Abstract
Introduction: Diastasis recti abdominis (DRA), defined as the widening of the linea alba with separation of the rectus muscles, is commonly managed as a benign cosmetic consequence of pregnancy. However, increasing evidence suggests that DRA should be reconceptualised as a chronic disease of the abdominal wall, given its association with significant impairment in quality of life. Objective: This review synthesises current evidence to reframe DRA as a chronic disease of the abdominal wall, characterises its multidimensional impact on quality of life, and evaluates conservative, surgical, and nutraceutical strategies for improving quality of life. Methods: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from 1 January 2000 to 31 January 2026 for systematic reviews, randomised controlled trials, and longitudinal cohort studies addressing DRA epidemiology, pathophysiology, validated patient-reported outcomes (PROs), and management. Reporting adhered to the SANRA scale and relevant items from the PRISMA 2020 statement for narrative reviews. The search identified 487 records; after duplicate removal and staged screening, 52 sources were included for thematic synthesis (Section 2.4 and Figure S1). Methodological quality was assessed qualitatively using the Cochrane Risk of Bias 2 tool and the AMSTAR 2 tool. Results: DRA persisted in 32–46% of women at 12 months postpartum and in 22–36% between 5 and 30 years postpartum, meeting epidemiological criteria for a chronic condition. Validated PROs (SF-36, HerQLes, PFDI-20, Disability Rating Index, body-image scales) consistently demonstrated impairment in physical function, body image, urinary symptoms, and mental health. Surgical plication and minimally invasive techniques resulted in statistically significant and sustained improvements in quality of life. Conservative exercise modestly reduced the inter-recti distance and contributed to improved quality of life as part of a multimodal care strategy. Conclusions: DRA should be recognised as a chronic disease of the abdominal wall. Nutrition-informed multimodal care, including nutritional optimisation, structured rehabilitation, and individualised surgical repair, is essential for improving quality of life in this prevalent population.