Symptoms, diagnosis and treatment
Rectus diastasis: more than an aesthetic concern
Rectus diastasis is a widening and weakening of the linea alba between the two rectus abdominis muscles. It can alter the shape and function of the abdominal wall and may coexist with umbilical or epigastric hernias.
Understanding the abdominal wall
What is rectus diastasis?
The two rectus abdominis muscles run vertically from the chest to the pubis and are joined in the midline by a strong connective structure called the linea alba. Rectus diastasis develops when this tissue becomes wider and thinner, allowing the muscles to move apart.
Rectus diastasis is not itself a true hernia because the abdominal contents are not necessarily passing through a defined hole. However, the weakened midline may be associated with an umbilical or epigastric hernia, which must be identified during the surgical assessment.
Rectus diastasis is a functional disorder of the abdominal wall. Its relevance depends not only on the measured width, but also on symptoms, tissue quality, abdominal contour and associated hernias.
Who can be affected?
Not only women after pregnancy
Pregnancy is a frequent setting, but rectus diastasis can affect women and men of different ages and body types.
After pregnancy
The progressive expansion of the abdomen can stretch and weaken the linea alba. The separation may persist months or years after childbirth, even after weight has returned to normal.
In men
Rectus diastasis may occur in men, particularly in association with central weight gain, repeated increases in abdominal pressure, intense physical effort or ageing of connective tissues.
After major weight change
Weight gain, weight loss and reduced tissue elasticity may reveal or worsen weakness of the abdominal midline. Skin excess and fat distribution must be assessed separately from the diastasis itself.
How it may present
Common signs and symptoms of rectus diastasis
Symptoms vary considerably. Some patients are mainly concerned by the change in abdominal shape, while others report functional problems affecting daily activities.
Persistent abdominal bulging
A rounded or protruding abdomen that remains despite weight control and exercise, often becoming more evident later in the day.
Midline doming
A ridge or dome appearing along the centre of the abdomen during movements such as sitting up, coughing or lifting.
Core weakness and back discomfort
Reduced abdominal support may be associated with difficulty stabilising the trunk, postural fatigue or lower back discomfort.
Pelvic floor or digestive complaints
Urinary leakage, constipation, bloating or reflux may coexist with rectus diastasis, although these symptoms can have several different causes.
Umbilical or epigastric hernia
A small lump, tenderness or discomfort around the navel or in the upper midline may indicate an associated hernia.
Difficulty with certain movements
Some patients report discomfort or insecurity when bending, lifting, exercising, changing position or performing tasks that increase abdominal pressure.
Specialist assessment
How rectus diastasis is diagnosed
The clinical examination is the central part of the diagnosis. Imaging is used selectively and is not routinely required before an in-person consultation.
Medical history
The assessment considers pregnancies, previous abdominal operations, weight changes, symptoms, physical activity and the patient’s functional and aesthetic priorities.
Clinical examination
The surgeon evaluates the width and length of the separation, tissue tension, abdominal contour, skin quality and any umbilical or epigastric hernia.
Imaging when needed
For an in-person consultation, ultrasound or CT is not routinely required beforehand. For a video consultation, an abdominal wall ultrasound or, preferably, a CT scan must be available for review.
A personalised surgical strategy
Treatment depends on anatomy, symptoms and skin quality
Physiotherapy can improve core control and function, especially in mild cases. When an established anatomical defect requires stable reconstruction, surgery is the only way to physically restore the linea alba.
Specialist physiotherapy
Targeted rehabilitation may improve breathing, posture, trunk control and pelvic floor coordination. It is also an important part of preparation and recovery for selected surgical patients.
REPA
REPA is an endoscopic pre-aponeurotic repair performed through three small suprapubic incisions. It reconstructs the midline and can treat suitable associated hernias, with mesh reinforcement of the abdominal wall.
MILA
MILA combines abdominal wall repair with VASER-assisted liposculpture and Quantum RF skin tightening. It is considered in carefully selected patients requiring both functional repair and more complete abdominal remodelling.
Rectus diastasis assessment in Milan
Consult Dr. Salvatore Cuccomarino, MD, FACS
Dr. Salvatore Cuccomarino is a general surgeon focused on minimally invasive abdominal wall surgery. He performed the first REPA procedure in Europe in 2017 and has developed extensive experience in the surgical treatment of rectus diastasis and associated midline hernias.
International patients can arrange an in-person consultation in central Milan or begin with a video consultation via Google Meet. The indication for REPA, MILA, abdominoplasty or conservative treatment is established individually.
Via Visconti di Modrone 7
20122 Milan, Italy
Via Santa Croce 10/A
20122 Milan, Italy
Frequently asked questions
Rectus diastasis: practical information
Is rectus diastasis the same as a hernia?
Can rectus diastasis affect men?
Can exercise close rectus diastasis?
Do I need an ultrasound or CT scan before a consultation?
When is surgery considered?
Which operation is best: REPA, MILA or abdominoplasty?
Specialist evaluation in Milan or online
Do you think you may have rectus diastasis?
Request an in-person consultation in Milan or an initial video consultation for international patients.
The information on this page is general and does not replace a specialist medical consultation. Diagnosis and suitability for treatment can be established only after an individual assessment.