Diastasis recti or abdominal separation refers to the separation of the two bands of abdominal muscles (recti-abdominis or six-pack muscles) that extend from the chest to the pelvis and meet along the mid-line of the stomach. The linea alba (connective tissue) that connects these muscle groups expands sideways as they separate, making the connective tissue weaker and thinner (1).
This condition, also known as rectus abdominis muscle diastasis (DRAM), frequently occurs during and after pregnancy. This post explains the causes, symptoms, treatment, and management of diastasis recti as well as some exercises to control the condition.
What Causes Diastasis Recti During Pregnancy?
Diastasis recti can occur due to the intra-abdominal pressure created by the growing fetus (2). Also, the pregnancy hormones cause the connective tissue to relax, further contributing to the separation (3).
This condition usually develops in the later stages of pregnancy, and the second stage of labor with pushing may also contribute to the separation.
Apart from the above causes, here are some factors that are likely to increase the risk of diastasis during or after pregnancy.
- Second or subsequent pregnancies
- Advanced maternal age (>35 yo)
- Having twins or multiples
- Being petite (small-stature) and having a larger than average baby
- Poor abdominal tone before pregnancy
- Family history of abdominal separation
When Do You Experience Diastasis Recti During/After Pregnancy?
You may develop diastasis recti after the 35th week of pregnancy, although it becomes an issue only after delivery. It could continue up to six weeks postpartum with about 50 to 60% prevalence and after six months postpartum with 39 to 45% prevalence (5).
The space created between the abdominal muscles usually shrinks after eight weeks of birth. But in some cases, an overly wide gap remains for months to years after delivery. If the gap does not heal on its own in three to six months after birth, it may need treatment.
Signs And Symptoms Of Diastasis Recti During/After Pregnancy
The most common signs and symptoms of diastasis recti include:
- A bulge in the midline of your abdomen
- Physical discomfort in the abdomen
- Poor posture
- Lower back pain and hip pain
- Bloating and constipation after eating
During pregnancy, you will notice a ridge or bulge developing over your belly, both above and below the navel. It is more apparent when you are using your abdominal muscles for standing, sitting, or lying down. In rare cases, you may experience severe abdominal, pelvic, or back pain that needs a doctor’s attention.
Postpartum, the signs and symptoms are the same (6).
Other Ways To Identify Diastasis Recti
Here are other ways to check if your symptoms indicate abdominal separation (7):
- Lie down on your back with knees bent and feet placed flat on the floor.
- Place your right hand over your belly with fingers pointing towards the toes.
- Slowly press your fingers onto the belly button while lifting your head and bringing the chin to the chest. This will contract the ab muscles.
- Check if you can fit your fingers in the gap between the muscles.
- If you feel a gap or separation of at least two-finger width, you are likely to have diastasis recti.
- You may repeat the procedure by checking both above and below the navel as separation is different in different places.
Your physical therapist can check the condition’s severity with the help of a tool known as a caliper or an ultrasound. It will give accurate measurements.
When Is Diastasis Recti Considered Severe?
Diastasis is generally classified as a gap of two fingertips (that is roughly 2.7cm or over an inch) between the abdominal muscles. It is regarded as severe when the gap is of four to five fingertips (8).
Treatment And Management Of Diastasis Recti
Diastasis recti is not a health hazard overall. It just causes mild discomfort and an appearance that you may not like. Correction is possible with certain measures and exercises, and it usually gets corrected often with time. Some dos and don’ts you should keep in mind are mentioned here.
- Do not strain as it can make the condition worse. Lifting heavy things and constipation could strain the connective tissue. Also, standing and sitting frequently strains the tissue as you tend to lift your body weight while doing so.
- Exercise with caution. Crunches, push-ups, sit-ups, front planks, press-ups can aggravate the abdominal separation. The same is the case with some yoga postures (such as a downward dog) and other activities involving your knees and hands.
- Heal your belly. The Tupler Technique is an exercise that is considered safe and effective in treating postnatal diastasis recti. It involves exercises while wearing a belly splint that protects and holds the abdominal muscles together (9). Pelvic floor exercises and deep core belly exercises will also reduce abdominal muscle separation (10). However, talk to your doctor or a physical therapist before trying these exercises.
If the diastasis recti is severe, and the core strengthening exercises do not work, your doctor may recommend surgery as the next option.
Surgery involves stitching back the abdominal muscles along the mid-line. It is done laparoscopically, and in severe cases, open abdominal surgery may be necessary. In case you want to have another baby in the future, then surgery is not advisable. The healthcare professional may recommend only physical therapy, although there is a small chance that the condition may recur even after that.
Exercises To Correct Diastasis Recti
Every time you exercise to fix the diastasis recti, focus on the deep core. This will make the abdominal separation exercises highly effective, and also establishes the mind and the body connection.
1. Deep ab activation (Transverse Abdominis (TA) breath)
This is a basic exercise that engages your transverse abdominals.
How to perform
- Lie down on the floor, with your knees bent and feet flat on the floor.
- Place one hand below the rib cage. This way, you can feel your diaphragm move as you take a breath.
- Inhale slowly so that your tummy moves against your hand.
- Now exhale while using your fingers to draw the sides of the ab muscles together. Also, draw your navel towards your spine.
- Repeat for two to three times, and rest.
2. Pelvic tilts
This will activate not only your transverse abdominals but also pelvic floor muscles. It will, therefore, ease postpartum recovery.
How to perform
- Lie down on the floor with your knees bent and feet flat on the floor.
- Press your lower back to the floor, and try drawing in your navel towards the spine.
- By keeping your lower back pressed to the floor, gently lift your pelvis up to an inch and then put it down. This will engage your pelvic floor muscles.
3. Fit ball rolls
Sit on an exercise ball and place your hands on the knees. Begin by drawing in your tummy and rollback. Watch your tummy to see if it is doming or forming a triangular shape. If you see it doming, it indicates that the core muscles are not engaged. In that case, start again and go as far as you don’t see the triangular formation.
Can A Diastasis Recti Lead To Other Health Complications?
The abdominal muscle separation could lead to problems such as:
- Back pain
- Pelvic pain
- Jeopardized stability and mobility of torso
- Pelvic floor dysfunction
- Change in the body’s posture
- Rarely contribute to hernia in severe cases
Can You Prevent Diastasis Recti?
No, however, before you plan to get pregnant, you may start doing exercises that strengthen your core. You may continue with some of them through your pregnancy.
Is It Ever Too Late To Correct Separated Ab Muscles?
Not at all. You can help to fix the diastasis recti even after years of baby’s delivery. The time taken to heal depends on the severity of separation and damage to the connective tissue.
Frequently Asked Questions
1. Can I do anything about diastasis recti when pregnant?
Yes. As listed above, different management techniques such as exercising and safety measures can help you through this condition in pregnancy.
2. Will losing weight help diastasis recti in pregnancy?
No, losing the extra weight or exercising may not help eliminate the bulge from diastasis recti in pregnancy (11).
Diastasis recti occur due to the pressure caused by the growing fetus and the pregnancy hormones that relax the muscles. You may experience this condition if you are expecting twins, have poor abdominal tone, or are of advanced age. If you have diastasis recti, you may notice a bulge in the middle of your abdomen, experience bloating after eating, or have poor posture. The condition does not cause severe health hazards; however, you may experience slight discomfort or a change in the appearance of your abdomen. Avoid straining yourself by lifting heavy objects, and perform exercises such as deep ab activation or pelvic tilts. Further, consult a doctor if you experience back pain, pelvic pain, or pelvic floor dysfunction.
- Intra-abdominal pressure by fetal growth and relaxation of abdominal tissues due to surge in pregnancy hormones are the main causes of diastasis recti.
- Advanced maternal age (>35 years), subsequent pregnancies, and family history of abdominal separation are the risk factors.
- Diastasis recti may develop during the 35th week of pregnancy and could continue up to six weeks or six months after delivery.
- Poor posture, lower back pain, bloating, and constipation after eating are common signs and symptoms.
- Certain measures and exercises can correct diastasis recti in most women.
2. Diastasis recti; NIH (2017)
3. Divarication of rectus abdominis muscles (DRAM) postpartum; NHS
4. Fernandes da Mota PG et al.; Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain; Man Ther( 2015)
5. Dalia M. Kamel and Amel M. Yousif; Neuromuscular Electrical Stimulation and Strength Recovery of Postnatal Diastasis Recti Abdominis Muscles; Ann Rehabil Med (2017)
6. Diastasis recti; Florida Agency for Health Care Administration (2017)
7. Your post-pregnancy body; NHS (2016)
8. Lauren Milan; Pilates for Diastasis Recti; West Caldwell, NJ (2015)
9. Mohamed A. Awad et al.; Effects of Tupler’s Technique on Postpartum Diastasis Recti and Strength Recovery of Abdominal Muscles; NIH
; British Journal of Applied Science & Technology (2016)
10. DR Benjamin; Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review; Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews (2014)
11. Diastasis Recti, Cleveland Clinic