An Overview of Diastasis Recti

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You've made it through pregnancy, given birth, and had your body stretched in ways you never thought possible. And now that you’re in the postpartum period, you might be wondering what the heck happened to your abdominal muscles. 

We have two words for you: Diastasis recti. According to Dr. Mia Di Julio, MD, OB/GYN at Providence Saint John’s Health Center in Santa Monica, CA, diastasis recti is an anatomic term describing an abnormal distance separating the two rectus muscles of the muscular abdominal wall. A separation of 1.5 to 2 centimeters is generally considered abnormal. 

This separation can happen during pregnancy when the layer of connective tissue between the rectus abdominis muscles weakens, causing a bulging of abdominal contents. While uncomfortable and bothersome, this separation usually lessens within a few months after birth.

Symptoms

Diastasis recti only affects your mid-section, so identifying common symptoms with this condition is often easier than other postpartum issues. Most of the symptoms will be absent during the first half of your pregnancy; however, some women may begin to notice symptoms appear towards the end of the second trimester or beginning of the third trimester.

By the postpartum period, all women experiencing diastasis recti should be able to see a visible bulge or ridge where the abdominal muscles separated. With that in mind, here are the warning signs that may indicate you have diastasis recti. 

  • Bulge or ridge that runs down the middle of the abdomen
  • Most noticeable when abs are engaged or contracted
  • Low back pain
  • Weak abdominal muscles 
  • Difficulty lifting objects 
  • Difficulty performing routine tasks 
  • Poor posture

Causes

According to Di Julio, elevated intra-abdominal pressure is the culprit behind diastasis recti. When you’re pregnant, your abdominal muscles stretch to accommodate your growing uterus, which causes the connective tissue to become thin. As this continues to progress, a partial or complete separation of the rectus abdominis can occur. 

Although diastasis recti is most prevalent in pregnant and postpartum women, it’s important to note that it can also occur in postmenopausal women and in men.

Diagnosis

Many women can see the separation in their midsection, but in order to receive proper treatment, it’s important to consult your doctor for an official diagnosis. They will be able to do a thorough physical exam to determine if you have diastasis recti. Additionally, some docs will use imaging with ultrasound or CT scan to aid with the diagnosis. 

In addition to your OB/GYN, a physical therapist trained in postpartum care can also conduct a physical exam to look for diastasis recti. Alice Holland, DPT, a physical therapist at Stride Strong Physical Therapy, says she diagnoses diastasis recti using a very simple procedure. 

First, Holland has the patient lie on their back and do a slight abdominal crunch. While in this position, she palpates the midline of the rectus abdominus muscle. If the separation between the two halves is greater than 1.5 centimeters, Holland says she diagnoses the patient with diastasis recti. This diagnosis then leads to a series of rehab exercises designed to treat and repair the separation. 

Treatment

The treatment plan for diastasis recti focuses on rehab exercises to repair the separation. But it also includes education about exercises that may make the separation worse, and therefore, should be avoided until you are fully healed. 

Surgical procedures

As far as surgery or other medical procedures are concerned, Di Julio says since diastasis recti is not a true hernia (there is no herniation of intrabdominal contents through the connective tissue of the abdominal wall), it does not necessarily require surgical repair. That’s why safe and appropriate exercises are the recommended first-line of treatment, which Di Julio says are often very successful in the resolution of diastasis recti. 

That said, some women who may find that rehab exercises are not enough to resolve their diastasis recti. “In this case, abdominoplasty or “tummy tuck” is an option,” she says. “There is also a potential emerging, non-surgical treatment, which may help cosmetically with diastasis recti, called the Emscuplt, which uses a high power magnet to induce muscle contractions,” adds Di Julio. 

Exercises to avoid

When it comes to exercises to avoid, Holland says new mothers should always avoid excessive abdominal exercises, particularly crunches. In addition to crunches, other exercises she recommends avoiding include:

  • Abdominal twists
  • Backward bends that stretch the abdominal area
  • Common yoga poses (not modified)
  • Any heavy lifting activities that bulge out the stomach (like in a Valsalva maneuver)
  • Any exercises that require you to be on your hands and knees without abdominal support or strength.

Exercises to Perform

While it may seem limited, there are still exercises you can safely perform with Diastasis recti.

Holland says her treatments consist of deep abdominal exercises performed with a neutral spine (this is usually lying down with knees up) that stimulate control and use of the transverse abdominis. She also points out that pelvic floor exercises, such as Kegel’s and pelvic tilts, help as well.

Performing these moves with proper form is critical. That’s why it’s a good idea to consult with a physical therapist who can supervise your workouts.

If you are planning on getting pregnant again, you may want to strengthen your abdominal muscles before you become pregnant and also during pregnancy. Results from a 2019 study found that abdominal strengthening programs provided to pregnant women can help decrease the severity of diastasis recti. 

A Word From Verywell

The postpartum period is often physically and emotionally exhausting, especially if you are dealing with any complications from pregnancy or childbirth. That’s why it’s important to make time to care for yourself and get the help you need. Diastasis recti, while common and treatable, is not a condition to take lightly.

The good news? Talking with your doctor about your concerns can lead to a thorough examination, proper diagnosis, and a referral to a physical therapist who can design a treatment plan that will help you begin to feel stronger and more confident about your postpartum body. 

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Article Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mayo Clinic. Why do abdominal muscles sometimes separate during pregnancy? 2017. 

  2. Sperstad J, Tennfjord M, Hilde G, Ellstron-Engh M, Bo K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine. 2016 Sep; 50(17): 1092–1096. doi: 10.1136/bjsports-2016-096065.

  3. Nakip G, Akbayrak T, Cinar G, et al. The association between the amount of diastasis recti abdominis and the strength of abdominal muscles in pregnant women. Annals of Rheumatic Diseases. 2019 June; 78(2). doi.org/10.1136/annrheumdis-2019-eular.6975

Additional Reading
  • Di Julio, Mia, MD. Email interview. October 24, 2019.

  • Holland, Alice. Email interview. October 21, 2019.