Diastasis Recti: What It Is and How to Treat It

Did you know that every woman gets Diastasis Recti in their 3rd trimester (some may not even know they have it)? 100% of women at birth have some degree of abdominal separation.

After delivery, roughly 40% of new mothers will heal on their own, however, 60% won’t and will need some focused attention in this area.

This article will explain what diastasis recti is and what causes it.

We’ll also go over the common diastasis recti symptoms, how to check for diastasis recti, what to do if you have pain, and diastasis recti treatment with the physical therapist, as well as prevention.

What is diastasis recti?

Diastasis recti is a separation of the rectus abdominis (six-pack) muscles, either partially or completely.

Although rectus abdominis diastasis is most common during pregnancy since all pregnant women experience it due to their expanding uterus, diastasis recti can also occur in men who use the improper technique when lifting heavy objects or a variety of other reasons, as well as babies who were born prematurely and have underdeveloped abdominal muscles and internal organs.

Although it sounds scary, women rarely feel any diastasis recti pain.

The condition can correct itself and gradually go away as your body’s hormone levels drop after delivery.

However, 60% of women do NOT heal naturally.

Since your body needs time to heal, don’t check if you have diastasis recti immediately after birth.

Wait about 6-8 weeks before checking and if it doesn’t improve, several effective options for diastasis recti treatment include specific exercises and focused breath work.

Why does it matter if you have diastasis recti?

The integrity of the core muscles are reduced, leading to dysfunctions.

Some common symptoms are:

• Lower back pain
• Pelvic pain
• Pelvic floor issues (prolapse, incontinence, leakage)
• Constipation
• Bloating
• Hernia

These symptoms may worsen and, if you are in the 60%, they will NOT fix themselves on their own.

Change to this condition only happens if focused breathwork and approved diastasis recti work happens.

Causes of diastasis recti abdominis?

As hormonal levels change during early pregnancy to help tissues in the abdominal area to stretch in order to accommodate the growing baby, the tissue that connects all of the abdominal muscles (linea alba) at the belly’s midline also becomes thin.

This change can develop diastasis recti in the postnatal periods, literally translated as abdominal separation or the stretching of the abdominal wall.

It had been commonly believed that the amount of weight gained during pregnancy, the weight of the baby, and the mother’s body mass index (BMI) were factors that increased the risk of diastasis recti and the abdominal wall muscles stretching out.

However, a study in 2015 concluded that there was no connection between these factors and the increased or decreased likelihood of a woman experiencing abdominal separation during pregnancy.

One of the main causes of rectus diastasis is the hormones relaxin and estrogen, which allow body tissues and muscles to relax and stretch during pregnancy to make space for the growing baby.

Some additional factors may include:

• Number of pregnancies
• Genetics
• Posture
• Hormone levels
• Body type
• Prenatal exercise levels and workouts

This abdominal separation usually naturally improves after childbirth, but it can happen that tissues in the belly area lose elasticity from extreme stretching, in which case women may need to seek other options for diastasis recti treatment.

Women are at higher risk for more severe diastasis recti if they have had multiple pregnancies, are carrying more than one baby (e.g. twins, triplets, etc.) or a particularly heavy baby, are pregnant after the age of 35, have weak muscle tone, and if they are petite.

Even the pressure of pushing during delivery can cause or exacerbate it.

100% of women have some level of diastasis of the rectus abdominis in the third trimester – Gilliard and Brown 1996, Diane Lee 2013

Diastasis recti abdominis symptoms

The most obvious signs of diastasis recti are:

1. The postpartum belly pooch or bulging of the belly, especially when contracting or straining the abdominal muscles.
2. When sitting up from a lying position on your back, you may notice a “doming” of your belly, as if you’re still a few months pregnant.

During pregnancy, you might start to notice these symptoms:

• A ridge or bulge developing down the middle of your belly or above and below your belly button.
• Poor posture
• Lower back pain
• Weak core
• Bloating
• Constipation
• Leaking, inability to control bladder
• Overall pelvic floor issues

It becomes especially noticeable in the second or third trimester when you’re engaging your ab muscles to stand up, sit down, or lie down.

“Sixty-six percent of all the patients with DRA had at least one support-related pelvic floor dysfunction (SPFD) diagnosis,” according to a study by Spitznagle et al 2007. Because of this, other signs of diastasis recti might include leaking urine, especially when laughing or sneezing.

Women rarely feel pain during or after pregnancy from abdominal separation.

If you feel extreme pain in your abs, back, or pelvic area, consult your doctor right away. It may be a sign of a more serious issue like a diastasis recti hernia.

Although not as common, diastasis recti hernia can occur when the connective tissue that supports the bowels, uterus, and other organs become overly stretched and tear.

The organs protrude from the hole in the connective tissue, causing pain and possibly more serious problems.

How to check for diastasis recti

You should NOT test too soon after having a baby.

For some new moms, the mid-line closes on its own after having a baby, at least partially.

So testing before 6-8 weeks postpartum will likely give you an inaccurate reading and can create worry and very real insecurities in the mother.

There’s a simple diastasis recti physical exam you can do if you suspect that you might have the condition.

1. Lie flat on your back on the floor or somewhere where your body is fully supported.
2. Raise your knees with your feet flat on the floor. Have your knees bent.
3. Place one hand just above your belly button with your fingers pointed down toward your pelvis. Put your other hand behind your neck.
4. Slowly lift your head, with the support of your hand, just slightly off the floor. You’re not doing traditional crunches here, so don’t lift your head too high and don’t lift your shoulders off the floor.
5. With the hand above your belly button, feel if there’s a gap between your abdominal muscles. If there is one, measure how many finger width it is.
6. Keeping your head raised, move your hand a couple of inches above your belly button and measure if there is any gap there.
7. Finally, move the same hand a couple of inches below your belly button and measure any gap there, as well.

Results

• A gap of one to two fingers indicates moderate rectus diastasis.
• If the gap is greater than the width of two fingers, you should have it assessed by a doctor, physical therapist, or pelvic floor therapist.

Your doctor can use a caliper or ultrasound to test it more accurately and give you a plan for diastasis recti treatment.

With this being said, you do not need to wait until your 6-week check-up to begin healing.

Most new moms can begin the recovery process immediately after childbirth (as you can assume you have this condition).

Breathwork and extremely gentle exercises are hugely beneficial to safely awaken and guide your deep core muscles, along with your pelvic floor.

Diastasis recti treatment

For mild to moderate cases of abdominal separation, your muscles will often move back together naturally without special physical therapy (this is roughly 40% of women, the other 60% will need more focused support).

If you’re still experiencing symptoms beyond eight weeks after delivery, there are a few things to consider.

You can try exercises for diastasis recti postpartum that are often taught at physical therapy, or consult a doctor, pelvic floor therapist, or physical therapist for more severe cases.

A certified personal trainer can also help in some cases.

In rare instances and extreme cases, a physical therapist might suggest reconstructive surgery or aesthetic plastic surgery after assessment.

There isn’t an exact protocol on how to heal diastasis recti, but there are some things you can do and not do that’ll allow the muscles to grow back together and regain strength naturally.

An encouraging stat about abdominal separation is that women years out from having a baby can still repair their diastasis recti.

Belly binder for abdominal muscles

A maternity belt or belly binder can help support abdominal muscles and improve your posture during and after pregnancy.

A tubular bandage-like Tubigrip can help, as well. Belly binding, in which a long cloth wrap is used to wrap the entire abdomen, is another method that’s growing in popularity.

• Try to maintain good posture whenever possible. Keep your head up and shoulders back with your back straight.
• When sitting, use a pillow or rolled-up towel between your back and the chair to support your lower back.

More times than not, new moms will purchase a waist trainer (that is far too tight for them) in the hopes of fixing their diastasis recti.

This is detrimental to their pelvic floor health and focuses pressure down towards the pelvic floor and towards the diaphragm. Imagine squeezing a water balloon in the middle!

Belly wrapping is more gentle on the midsection and has proven to work on supporting the new mother (both emotionally and physically).

Imagine a snug hug for your midsection. Nothing should be painful or constricting.

Be careful when getting up

When getting up from a lying position, don’t engage your core by sitting directly up, because that can put your rectus abdominis muscle at risk.

Instead, bend your knees and roll to your side, then use your arm to push yourself up to a sideways sitting position. Then slide your legs to the front and push yourself up off the bed or sofa with your arms and legs.

Do not lift heavy objects

Avoid lifting any heavy objects, including children, during pregnancy, as this can weaken abdominal muscles.

This applies to movement both in physical therapy and out of physical therapy as well.

After delivery, lift everything very carefully, and if you feel any pain or strain, stop immediately.

Avoid placing children on your hip, as this puts further strain on your core muscles.

Be careful on the toilet

If constipated, avoid any excessive pushing or straining that can further damage or even tear your muscles and connective tissue.

If you need to cough, use one hand to support your stomach muscles to reduce strain from the pressure.

Diastasis recti treatment is more about avoiding further damage or strain to your abdominal muscles so they can heal naturally.

So try to find ways to avoid unnecessary bending and lifting.

If you do seek the help of a doctor or physical therapist after giving birth, they might use electrical muscle stimulation to gently stimulate the rectus abdominis muscle.

This often helps reduce the amount of muscle separation and improves muscle function more quickly.

Diastasis recti prevention

Much like diastasis recti treatment, there aren’t a lot of specifics on how to prevent diastasis recti.

Core strengthening exercises before and during pregnancy are the best prevention, as well as exercises that strengthen the pelvic floor.

Check out these specialized postpartum exercises that are diastasis-safe.

As we’ll discuss in the next section, the same exercises can be done for both treatment and prevention.

While pregnant, the best prevention is also to avoid any movement that puts extra strain on the abdominal muscles like heavy lifting, holding children on one hip or any exercises that cause the stomach muscles to bulge out.

The traditional ways of strengthening your core do not apply during pregnancy or after having a baby.

Avoid front planks, crunches, and weighted twists.

These can actually cause more harm and intensify the bulging of the abdomen.

Instead, focus on breathwork (imagine blowing out candles and engaging your core) and only approved diastasis recti exercises.

Start with breathing movements to learn how to engage your deep core muscles.

Slowly progress into more advanced movements with the engagement of those muscles.

The goal here is to focus on your pelvic floor and the deepest layer of your ab muscles: the transverse muscles.

Many women may be under the impression that core work (front planks and tons of crunches) will flatten and tone the tummy and close the diastasis recti gap quicker.

This is the opposite of what you should be doing! Many core exercises aggravate this condition and will set you back in your diastasis recti recovery, including your stomach protruding.

Post-baby, be sure to give your body some time to re-adjust, allow organs to move back to previous places, and let the healing begin.

Debunking Diastasis Recti Myths

MYTH – You need to wait for your 6-week postpartum checkup to heal your diastasis recti.

Most new moms can begin the recovery process immediately after childbirth.

Breathwork and extremely gentle exercises are hugely beneficial to safely awaken and guide your deep core muscles, along with your pelvic floor.

MYTH – Your abs are cut during a C-section

Your abs are not cut during a c-section, but 8 layers of tissue are!

MYTH – There is no reason to work on my DR because I want to get pregnant another time. This will just happen again!

No no no! It is essential to learn the core concepts now, no matter where you are in your life, pregnancy, or postpartum journey.

Recovering safely now, will minimize pressure during another pregnancy, and develop healthy habits.

MYTH – If you are currently pregnant, you can’t help minimize the DR gap.

Not true! What you do during pregnancy can help minimize DR!

You cannot 100% prevent DR, but you can help reduce this.

This is ‘prehab.’ Learning how to move and breathe with your growing belly, strengthening your core safely, and limiting stress and strain on this weakened area, is critical to maintaining core connection and limiting the gap to a healthy ab separation.

Conclusion

Diastasis recti happens when ab muscles separate during pregnancy, thanks to pregnancy hormones, the growing uterus, higher body weight, and losing abdominal strength in the abdominis muscles.

This condition is extremely common for pregnant and postpartum women.

It may cause some discomfort and limited functionality due to muscle weakness.

On the other hand, it shouldn’t cause any pain or other major issues and should heal naturally on its own.

If you do feel a lot of pain, or the condition is prolonged for more than eight weeks postpartum, then it’s a good idea to consult your healthcare provider or physical therapist to provide medical advice.