What is diastasis recti?
Diastasis recti is the partial or complete separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Diastasis recti is very common during and following pregnancy. This is because the uterus stretches the muscles in the abdomen to accommodate your growing baby. One study found that up to 60 percent of women may experience diastasis recti during pregnancy or postpartum.
The condition isn’t limited to pregnancy, though. It can affect anyone, including newborn babies and men. In some cases, it can result from lifting heavy weights incorrectly or performing excessive or unsafe abdominal exercises.
A vertical bulge down the midline of the abdomen can be seen in many newborns when intra-abdominal pressure increases. In this photo, a shadow lateral to the bulge can be seen going up the left side of the abdomen, starting near the umbilical clamp. Diastasis recti is caused by a relative weakness of linea alba “the fascia between the two rectus abdominus muscles”.
What are the diastasis recti symptoms?
The most common symptom of diastasis recti is a pooch or bulge in your stomach, especially when you strain or contract your abdominal muscles. Additional symptoms include:
- lower back pain
- poor posture
During pregnancy, you might not have any noticeable symptoms as your abdominal muscles separate. But during the second or third trimester, you might see a bulge or ridge developing on your belly. It can appear above and below the bellybutton. It might be most noticeable when you’re trying to use your ab muscles to stand, sit up, or lie down.
If you experience any extreme abdominal, back, or pelvic pain, see your doctor right away.
After delivery, the most noticeable symptom is a bulge or “pooch” in your belly area. Even though you’re no longer pregnant, it might look like you still are.
Here’s how to self-check yourself for diastasis recti after childbirth:
- Lie on your back, legs bent, feet flat on the floor.
- Raise your shoulders up off the floor slightly, supporting your head with one hand, and look down at your belly.
- Move your other hand above and below your bellybutton, and all along your midline ab muscles. See if you can fit any fingers in the gaps between your muscles.
- If you feel a gap, or separation of one to two finger lengths, you likely have a moderate case of diastasis recti. After a few weeks postpartum, the gap will start to narrow as your muscles regain strength.
Your doctor or physical therapist can also check for diastasis recti using a measuring tool called a caliper or an ultrasound. These will give them a more accurate measurement. Your doctor or physical therapist should also evaluate any gap greater than two finger lengths.
What are the causes?
Excessive inner-abdominal pressure causes diastasis recti. During pregnancy, your abdominal muscles and connective tissues are stretched out from your expanding uterus. They’re helped along by the pregnancy hormones relaxin and estrogen. Pushing during delivery can also lead to such condition. Experiencing some abdominal separation during and following pregnancy is expected.
In the past, body mass index (BMI), weight gain during pregnancy, weight of the baby, and maternal age were considered risk factors. But a 2015 study found no connection between these factors and pregnant women being more or less likely to experience the condition.
Newborn babies are sometimes born with diastasis recti, especially if they’re premature. That’s because their abdominal muscles aren’t fully developed and connected. The condition usually corrects itself with time.
How is it treated?
Most women will experience some abdominal separation during pregnancy. This can weaken your core and lead to back or pelvic pain. You may need to wear a binder or Tubigrip for support during the day. Also, take care to do the following:
- Avoid any heavy lifting or further straining of your abdominal muscles until after you deliver.
- Practice good posture.
- Support your lower back when sitting with a towel or pillow placed behind you.
- Bend your knees, roll, and support yourself with your arm when getting in or out of bed, or standing up off the floor.
During pregnancy, you can continue to strengthen your core, but follow modified, pregnancy-safe exercises for diastasis recti.
For some women, diastasis recti may correct itself after delivery as the ab muscles regain strength. If you’re still experiencing symptoms or separation eight weeks postpartum, exercises may help. You can perform the exercises at home, or work with a physical therapist or postpartum fitness specialist.
Postpartum treatment for diastasis recti usually involves pelvic floor and deep stomach muscle exercises. Always check with your doctor and get their approval before you start exercising after delivery. After you get the OK, follow a specialized workout for diastasis recti.
Things to avoid
Avoid traditional crunches, situps, and planks postpartum until your abdomen is healed from diastasis recti. These exercises can make the condition worse.
You should also avoid:
- any strenuous exercises where your ab muscles are bulging out
- holding your baby on one hip, if it’s painful
- lifting or carrying heavy loads
- coughing without supporting your ab muscles.
Are there any complications?
Diastasis recti can lead to the following complications:
- jeopardized trunk stability and mobility
- back pain
- pelvic pain
- damage to your posture
- pelvic floor dysfunction
- hernia, in extreme cases
Preventing diastasis recti
Pre-pregnancy, practice strengthening your core. This should include your pelvic floor and oblique muscles. It’s important to always use good form when performing abdominal exercises. Avoid any exercise where your tummy bulges out or that causes your back to strain. Ask a certified personal trainer for help.
What’s the outlook?
A physical therapist who specializes in postpartum recovery can recommend exercises to help improve diastasis recti symptoms. If pain from diastasis recti is interfering with your ability to perform day-to-day activities, surgery is an option. Some women also elect for surgery for cosmetic reasons. Talk to your doctor about a treatment plan that will work best for you.