Abdominis diastasis in Post-gravidic WomenHernia, 2025doi:10.1007/s10029-025-03403-x ↗
- Non operative management of postpartum Diastasis Recti: a systematic review and metanalysis of randomized controlled trialsHernia, 2026doi:10.1007/s10029-026-03671-1 ↗
- What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? An updated systematic review and meta-analysis of randomized clinical trials and trial sequential analysisHernia, 2026doi:10.1007/s10029-026-03660-4 ↗
- Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysisBritish Journal of Sports Medicine, 2025doi:10.1136/bjsports-2024-108619 ↗
- Comparative Efficacy of Abdominal Exercises and Abdominal Binding on Diastasis Recti Abdominis Reduction in Postpartum Women: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsPhysiotherapy Research International, 2025doi:10.1002/pri.70038 ↗
- Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic painBritish Journal of Sports Medicine, 2016doi:10.1136/bjsports-2016-096065 ↗
- Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic reviewPhysiotherapy, 2019doi:10.1016/j.physio.2018.07.002 ↗
- Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining suturesSurgery, 2016doi:10.1016/j.surg.2016.05.035 ↗
- Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of lifeBJS Open, 2019doi:10.1002/bjs5.50213 ↗
- The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgeryBJS Open, 2023doi:10.1093/bjsopen/zrac162 ↗
- Surgical treatment of rectus abdominis diastasis with concomitant abdominal wall hernias—perioperative outcomes of 11,658 cases from the Herniamed RegistryHernia, 2025doi:10.1007/s10029-025-03457-x ↗
- Treatment of rectus diastasis: should the midline always be reinforced with mesh? A systematic reviewJournal of Plastic, Reconstructive & Aesthetic Surgery, 2021doi:10.1016/j.bjps.2021.01.004 ↗
- A systematic review on the outcomes of correction of diastasis of the rectiHernia, 2011doi:10.1007/s10029-011-0839-4 ↗
- Your post-pregnancy bodyNHS, 2026nhs.uk/baby/support-and-services/your-post-pregnancy-body ↗
- Umbilical herniaNHS, 2025nhs.uk/conditions/umbilical-hernia ↗
- HerniaNHS, 2026nhs.uk/conditions/hernia ↗
The figures on the page are from these sources.
The abdomen has not returned
after childbirth?
Send a photo of your abdomen and an ultrasound if available. The doctor will tell you whether it is diastasis, if there is a hernia, and where to start.