Diastasis Recti

Diastasis recti (diastasis or rectus diastasis) is the separation of your rectus abdominis muscles. It’s a common condition that affects 6 in 10 women after childbirth. If you have it, your belly may appear to stick out just above or below your belly button, making you appear pregnant months or years after your last baby.

The rectus abdominis is a pair of muscles that run vertically along the front of your stomach. It’s frequently referred to as “six-pack abs.” The rectus abdominis is divided into left and right sides by a band of tissue called the linea alba.

As your uterus expands during pregnancy, your linea alba thins and pulls apart. Once you deliver your baby, your linea alba can heal and come back together. It’s elastic and retracts back (like a rubber band). But, just like a rubber band, your linea alba can lose its elasticity from stretching. When this happens, the gap in your abdominals won’t close as much as it should. The left and right sides of your abdominals stay separated and appear pushed outward. This is diastasis recti, and it can range from mild to severe.

Symptoms of diastasis recti

Diastasis usually develops in the third trimester. You may not notice signs of diastasis recti until several weeks after your baby is born.

Common signs of diastasis recti are:

• A visible bulge or “pooch” that protrudes just above or below your belly button (even after losing any weight you may have gained during pregnancy)
• Softness or jelly-like feeling around your belly button
• Coning or doming when you contract your ab muscles or lean back in a chair
• Difficulty lifting objects, walking or performing everyday tasks
• Low back pain
• Poor posture

What does diastasis recti feel like?

Diastasis recti isn’t painful. You may feel pain due to some of the side effects of diastasis, but the ab separation itself doesn’t hurt. You may feel weakness in your core when doing once-easy tasks, like lifting a laundry basket. Some people feel a jelly-like texture in the space between the left and right abdominals when contracting their ab muscles.

Risk factors

Several factors can increase your risk for developing diastasis recti:

• Having fewer than 12 months between pregnancies
• Being over 35 years old
• Having multiples (such as twins or triplets)
• Having a heavy or big baby
• Being extremely petite
• Pushing during a vaginal delivery

Complications of diastasis recti

If you don’t receive treatment or if you have severe diastasis recti, complications can include:

• Umbilical hernia
• Constipation
• Increase in back pain
• Leaking pee
• Pain during sex
• Pelvic and hip pain

How doctors diagnose diastasis recti

Your healthcare provider will check for diastasis, where it’s located and how severe it is. Diastasis recti can occur above your belly button, below your belly button and at your belly button

Your provider will use their hands and fingers to feel your abdominal area for gaps and muscle tone. Some providers may use ultrasound, measuring tape or a tool called a caliper for a more accurate measurement.

An abdominal gap wider than 2 centimeters is considered diastasis recti. Diastasis recti is also measured in finger widths, for example, two or three fingers’ separation.

Your healthcare provider may recommend exercises for diastasis recti, or they may refer you to a physical therapist.

How do I test myself?

You can test yourself for diastasis recti:

1. Lie on your back with your knees bent and feet flat on the floor.
2. Lift your shoulders slightly off the ground, keeping one hand behind your head for support, almost like you are doing a sit-up. Look down at your belly.
3. Move your other hand above your belly button area, palms down and fingers towards your toes.
4. Use your fingers to feel for a gap between the abs. See how many fingers can fit in the gap between your right and left abdominals.

If you feel a gap of two or more finger widths, discuss your concerns with your healthcare provider. They can confirm you have diastasis recti and recommend treatment.

How do I fix my diastasis recti?

To fix diastasis recti, you’ll need to perform gentle movements that tighten your abdominal muscles. Before starting an exercise program, be sure it’s safe for diastasis recti. Work with a physical therapist who has experience with diastasis recti. They can create a treatment plan to make sure you’re performing the movements correctly and progress to more challenging movements at the right time.

Certain movements will make abdominal separation worse. Here are some modifications you should make in the first six weeks postpartum:

• Avoid lifting anything heavier than your baby.
• Roll onto your side when getting out of bed or sitting up. Use your arms to push yourself up.
• Skip activities and movements that push your abdominals outward (like crunches and sit-ups).

You can wear an elastic belly band to help hold your belly in and support your lower back. Wearing binders can’t heal diastasis recti and won’t strengthen your core muscles. But they can be a helpful reminder to engage your core and use good posture.

Is it too late to fix it?

It’s never too late to repair your diastasis recti. With the proper exercises, you can fix your ab separation years after you’ve delivered your last baby.

Can you fix diastasis recti without surgery?

Yes, it’s possible to fix diastasis recti without surgery. Healthcare providers will recommend physical therapy or at-home exercises to help heal diastasis before surgery. They might do surgery if you have an umbilical hernia or if you want diastasis recti surgery (a tummy tuck).

Will it heal on its own?

Possibly. It depends on the severity and if you’re taking steps to help it. For example, mild cases with a little separation may improve with minimal effort

What are the best exercises?

The best exercises for diastasis recti are those that engage the deep abdominals. Most diastasis recti exercises involve deep breathing and slow, controlled movements. Unfortunately, many of the most common ab exercises (like crunches) can worsen your diastasis.

What movements make diastasis recti worse?

Any movement that bulges the abdominal wall forward can worsen your diastasis recti. Everyday movements like getting out of bed or up off a chair can make it worse. Try to be mindful about how you are using your abdominals as you go about your day.

You should avoid these exercise movements if you have diastasis recti:

• Crunches or sit-ups of any kind
• Planks or push-ups (unless using modifications)
• Downward dog, boat pose and other yoga poses
• Double leg lifts, scissors and other Pilates moves
• Any exercise that causes your abdominals to bulge, cone or dome

When should I see my healthcare provider?

Diastasis recti is a common and treatable condition. If you have more than a two-finger gap between your abdominals or are experiencing pain, contact your healthcare provider for a diagnosis. They may want you to see a physical therapist or pelvic floor specialist to help strengthen your abdominal muscles.

How do I prevent diastasis recti?

Some abdominal separation is normal and expected with pregnancy. There are some things you can do to lower your risk of developing diastasis recti:

• Maintain a healthy weight gain during pregnancy. Exercising and eating healthy foods can keep weight gain within a healthy range. Ask your pregnancy care provider if you’re unsure how much you should gain.
• Practice good posture and deep breathing. Stand up straight with your shoulders back. Take deep breaths that allow your ribs to expand and not just your belly.
• Perform safe core exercises. Avoid exercises like sit-ups and crunches that put pressure on your abdominals after 12 weeks of pregnancy and postpartum.
• Don't strain while lifting. Certain day-to-day activities like lifting grocery bags or your children can put undue strain on your abdominals.
• Log roll when getting out of bed. Roll to one side and use your arms to push up out of bed.

How long will it take to heal?

One study found that 45% of women have diastasis at six months postpartum. But the exact time it takes to heal depends on the amount of ab separation and how consistent you are with your strengthening exercises. After several weeks postpartum, this gap will start to close as your muscles regain strength.

Can I get diastasis recti again?

Yes, you can heal your diastasis recti and get it again. Your risk for diastasis recti increases the more times you’re pregnant. Think of the linea alba as a rubber band that’s continuously stretched. Over time, the rubber band will lose its elasticity. The linea alba may not regain its original shape or form after being stretched multiple times.

Can men get diastasis recti?

Yes, anyone can get it. It’s just most common in pregnancy. Men can get it from excessive or chronic straining. Things like lifting heavy weights, constipation or sudden weight gain/weight loss can contribute to men getting diastasis.