Diastasis Recti: Causes, Symptoms, and Treatment

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Verywell / Madelyn Goodnight

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Diastasis recti (technically, diastasis rectus abdominis or DRA) is an anatomic term describing an abnormal distance separating the two rectus muscles of the muscular abdominal wall. This condition is extremely common postpartum, impacting an estimated 65% to 100% of pregnant and postpartum women.

A persistent separation of 1.5 to 2 centimeters or more between the "six-pack" muscles is generally considered abnormal and in need of treatment. The condition usually resolves with consistent treatment.

This separation can happen during pregnancy when the layer of connective tissue between the rectus abdominis muscles stretches and weakens, causing a bulging of abdominal contents. While uncomfortable and bothersome, this separation often lessens within a few months after birth. However, without treatment, the condition persists for many women.

Symptoms

Most of the symptoms of diastasis recti will be absent during the first half of your pregnancy. Some women may begin to notice symptoms towards the end of the second trimester or the beginning of the third trimester. Other women don't notice a change in their abdominals until after delivery.

By the postpartum period, new moms experiencing diastasis recti should be able to see a visible bulge or ridge where the abdominal muscles separated. Conversely, when lying on your back, this area between the muscles around the belly button will recess. Signs and symptoms that may indicate you have diastasis recti include:

  • A bulge or ridge that runs down the middle of the abdomen, which is most noticeable when abs are engaged or contracted
  • Difficulty lifting objects 
  • Difficulty performing routine tasks 
  • Low back pain
  • Poor posture
  • Trunk instability
  • Urinary incontinence
  • Weak abdominal muscles 

Causes

Elevated intra-abdominal pressure is a key 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. The pregnancy hormones relaxin, progesterone, and estrogen also contribute to the relaxing of the tissues. As this continues to progress, a partial or complete separation of the rectus abdominis can occur.

Risk factors that make DRA more likely to be a complication of your pregnancy include the following:

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. In these cases, the main causes are straining, rapid shifts in body weight, heavy lifting, and exercises such as crunches.

Babies are sometimes born with diastasis recti but it's not a cause for concern as it typically goes away on its own. 

Diagnosis

Many women can see the separation in their midsection. However, in order to receive proper treatment, it’s important to consult your doctor for an official diagnosis. Your doctor will do a thorough physical exam to determine if you have diastasis recti, and if so, how severe it is. Your DRA can be open (the separation is above and below the navel), below the navel, or above the navel. Some doctors 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 diagnose and treat 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 palpitates (touches) the midline of the rectus abdominus muscle. If the separation between the two halves is greater than 1.5 centimeters, Holland diagnoses the patient with diastasis recti. This diagnosis then leads to a series of rehab exercises designed to treat and repair the separation. 

DRA Self-Exam

You can check yourself for diastasis recti by lying on your back and feeling between your abdominal muscles around your belly button. If you notice a depression and separation between the muscles, you may have DRA. If so, consult your doctor for a referral to a physical therapist who can provide a treatment protocol.

Treatment

The treatment for diastasis recti focuses on rehab exercises to repair the separation. It also includes education about exercises to be avoided that may make the separation worse until you are fully healed. Know though that even with physical therapy your abdominals may not return completely to their pre-pregnancy state, as the stretching endured during pregnancy may never fully bounce back.

If your DRA is particularly severe, surgery may be indicated, but in most cases, physical therapy can improve your condition enough that invasive measures are not needed.

Surgical Procedures

Since diastasis recti is not a true hernia (there is no herniation of intrabdominal contents through the connective tissue of the abdominal wall), as noted above, it does not usually require surgical repair. Instead, safe and appropriate exercises are the recommended first-line of treatment, which are often successful in the resolution of diastasis recti, particularly if you avoid re-straining your diastasis recti (see more on this below).

That said, some women may find that rehab exercises are not enough to resolve their diastasis recti. “In this case, abdominoplasty or “tummy tuck” is an option,” says Dr. Mia Di Julio, MD, OB/GYN at Providence Saint John’s Health Center in Santa Monica, CA. A 2019 study found high surgical success rates in improving trunk stability and reducing urinary incontinence in women whose DRA did not resolve using non-invasive measures.

Neuromuscular Electromagnetic Stimulation

“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. Neuromuscular electromagnetic stimulation causes contractions of the abdominal muscles to promote strengthening and healing. Studies have found this treatment to be beneficial, particularly in conjunction with performing exercises prescribed to strengthen the area.

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 sit-ups, other exercises to avoid include:

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

Exercises to Perform

While it may seem limited, there are effective exercises you can safely perform with diastasis recti. Consistent practice of these exercises will give you the best results. 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.

Essentially, the abdominals are tightened, squeezing toward the spine, with progressive strength, and held for longer and longer periods, starting with around 10 seconds each. Ideally, these holds are done for a total of 10 minutes daily. Holland 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 and your recovery progress.

Prevention

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.

Binding Devices

Some experts recommend binding devices (basically a tight, elastic band around your middle) and others don’t. The main purposes of the binders, which are also called belly bands, are to serve as a reminder to keep your abdominals engaged and to provide low back support. Wearing binders can't cure your DRA and also don't strengthen your abdominals. However, proponents of the devices contend that having one on helps you to be more diligent with your treatment regimen.

Prognosis

While most pregnant women have DRA right after childbirth, by six months postpartum only 40% do. Additionally, the success rate is even higher for those that do the prescribed exercises, which can show improvement by around four weeks but may take twelve or more weeks for satisfactory recovery. In fact, multiple studies have shown that the vast majority of the people who go through a treatment protocol improve their diastasis recti.

A Word From Verywell

Diastasis recti can make your belly appear pregnant well after childbirth, but rest assured that getting treatment can help. So, if you have diastasis recti, talk with your doctor about your concerns to make a treatment plan, which likely includes a referral to a physical therapist who can help you begin to feel stronger and more confident about your postpartum body. 

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

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