Diastasis recti abdominis: A comprehensive review

Du Y; Huang M; Wang S; Yang L; Lin Y; Yu W; Pan Z; Ye Z

doi:10.1007/s10029-025-03417-5

Diastasis recti abdominis: A comprehensive review

Du Y, Huang M, Wang S, Yang L, Lin Y, Yu W, Pan Z, Ye Z

Published July 7, 2025 Hernia : the journal of hernias and abdominal wall surgery

DOI 10.1007/s10029-025-03417-5 PMID 40622579 PMC PMC12234620

RRM Academy Synopsis

Diastasis recti is common in postpartum women and can also affect men

A review of studies from the past 20 years finds that diastasis recti, a midline muscle separation, is common in postpartum and menopausal women. It is also increasingly recognized in men, where it may be associated with older age and obesity. The review reports that core stabilization exercise improves function in mild cases. Severe cases may need surgery.

About 4 in 10 peri- and postmenopausal women in one study had diastasis recti above the navel. Source: Du Y et al., 2025, PMID 40622579.

Study at a glance, literature review: Diastasis recti is common in postpartum women and can also affect men. Source: Du Y et al., 2025, PMID 40622579.

Key Findings

Studies report postpartum incidence of approximately 21% to nearly 30%. In 150 peri- and postmenopausal women, 37.3% had supra-umbilical diastasis recti, and 78.6% of those with it also had pelvic floor dysfunction.
The review compares physical examination, ultrasound, CT, and MRI. CT involves ionizing radiation, and MRI carries higher cost and longer examination time.
In a randomized trial of 40 postpartum women with diastasis recti, added core stability training reduced inter-rectus distance and improved quality of life more than abdominal exercises alone (each P < 0.0001).
In a series of 45 patients having robotic-assisted diastasis recti repair (r-TARRD), 1 patient (2.22%) had a mesh infection at one month, and 4 patients (8.88%) had a recurrence at one year.
To date, no global consensus guideline exists for managing the condition. Germany and Sweden have put forward suggestions for national guidelines, and their surgical thresholds have not yet been unified.

Interpretation

The paper is a literature review of studies from the past 20 years. The authors state that it involves no data analysis of its own. The initial literature search yielded 355 publications. Priority went to 25 randomized trials, 19 observational studies, 49 systematic reviews, and 11 meta-analyses. Prevalence figures vary across studies. The authors say this is likely due to different measurement methods, sites, and diagnostic criteria. The review describes research on men as more limited. The authors also note that early postpartum separation often narrows on its own, which may bias early rehabilitation studies.

RRM Context

RRM considers the whole body across a woman's life. That includes how hormones change in pregnancy and menopause. In the review's account, pregnancy hormones loosen the connective tissue of the abdominal wall. The growing uterus also stretches it. In peri- and postmenopausal women, the condition often occurs with pelvic floor dysfunction.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Diastasis recti abdominis (DRA) refers to the separation of the rectus abdominis muscles along the linea alba. Though traditionally viewed as a postpartum cosmetic issue, DRA has functional implications and affects both women and men.

Methods

A comprehensive literature review was conducted using PubMed, Web of Science, and Google Scholar, identifying 355 relevant publications over the past two decades. Priority was given to high-quality studies including randomized trials, observational studies, systematic reviews, and meta-analyses.

Results

DRA is highly prevalent in postpartum and menopausal women, and increasingly recognized in males with risk factors such as obesity and aging. Diagnostic tools have evolved from clinical assessment to imaging modalities such as ultrasound, CT, MRI, and elastography. Conservative management, especially core stabilization, improves function in mild cases. Severe DRA may require surgical repair, including open, laparoscopic, or robotic-assisted techniques, often with mesh reinforcement. Rehabilitation and biomaterials enhance surgical outcomes. However, consensus is lacking on treatment indications and long-term efficacy.

Conclusion

Advances in diagnostics, surgical techniques, and rehabilitation have improved DRA management. Future efforts should focus on standardizing treatment criteria, enhancing personalized care, and evaluating long-term outcomes.

Shisong Wang, Libin Yang, Yunshou Lin

S Wang, L Yang, Y Lin

PMID 40622579 40622579 DOI 10.1007/s10029-025-03417-5 10.1007/s10029-025-03417-5 Du et al. 2025, Du 2025

Diastasis recti abdominis: A comprehensive review

Diastasis recti is common in postpartum women and can also affect men

Key Findings

Interpretation

RRM Context

Abstract

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