Abdominal diastasis and abdominal wall hernias: why it is important to assess them together

Diastasis of the rectus abdominis muscles is frequently associated with midline hernias, especially umbilical and epigastric hernias.

Diastasis and umbilical hernia

Some patients may also have hernias in other regions of the abdominal wall, including inguinal hernias.

This association may depend on

Why do people with diastasis often develop umbilical and epigastric hernias?

The linea alba is the structure that joins the rectus muscles and contributes to the stability of the abdominal wall.

When a diastasis develops, this structure widens and may become thinner, changing the distribution of tension and the wall's ability to withstand intra-abdominal pressure.

The most frequently associated hernias are:

Why can inguinal hernias also be present?

Not all hernias associated with diastasis are located on the midline.

Some patients have at the same time

• Inguinal hernias+
• Femoral hernias+
• Other abdominal wall defects

This association may be favoured by common factors:

• Individual and genetic predispositionCharacteristics of collagen and connective tissue can influence the strength of the fascial structures.

• Increased intra-abdominal pressureObesity, repeated straining and chronic cough can contribute to the development of hernia defects.

• Pregnancy and changes to the wallCan favour widening of the linea alba and reveal pre-existing weaknesses.

• Tissue ageingCan contribute to a progressive loss of strength of the wall.

How can you tell if more than one hernia is present?

Some cause an obvious swelling, while others may be very small, cause few symptoms or be visible only during effort.

The most common signs include:

• Bulging of the navel or the area above it
• Small swellings along the midline
• Swelling in the groin, especially when standing or straining
• Discomfort, a feeling of heaviness or localised pain

The absence of symptoms does not rule out a hernia.

A specialist consultation combined with a dynamic ultrasound or other imaging tests makes it possible to identify even barely noticeable defects.

A complete reconstruction, not just the correction of one defect

When planning midline reconstruction, it is essential to assess the entire abdominal wall and look for any associated hernias, even if small or asymptomatic.

Repairing a diastasis changes the distribution of tension across the abdominal wall. For this reason, identifying other defects before surgery makes it possible to plan a complete reconstruction and avoid leaving hernias that could grow or become symptomatic over time.

The aim is to identify all the defects that can compromise the function of the wall and to correct them.

The choice depends on

1. position of the hernias
2. size of the hernias
3. symptoms
4. previous operations
5. patient characteristics

A complete assessment of the abdominal wall

A specialist consultation, supplemented where indicated by dynamic ultrasound or other imaging tests, makes it possible to identify the diastasis and associated hernias and to define a personalised surgical strategy.

1. Specialist consultation
2. Dynamic ultrasound or imaging
3. Personalised surgical strategy

The aim is to achieve a functional, stable and lasting reconstruction, reducing as far as possible the risk of further operations.

Frequently asked questions