Rectus diastasis, also called diastasis recti, is widening between the paired rectus abdominal muscles as the connective tissue along the midline stretches. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains the abdominal wall, the difference between diastasis and a hernia, and approaches discussed for persistent concerns.
The recording focuses on changes associated with pregnancy, possible abdominal bulging and core weakness. It separates the abdominal wall from the fat and skin over it, helping explain why different causes of abdominal fullness need different assessments.
Key takeaways
🔬 The rectus muscles are a paired structure.
They run vertically along the abdomen and contribute to core function.
🔎 Pregnancy can stretch the midline.
Dr. Smith describes the expanding uterus and changes in the abdominal wall as a common scenario in his practice.
🔎 Diastasis and hernia are different.
With diastasis, the midline tissue is stretched; a hernia involves a defect in the abdominal wall through which tissue can protrude.
🔎 Function and appearance both enter the discussion.
The episode addresses core-strength concerns alongside abdominal contour.
🎯 Treatment needs an individual plan.
Dr. Smith discusses physical therapy, a historical Emsculpt approach and surgical plication in the context of a tummy tuck. These options should not be assumed to provide equivalent anatomical repair.
💬 Questions answered
Is diastasis recti the same as an abdominal hernia?
No. The episode distinguishes widening of the midline from an actual defect in the abdominal wall. An examination is needed to determine the cause of a bulge and whether a hernia is also present.
What does plication mean in this discussion?
It refers to surgical tightening with sutures to bring the stretched midline tissue closer together. Dr. Smith describes this as part of the abdominal-wall repair performed during selected tummy tucks.
ℹ️ Current context for this 2020 recording
Postpartum separation can improve during recovery after childbirth, although the degree and timing vary. The NHS postpartum guidance discusses this improvement and assessment for persistent concerns. This should not be generalized to every chronic or adult diastasis.
The European Hernia Society's 2021 guideline states that physiotherapy may be considered before surgery. A current assessment should guide rehabilitation and any surgical discussion; the recording's device comments do not establish that Emsculpt substitutes for that care.
🎧 Episode chapters
00:26 — Abdominal-wall anatomy
02:06 — Pregnancy and abdominal separation
02:43 — Diastasis versus hernia
04:22 — Nonsurgical treatment discussion
05:45 — Plication and tummy tuck surgery
🔗 Related information
Explore tummy tuck surgery, post-pregnancy contouring information, body-contouring procedures, or request a consultation with Dr. Smith in New York City.
About the host — current biography
Darren M. Smith, MD, FACS is a board-certified plastic surgeon in Manhattan specializing in mommy makeover surgery, breast surgery, and body contouring. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Originally released September 25, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Full transcript and related resources
