Difference Between Central Hernia and Diastasis Recti
A central hernia is a true defect in the abdominal wall with protrusion of abdominal contents through the linea alba, while diastasis recti is a separation of the rectus abdominis muscles without a fascial defect—it is not a hernia. 1
Key Anatomical and Clinical Distinctions
Diastasis Recti
- Defined as separation of the rectus abdominis muscles wider than 2 cm, with thinning and stretching of the linea alba tissue but without a true fascial defect 2
- The linea alba remains intact but becomes attenuated and widened 3
- Results in bulging of the abdominal wall but does not carry the same risks of actual herniation as a true hernia 4
- Most commonly occurs in women during pregnancy and postpartum 1
Central (Midline) Hernia
- A true fascial defect in the linea alba with protrusion of abdominal contents through the defect 3
- Carries risk of incarceration, strangulation, and bowel obstruction—complications that do not occur with isolated diastasis recti 4
- Includes umbilical hernias, epigastric hernias, and other midline defects 5
Critical Clinical Relationship
Diastasis recti is an important risk factor for developing midline hernias and increases the rate of hernia recurrence after repair 3. The thinning and widening of the linea alba in diastasis creates structural weakness that predisposes to true hernia formation 3.
Common Clinical Presentation
- 85% of patients presenting with diastasis recti have a concomitant abdominal wall hernia, most commonly umbilical 5
- When both conditions coexist, they represent a more challenging surgical problem requiring different treatment strategies 3, 5
Management Implications
Diastasis Recti Alone
- Correction is largely cosmetic rather than medically necessary 4
- Primary symptoms include impaired body image and core instability 2
- Physiotherapy may be considered as initial management 2
- Surgical repair involves plication of the linea alba without necessarily requiring mesh 2
Central Hernia (with or without Diastasis)
- Requires surgical repair due to risk of complications including incarceration and strangulation 3
- When diastasis recti coexists with midline hernia, mesh-based repair with linea alba plication is recommended to address both the hernia defect and provide abdominal wall support 2, 3
- Failure to address underlying diastasis when repairing a midline hernia results in increased recurrence rates (potentially as high as 40%) 4, 3
Common Diagnostic Pitfall
The presence of abdominal wall bulging does not automatically indicate a hernia—it may represent diastasis recti alone 1. Physical examination should specifically assess for a palpable fascial defect versus diffuse widening of the linea alba. When a true hernia defect is present alongside diastasis (which occurs in the majority of cases), both conditions must be addressed surgically to achieve optimal outcomes 3, 5.