Body
What Is a Rectus Diastasis?
Rectus diastasis, also called diastasis recti, is widening between the paired rectus abdominal muscles as the connective tissue along the midline stretches. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains the abdominal wall, the difference between diastasis and a hernia, and approaches discussed for persistent concerns.
In this episode.
Episode summary
Rectus diastasis, also called diastasis recti, is widening between the paired rectus abdominal muscles as the connective tissue along the midline stretches. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains the abdominal wall, the difference between diastasis and a hernia, and approaches discussed for persistent concerns.
The recording focuses on changes associated with pregnancy, possible abdominal bulging and core weakness. It separates the abdominal wall from the fat and skin over it, helping explain why different causes of abdominal fullness need different assessments.
Key takeaways
🔬 The rectus muscles are a paired structure.
They run vertically along the abdomen and contribute to core function.
🔎 Pregnancy can stretch the midline.
Dr. Smith describes the expanding uterus and changes in the abdominal wall as a common scenario in his practice.
🔎 Diastasis and hernia are different.
With diastasis, the midline tissue is stretched; a hernia involves a defect in the abdominal wall through which tissue can protrude.
🔎 Function and appearance both enter the discussion.
The episode addresses core-strength concerns alongside abdominal contour.
🎯 Treatment needs an individual plan.
Dr. Smith discusses physical therapy, a historical Emsculpt approach and surgical plication in the context of a tummy tuck. These options should not be assumed to provide equivalent anatomical repair.
Questions this episode answers
Is diastasis recti the same as an abdominal hernia?
No. The episode distinguishes widening of the midline from an actual defect in the abdominal wall. An examination is needed to determine the cause of a bulge and whether a hernia is also present.
What does plication mean in this discussion?
It refers to surgical tightening with sutures to bring the stretched midline tissue closer together. Dr. Smith describes this as part of the abdominal-wall repair performed during selected tummy tucks.
ℹ️ Current context for this 2020 recording
Postpartum separation can improve during recovery after childbirth, although the degree and timing vary. The NHS postpartum guidance discusses this improvement and assessment for persistent concerns. This should not be generalized to every chronic or adult diastasis.
The European Hernia Society's 2021 guideline states that physiotherapy may be considered before surgery. A current assessment should guide rehabilitation and any surgical discussion; the recording's device comments do not establish that Emsculpt substitutes for that care.
🔗 Related information
Explore tummy tuck surgery, post-pregnancy contouring information, body-contouring procedures, or request a consultation with Dr. Smith in New York City.
Originally released September 25, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Original show notes
Board certified NYC plastic surgeon discusses rectus diastasis and the key to a flat abdomen.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. What is a rectus diastasis? We'll start with a little anatomy. Your abdominal wall is composed of several layers. The outermost layer, which we're looking at all the time, is the skin. Underneath that is some superficial or shallow fat. Underneath that is the abdominal wall itself which consists of thick connective tissue called fascia and several muscle groups and the most widely discussed of these are the rectus muscles or the rectus abdominis muscles and these are paired muscles that run vertically up and down your abdomen and are responsible for the appearance of a six pack and they're also really central to core strength.
[01:19] and below this level we get into the deep abdominal fat which is also called the visceral abdominal fat because it surrounds your viscera or internal organs which are also sitting below the abdominal wall itself. A rectus diastasis then sometimes called a diastasis recti is when the two paired rectus muscles, which remember are running vertically up and down your abdomen, become separated from one another. So there is only a weak layer of connective tissue that remains between these muscles and that separates the superficial fat above from your internal organs and visceral fat below. What causes a rectus diastasis? In our practice, the most frequent cause of rectus diastasis, and we see this all the time, is pregnancy. Because during pregnancy, the uterus grows and expands to accommodate the developing fetus. And as this happens, it...
[02:26] often needs to make more room for itself than the rectus muscles are providing. So the growing uterus can essentially stretch out the abdominal wall and separate the rectus abdominis muscles from one another and this results in a rectus diastasis. Is a rectus diastasis the same thing as a hernia? No, a rectus diastasis is not a hernia. The difference here is that a rectus diastasis is a separation of the rectus muscles which leaves behind a weakened area of connective tissue between these muscles and the abdominal wall itself does remain intact although it is weakened. In a hernia, and there are several kinds of hernia, but for the sake of this discussion we're focusing on an abdominal hernia, there is actually a break or a hole in the abdominal wall which can allow the deeper abdominal contents and visceral fat to bulge into or herniate into more superficial anatomical layers. Can erectus diastasis get worse over time?
[03:35] Yes, if you continue to place strain on your abdominal wall, either with further pregnancies or heavy lifting or anything else that can work to separate the rectus abdominis muscles from one another, the rectus diastasis can continue to evolve and worsen over time. Is a rectus diastasis permanent? unless steps are taken to address or fix erectus diastasis, it will remain permanently. These do not resolve or get better on their own. Can erectus diastasis be fixed? Yes, it can. And we'll get into that in a little bit more detail in a moment. Do you need to have surgery to fix erectus diastasis? That's a bit more of a complicated question.
[04:31] And the reason is that there are some physical therapy maneuvers that can improve erectus diastasis and help with core strength. And while in mild cases this therapy may significantly improve your core strength, it will not actually fix the anatomical basis of the rectus diastasis. Similarly, Another non-surgical way to fix erectus diastasis is with Emsculpt, and this is a procedure we've discussed at length in other episodes, but essentially it uses highly focused electromagnetic energy, or HIFEM, to stimulate the abdominal muscles. In fact, it can generate up to 20,000 contractions in about 30 minutes. Emsculpt can grow your rectus abdominal muscles, increase their muscle mass, and in so doing, it can actually reduce the width of a rectus diastasis by several percentage points. However, again, I would not rely on Emsculpt to treat a severe rectus diastasis, but in a mild case, it could offer some improvement.
[05:45] So, unfortunately, the only way to definitively manage erectus diastasis is with surgery. And we do this in a tummy tuck or abdominoplasty, which we've also discussed in an earlier episode, but as far as it pertains to erectus diastasis, During a tummy tuck or abdominoplasty we actually identify the borders of the rectus abdominis muscles in the midline and then we actually sew those medial borders of the rectus diastasis muscles together in a process called plication. So while a rectus diastasis is a very common problem and it can cause functional issues by making you feel like you have a weak core or aesthetic issues by causing an abdominal bulge and making it very difficult to achieve a flat abdomen, rectus diastasis is fairly easily managed in minor cases by other physical therapy or with Emsculpt and in more severe cases with an abdominoplasty. Thanks for listening and don't forget to subscribe, share the show, and head over to DarenSmithMD.com for more real-world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-09-25. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS