Is it a hernia or something else?

William Cobb, MD

General Surgery

Most people have heard of a hernia, but diastasis recti is a common condition that is frequently confused with hernia. The two are distinctly different and require different treatments. Surgeon William Cobb, MD, explained how to distinguish between them.

What is diastasis?

The term diastasis means a separation of two parts. Recti are the straight muscles of the midline of the abdominal wall, frequently referred to as the “six-pack” muscles. “With a diastasis, a bulge may become noticeable in the midline of the abdomen, especially when you raise your head while lying flat. For this reason, it is frequently confused with a hernia,” said Dr. Cobb.

What causes diastasis?

There are several things that can cause diastasis, including:

• It occurs naturally. Diastasis, or separation, of the rectus muscles can occur naturally, meaning that the patient is born this way.
• Weight gain. Over time, if you gain excess weight, pressures can widen the separation and make the bulge more apparent.
• Pregnancy. Separation of the midline muscles can also occur in women following pregnancy. As the abdominal wall expands to accommodate the baby, widening of the gap between the rectus muscles may occur. The separation may persist following delivery of the baby.

Can both men and women experience diastasis?

Typically, men have separation of the rectus muscles in the upper portion of the abdominal wall; whereas, women are more likely to have diastasis of the lower portion of the abdomen.

How can you distinguish between diastasis and a hernia?

Dr. Cobb said with a diastasis, there is a widening of the muscles, but the fascia of the abdominal wall stays intact. The fascia is the collagen sheet that covers the muscles and gives patients the shape and form of their abdominal wall. If there is a hole or defect in the fascia, this condition is the definition of a hernia. The implications of the two are dramatically different.

Distinguishing a diastasis from a hernia can be challenging. However, there are some clues, including:

• A diastasis occurs in the midline of the abdominal wall.
• Hernias can occur anywhere.
• Hernias of the abdominal wall are typically in the site of previous surgery.
• Diastasis does not enlarge over time, whereas hernias typically do.
• Hernias can strangulate which can present as emergent situations due to potential harm to the intestines. This concern does not exist with a diastasis, as the fascia remains intact.

What are the treatment options?

Dr. Cobb said the only definitive treatment of a hernia involves surgery with closure of the hole, usually supported by mesh. You may elect to not have surgery if the hernia is small in size, is not painful or if other conditions make surgery too risky.

For a diastasis, treatment rarely involves surgery. In the majority of cases, it is important to understand there is no possibility of the bowel becoming trapped with a diastasis. Additionally, it is uncommon for a diastasis to enlarge or worsen.

“Exercise to strengthen the core muscles may help to minimize the bulging. However, the normal anatomy will never be restored. Rarely, if the diastasis causes significant pain or loss of support of the back, surgery may be appropriate. Usually in this situation, the surgery is considered cosmetic and repair may be combined with the assistance of plastic surgery,” said Dr. Cobb.

If you have a bulge in your abdomen and are concerned about a hernia or diastasis, talk to your doctor.