If you have a postpartum belly pooch that doesn’t seem to go away, or you’re still looking pregnant even months after giving birth, you may have a condition called diastasis recti. Although it’s not often talked about, diastasis recti is common and highly preventable and treatable.
In this article, we’ll 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 and prevention. We’ll also talk about what to avoid so it doesn’t get worse.
What is diastasis recti?
Diastasis recti is a separation of the rectus abdominis (six-pack) muscles, either partially or completely.
Although it’s most common during pregnancy, with up to 60% of pregnant women experiencing it, it can also happen to men who use the improper technique when lifting heavy objects, as well as babies who were born prematurely and have underdeveloped abdominal muscles.
Although it sounds scary, women rarely feel any diastasis recti pain. The condition normally corrects itself and gradually goes away as your body’s hormone levels drop after delivery.
However, if it doesn’t improve within a few weeks, there are several effective options for diastasis recti treatment including specific exercises.
What causes diastasis recti
As hormonal levels change during pregnancy to help tissues stretch 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 can cause rectus diastasis, literally translated as abdominal separation.
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.
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.
The main causes of rectus diastasis are the hormones relaxin and estrogen, which allow body tissues and muscles to relax and stretch during pregnancy to make space for the growing baby.
This abdominal separation usually naturally improves after childbirth, but it can happen that tissues 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 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 symptoms
The most obvious signs of diastasis recti are:
- The postpartum belly pooch or bulging of the belly, especially when contracting or straining the abdominal muscles.
- 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
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 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 tears. The organs then protrude from the hole in the tissue, causing pain and possibly more serious problems.
How to check for diastasis recti
There’s a simple diastasis recti test you can do if you suspect that you might have the condition.
- Lie flat on your back on the floor or somewhere where your body is fully supported.
- Raise your knees with your feet flat on the floor.
- Place one hand just above your belly button with your fingers pointed down toward your pelvis. Put your other hand behind your neck.
- Slowly lift your head, with the support of your hand, just slightly off the floor. You’re not doing a crunch here, so don’t lift your head too high and don’t lift your shoulders off the floor.
- With the hand above your belly button, feel if there’s a gap between your abdominal muscles. If there is one, measure how many fingers wide it is.
- Keeping your head raised, move your hand a couple of inches above your belly button and measure if there is any gap there.
- Finally, move the same hand a couple of inches below your belly button and measure any gap there, as well.
- 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 or physical therapist.
Your doctor can use a caliper or ultrasound to test it more accurately and give you a plan for diastasis recti treatment.
Diastasis recti treatment
For mild to moderate cases of abdominal separation, your muscles will often move back together naturally. If you’re still experiencing symptoms beyond eight weeks after delivery, there a few things to consider. You can try exercises for diastasis recti postpartum, or consult a doctor or physical therapist for more severe cases. In rare instances, surgery may be required.
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.
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.
Be careful when getting up
When getting up from a lying position, don’t engage your core by sitting directly up. 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. After delivery, lift 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.
Diastasis recti is extremely common for pregnant and postpartum women and nothing to be afraid of. 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. However, 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 doctor or physical therapist.
We’d love to know if you’ve experienced diastasis recti and what exercises or treatments you used to prevent or treat the condition. Let us know in the comments what your experience was like and share any tips you have that might help others.