Running down the centre of your abdomen are two long muscles — the rectus abdominis, sometimes called the "six-pack" muscles — held together along the midline by a band of connective tissue called the linea alba. Diastasis recti (also known as divarication of the recti) is what happens when those muscles gradually drift apart, leaving a wider-than-normal gap between them.
The result is often a noticeable ridge or soft bulge running down the middle of the abdomen — most visible when you sit up from lying down, cough, or strain. Diastasis is not quite the same as a hernia (there is no hole through which bowel can push), though it can sometimes occur alongside a small umbilical or epigastric hernia. Both are checked for at the assessment.
Diastasis recti is extremely common after pregnancy — some estimates suggest it affects 30–60% of women by the third trimester. For many women it improves naturally in the months after delivery, particularly with the right exercises. For some it persists and continues to cause problems.
It is not only a post-pregnancy condition. Men can develop diastasis too — particularly after significant weight gain followed by weight loss — as can anyone with naturally looser connective tissue. Whoever you are, please know it is common, well-understood, and not your fault.
Many people with diastasis feel completely well and just notice the cosmetic change — a soft ridge or "dome" appearing when they sit up. For others, the separation causes real functional problems. Common symptoms include:
- Lower back pain — the weakened midline reduces the natural support the abdominal muscles give to the spine
- A sense of core weakness or instability — particularly noticed during lifting, exercise, or getting up from lying down
- Urinary leakage when coughing, sneezing, or straining (often together with pelvic floor weakness)
- Pelvic floor symptoms more broadly — heaviness, prolapse sensations, or difficulty emptying
- The cosmetic appearance of a persistent ridge or bulge, which some people find distressing in itself
If any of these are affecting your daily life, it is worth getting assessed. These symptoms are very real, and there is help available.
In most cases a physical examination is enough to confirm diastasis recti. The gap can be felt and measured while you do a small "head lift" from lying down — this brings the muscles into focus and makes the separation easy to assess. It is quick and not uncomfortable.
If the picture is unclear, or if there is a suspicion of an associated hernia, an ultrasound or CT scan can give a more detailed look at what is going on.
The first step is almost always physiotherapy — specifically, targeted rehabilitation of the pelvic floor and deep core muscles with a physiotherapist who has experience in abdominal rehabilitation. This kind of focused programme can produce meaningful improvement, particularly for mild to moderate separation, and many patients improve enough that no further treatment is needed.
You will be guided on which exercises help and which ones to avoid. In particular, traditional sit-ups and crunches create downward pressure inside the abdomen — pressure that pushes directly on the weakened midline and can make the gap wider rather than narrower. They are usually put on hold while you work with a physiotherapist on safer alternatives that engage the deep core in a way that supports the midline.
Surgery is considered when your symptoms are significant and have not improved enough after a proper course of physiotherapy, or when there is an associated hernia that needs repairing at the same time.
The operation involves stitching the widened gap in the linea alba back together to restore a stronger, more stable midline. Mesh is often added to reinforce the repair and reduce the chance of the gap reopening. It can be done through a traditional open incision down the midline, or — in suitable cases — through a keyhole (laparoscopic or robotic) approach, which has a faster recovery. This is a form of abdominal wall reconstruction, and it should be performed by a surgeon experienced in this area.
Recovery depends on how extensive the repair is. Most people stay in hospital for 1–3 nights. A return to desk work is usually possible within 2–4 weeks. Getting back to full physical activity — including core exercise — takes several months, and post-operative physiotherapy is an important part of the recovery to make the most of the repair. Clear guidance on what to expect at each stage is given at every follow-up.
Mr Nguyen's starting point is always physiotherapy — targeted abdominal wall and core rehabilitation with a physiotherapist experienced in this area is the right first step, and for many people it makes a real difference without ever needing surgery. For women, this often means a women's health physiotherapist; for men, a physiotherapist with sports or musculoskeletal expertise in core rehabilitation. Surgery is only considered once a proper course of physiotherapy has been completed and significant symptoms remain.
If surgery is the right option, Mr Nguyen will discuss what the operation involves, what realistic outcomes look like, and which approach is best for your specific anatomy. Where technically appropriate, he prefers a laparoscopic or robotic repair — a precise reconstruction with less disruption and a more comfortable recovery than open surgery.
It is worth asking your GP for a referral if you have a visible separation that has not improved enough after 12 months of physiotherapy following pregnancy, ongoing back pain or core weakness linked to the abdominal wall, or a bulge that you suspect may be a hernia as well as diastasis. This condition is far more treatable than many people realise — you do not need to simply live with the discomfort or the cosmetic concern.
Your GP will send a referral and most patients are seen within one to two weeks. At the consultation the abdominal wall is examined, the separation is measured, and any associated hernia is checked for.
For almost everyone, the next step is a structured physiotherapy programme — and follow-up appointments are arranged at each stage so progress can be reviewed properly. If symptoms remain significant after a proper course of physiotherapy (or if there is a hernia that needs repair), the surgical options are discussed in detail at a second consultation. There is no rush, and no decision is pushed on you.
Yes, often — particularly in the first 6–12 months after delivery. Mild to moderate separation frequently improves naturally during this time, especially when supported by targeted physiotherapy. If significant symptoms are still present beyond 12 months, full resolution without some help is less likely — and that is when it is worth seeking a specialist opinion.
Not at all. Many people manage very well with physiotherapy alone. Surgery is only considered for those whose symptoms remain significant after completing a proper physiotherapy programme, or for those with an associated hernia that needs repair. The decision is always made together, not pushed on you.
Traditional sit-ups and crunches create a lot of downward pressure inside the abdomen — and that pressure pushes directly on the weakened midline, which can make the gap wider rather than narrower. A physiotherapist experienced in abdominal rehabilitation will teach you safer alternatives that activate the deep core muscles (particularly the transversus abdominis) in a way that supports the midline instead of loading it.
Yes, they can. It is most talked about in the context of pregnancy, but diastasis recti can affect men too — particularly after significant weight gain followed by weight loss, or in those with naturally looser connective tissue. The assessment and treatment approach is essentially the same.
Recurrence after a properly performed repair — particularly when mesh is used to reinforce the midline — is uncommon. Post-operative physiotherapy and avoiding the activities that contributed in the first place (heavy abdominal loading, untreated chronic cough, significant unplanned weight changes) all help reduce the chance of it coming back.
Have questions about diastasis recti (abdominal wall separation)?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.