Understanding Postpartum Abdominal Changes: Diastasis Recti vs. Hernia

The postpartum period brings many physical changes, and concerns about abdominal appearance and function are among the most common issues new mothers face. Two conditions that frequently cause confusion are diastasis recti and abdominal hernias. While both can create visible changes to the abdominal area and cause discomfort, they are distinctly different conditions that require different approaches to treatment.

What is Diastasis Recti?

Diastasis recti, also known as abdominal separation, occurs when the rectus abdominis muscles (the “six-pack” muscles) separate along the midline of the abdomen. This separation happens at the linea alba, the connective tissue that runs down the center of your abdomen. During pregnancy, hormonal changes and the growing uterus cause this tissue to stretch and thin, allowing the abdominal muscles to move apart.

This condition is incredibly common, affecting up to 60% of pregnant women and remaining present in about 32% of women at 12 months postpartum. The separation can range from mild to severe, and while it’s a natural adaptation to pregnancy, it doesn’t always resolve on its own without proper intervention.

Signs That May Indicate Diastasis Recti

A visible ridge or “doming” down the center of the abdomen when sitting up or coughing is the most recognizable sign. You might also notice a soft, squishy feeling along the midline of the abdomen, difficulty engaging your core muscles effectively, lower back pain or pelvic floor dysfunction, poor posture, or feeling like your core isn’t providing adequate support during daily activities.

Understanding Abdominal Hernias

An abdominal hernia occurs when internal tissue or organs push through a weakened area in the abdominal wall, creating a noticeable bulge. In postpartum women, the most common types are umbilical hernias (around the belly button) and incisional hernias (at cesarean section sites).

Unlike diastasis recti, which involves muscle separation without a true defect in the abdominal wall, a hernia represents an actual hole or weakness through which internal contents can protrude. This makes hernias a more serious medical condition that often requires surgical intervention for proper resolution.

Signs That May Indicate a Hernia

A distinct bulge that becomes more prominent when coughing, straining, or standing upright is the hallmark sign. You might experience pain or discomfort, especially when lifting or bending, notice a bulge that can often be pushed back in when lying down, or in more serious cases, experience nausea or vomiting. A firm, tender mass that doesn’t reduce when lying down requires immediate medical attention.

The Complexity of Accurate Diagnosis

Distinguishing between diastasis recti and hernias can be challenging, even for experienced healthcare professionals. Both conditions can coexist in the same patient, and symptoms can overlap significantly. Some women may have diastasis recti with a small hernia, while others might have what appears to be diastasis recti but is actually a wide hernia defect.

The location, size, depth, and characteristics of the abdominal changes all play crucial roles in accurate diagnosis. Additionally, the width of separation in diastasis recti, the tension and quality of the connective tissue, and the presence of any true fascial defects all influence both the appearance and the appropriate treatment approach.

Why Professional Assessment is Essential

While it’s natural to want to understand what’s happening with your body, self-diagnosis of abdominal conditions can be problematic and potentially dangerous. Physical therapists trained in women’s health have specialized knowledge and hands-on assessment techniques to differentiate between these conditions accurately.

Professional evaluation is crucial for safety considerations, as hernias can have serious complications if left untreated, including strangulation of trapped tissue. A healthcare professional can identify warning signs and determine if immediate medical attention is needed.

The treatment approach for diastasis recti versus a hernia is completely different. Diastasis recti often responds excellently to targeted exercise programs and physical therapy, while hernias may require surgical repair. Using the wrong approach could potentially worsen the condition or delay appropriate treatment.

The Role of Physical Therapy

For diastasis recti, physical therapy has proven to be highly effective. A specialized women’s health physical therapist can design a progressive exercise program that focuses on restoring proper breathing mechanics and core activation, strengthening the deep abdominal muscles and pelvic floor, improving posture and movement patterns, and gradually increasing functional strength and endurance.

Even when a hernia is present, physical therapy can play an important role in preparing for surgery, optimizing recovery, and preventing future problems by addressing underlying movement patterns and core weakness that may have contributed to the initial problem.

When to Seek Professional Help

Don’t wait to address postpartum abdominal concerns. Early intervention often leads to better outcomes, whether you’re dealing with diastasis recti, a hernia, or both. Seek professional evaluation if you notice any changes in your abdominal area, experience pain or discomfort, or have concerns about your core function.

Remember that these conditions are common, treatable, and nothing to be embarrassed about. Your body has accomplished something incredible, and seeking help to optimize your recovery is an important part of taking care of yourself and your family.

Conclusion

Understanding the differences between diastasis recti and hernias is important, but professional assessment and guidance are essential for proper diagnosis and treatment. The women’s health specialists at Gordon Physical Therapy in Spokane Valley, WA have the expertise to accurately evaluate your postpartum abdominal concerns and develop an appropriate treatment plan.

Don’t let uncertainty prevent you from getting the help you deserve. Call us today at 509.892.5442 to schedule your comprehensive postpartum assessment. Our specialized approach can help you regain confidence in your body and return to the activities you love safely and effectively!