A midline gap between the six-pack muscles — the bulge that appears down the centre of the abdomen when you sit up. Extremely common after pregnancy, frequently dismissed, and very treatable when it matters.
The two rectus abdominis muscles — the 'six-pack' — are joined at the midline by a band of connective tissue called the linea alba. Pregnancy, significant weight change, and chronic straining can stretch this band, letting the muscles drift apart. The result is diastasis recti: a widened, lax midline that domes outward on exertion.
Unlike a hernia, there is no defect through which contents can strangulate — diastasis on its own is not dangerous. But it commonly causes a bulging profile, core weakness, back discomfort, and difficulty returning to exercise. It also frequently coexists with a true umbilical or epigastric hernia at the same midline, which does need repair.
The assessment that matters is distinguishing pure diastasis, diastasis with an associated hernia, and a primary hernia alone — because the treatment for each is different.
Diastasis announces itself functionally as much as visibly.
A ridge or dome running vertically from breastbone to navel when rising from lying — the classic sign, easily demonstrated at examination.
Difficulty with lifting and exercise, a feeling that the core doesn’t properly engage, and lower back discomfort from lost abdominal support.
A distinct lump at the umbilicus alongside the general midline laxity suggests a coexisting umbilical hernia — worth confirming with an ultrasound.
Every diastasis pathway at THI starts with a structured physiotherapy programme — progressive deep-core retraining over 8–12 weeks with our rehabilitation team. For many patients, particularly in the first year after delivery, this meaningfully narrows the gap and restores function.
Surgery is considered when a significant, symptomatic separation persists despite committed rehab, or when a true hernia coexists. Options range from endoscopic plication techniques (eTEP-RS, SCOLA) that repair the midline through keyhole incisions, to open plication combined with abdominoplasty where skin laxity is a dominant concern — often planned jointly with a plastic surgeon.
When an umbilical or epigastric hernia coexists, it is repaired in the same operation — one anaesthetic, one recovery.
Often, substantially — a structured deep-core programme narrows the gap and restores function for many patients, especially within the first year after pregnancy. Generic 'ab workouts' (crunches, planks done early) can make doming worse; the programme needs to be specific and supervised.
No — by itself it is a separation, not a hole, so nothing can strangulate. The caveat is that true umbilical or epigastric hernias commonly coexist along the same midline, and those do carry hernia risks. That is why a proper assessment matters.
When a significant separation remains symptomatic after 3–6 months of committed rehabilitation, or when a coexisting hernia needs repair anyway. Repair is a functional operation as much as a cosmetic one — restoring the midline restores core mechanics.
Techniques such as eTEP-RS and SCOLA repair the midline through a few keyhole incisions — plicating (stitching together) the stretched linea alba and reinforcing it with mesh where indicated — avoiding a long open incision. Suitability depends on your anatomy and skin quality.
Usually yes — a future pregnancy can stretch a repair. We generally recommend completing your family before definitive repair, and using rehabilitation to manage symptoms in the meantime. Every case is discussed individually.
Most consultations result in a clear, written plan within 30 minutes. For outstation patients, we offer teleconsultation before any travel is required.