Abdominal Diastasis: Interview with Dr. Casella

Diastasis of the rectus abdominis muscles, more commonly known as abdominal diastasis, occurs when the two muscle bands that form the rectus abdominis separate from their midline due to a weakening of the structure that normally keeps them together. This phenomenon causes a weakening of the abdominal wall and may be accompanied by symptoms such as bloating, reduced core strength, difficulty in movements involving the central musculature, as well as urinary and digestive issues.

We discussed this condition with Dr. James Casella, a specialist in general surgery with extensive experience in laparoscopic abdominal wall surgery at UPMC Salvator Mundi International Hospital.

What Is Abdominal Diastasis?

To understand this condition, it is necessary to take a step back and explain what the rectus abdominis muscles are and what their function is.

The rectus abdominis muscles are two vertical bands that run parallel from the chest to the pubic bone and form an important part of the abdominal wall. They work together with the obliques, the transverse abdominis, and the pelvic floor to stabilize the trunk and spine, support posture, and contribute to movements such as trunk flexion.

They also participate in forced breathing and help generate the internal pressure needed for everyday activities such as bowel movements, lifting weights, or exerting force during childbirth. They also protect the abdominal organs: they are therefore essential muscles.

In the middle, the two bands are separated by the linea alba, a connective tissue that acts as a point of connection and plays a crucial role in core stability. When the linea alba weakens, a separation — from the Greek “diastasis” — of the two muscles may occur, creating an abnormal space between them.

Does Abdominal Diastasis Affect Only Women?

No. Although it is much more common in women, it can also affect men.

In women, the most frequent cause is pregnancy: postpartum abdominal diastasis affects about 20–30% of new mothers. During pregnancy, the abdominal wall undergoes progressive and significant stretching, which may cause the rectus muscles to separate. Cesarean delivery may also contribute to this process, as surgical maneuvers performed in the area between the two muscle bands can further facilitate their separation.

In men, the prevailing cause is often a general weakening of the abdominal musculature. A sedentary lifestyle, lack of physical activity, or insufficient exercise can reduce core tone, making the abdominal wall less resistant to internal pressure.

Other risk factors include: weight gain and obesity; significant weight loss, such as after bariatric surgery; previous abdominal surgeries; congenital conditions that make tissues more fragile; intense and repeated physical exertion performed without proper management of abdominal pressure; aging.

What Are the Symptoms of Abdominal Diastasis?

Diastasis of the rectus muscles manifests with a visible bulge above or below the navel, often accompanied by related symptoms. Those affected may experience difficulty maintaining proper posture, leading to discomfort or back pain. The core muscles appear weaker and less efficient, causing a sense of instability, especially during movement or daily activities. In some cases, digestive, respiratory, or urinary issues may arise due to reduced support from the abdominal muscles.

What Are the Health Consequences of Abdominal Diastasis?

For a long time, abdominal diastasis was mistakenly regarded as merely a cosmetic issue. Today this is changing: it is now recognized as a real functional alteration that can significantly impact health and quality of life.

On a physical level, it can cause pain in the back, hips, and pelvis, digestive and respiratory difficulties, abdominal pain and bloating, nausea, postural problems, and incontinence. If not properly treated, it may lead to more serious complications: hernias — especially umbilical, but also abdominal or epigastric — incisional hernias, rectus muscle tears, and physical disabilities.

The psychological impact is also significant. Changes in abdominal appearance can affect emotional well-being, leading to insecurity, anxiety, sadness, relationship difficulties, and social withdrawal.

How Is Abdominal Diastasis Diagnosed?

Diagnosis begins with clinical observation, which allows the identification of a depression or ridge along the midline of the abdomen. To confirm the diagnosis, an ultrasound — a simple and non-invasive test — is commonly used to precisely measure the diastasis and detect any associated hernias (umbilical, inguinal, femoral, or Spigelian hernias).

One advantage of ultrasound is the ability to perform dynamic tests: evaluation during increase of intra-abdominal pressure (voluntary or reflex contraction of the abdominal muscles and diaphragm), which can reveal hernias not visible at rest, and assessment with the patient standing to better define the actual width of the diastasis. However, ultrasound has a limitation: limited overall visualization. For this reason, when a more detailed assessment is needed — for example before surgery or in complex cases — a CT scan without contrast may be performed for more accurate surgical planning.

In more complex cases or recurrent hernias after surgery, MRI may be used.

How Is Abdominal Diastasis Treated?

In mild cases, the first approach is often targeted physiotherapy for abdominal diastasis, aimed at restoring muscle control and improving core function. This treatment may reduce symptoms and, in some cases, decrease the separation.

When the gap between the muscles is significant or hernias are present, surgical treatment is the most effective solution. Traditional surgery involves abdominoplasty, which repositions the rectus muscles and removes excess skin and fat. Alternatively, minimally invasive techniques using laparoscopy or robotic assistance can be performed: surgery is carried out from inside the abdomen through small incisions, bringing the muscles closer together and often reinforcing them with a mesh. This approach minimizes scarring, usually causes less postoperative pain, allows quicker recovery than open surgery, and enables exploration of the abdominal cavity to address any associated conditions.

The Specialist’s Advice

The first step is not to underestimate the problem or consider it merely cosmetic. If you experience the symptoms described, it is advisable to consult a specialist for an early diagnosis and to evaluate the most suitable treatment plan.

It is equally important to rely on specialized centers offering a multidisciplinary approach. At UPMC Salvator Mundi International Hospital, patients are evaluated by highly specialized radiologists who perform precise and targeted diagnoses using cutting-edge technologies. The surgical team — including a general surgeon and a plastic surgeon — defines the therapeutic plan to resolve abdominal instability with increasingly refined and minimally invasive techniques. Physiotherapists specialized in treating abdominal diastasis support patients both before surgery, helping prepare the body by strengthening muscle tone, and during recovery, throughout and after hospitalization. Specialized nutritionists ensure proper dietary management crucial both before and after surgery. This multidisciplinary team is supported by inpatient and operating room nursing staff specialized in abdominal wall disorders.

Do you suspect you may have abdominal diastasis, or have you already received a diagnosis and would like a second opinion? Learn more about the Hernia Center at UPMC Salvator Mundi International Hospital and book an appointment with our specialists.