Diastasis recti (abdominal separation) is the separation of two bands of abdominal muscles (recti-abdominis or six-pack muscles), which run from the chest to the pelvis underneath the skin and meet along the mid-line of the stomach. The condition is also known as “diastasis of rectus abdominis muscle” (DRAM) and is common during and after pregnancy.
As these muscles separate, the linea alba (connective tissue) joining these muscle groups stretches sideways, making the connective tissue weaker and thinner (1). In this MomJunction post, we tell you more about the condition, what causes it, and how to manage it.
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 aiding in the separation (3).
This condition usually develops in the later stages of pregnancy, and sometimes develops due to the forceful pushing during delivery. Note that pregnancy does not cause abdominal separation, but the increasing load and shifts in bump alignment may create the problem.
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
- Getting pregnant at the age of 35 or more
- Having twins or multiples
- Being petite (small-stature) and having a larger than average baby
- Poor abdominal tone before pregnancy
- Swayback (excessive downward bent of the spine)
- 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 till 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 might need treatment.
Signs And Symptoms Of Diastasis Recti During/After Pregnancy
The most common signs and symptoms of diastasis recti include:
- A bulge in your stomach
- A belly that becomes bigger after eating
- Physical discomfort in the abdomen
- Poor posture
- Lower back pain and hip pain
- Bloating and constipation after eating
- Urine leakage
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, you will notice a pooch or bulge in your belly region that resembles a baby bump (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,s 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
You can fix a diastasis recti with specific 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.
- Avoid using binders and corsets that help in manually pushing back the abdominal muscles together. Unlike physiotherapy and surgery, these products will not offer long-term results and do not act to strengthen the core.
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.
Experts recommend these exercises only in the case of vaginal delivery. But if you had a cesarean section, check with your doctor before trying them.
1. Deep ab activation (Transverse Abdominis (TA) breath):
This is a basic exercise that engages your transverse abdominals.
How to do:
- 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 do:
- 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 on 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
- Hernia in severe cases
Can You Prevent Diastasis Recti?
There is no sure-shot way of preventing this condition. However, you may try to minimize the risk by exercising your core muscles. Before you plan to get pregnant, you may start doing exercises that strengthen your core. You may continue with some of them through your first trimester. However, gentle core exercises may also become ineffective as your belly becomes big.
Do not indulge in exercises that bulge out your tummy or strain the back.
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.
If you happen to experience a bulge in your stomach that combines pain and unbearable discomfort during pregnancy or postpartum, you should see your healthcare provider sooner than later. Your doctor will help you with the best treatment plan to correct the gap. Abdominal separation is not just related to pregnancy. It can affect everyone, from newborns to men and the elderly.
If you have also experienced ab separation during pregnancy or after pregnancy, and have followed any measures to correct it, do tell us about it in the comment section below.
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.; Efficacy of Tupler Technique on Reducing Post Natal Diastasis Recti: A Controlled Study; 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)