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Symptoms & Treatment of Diastasis Recti or Abdominal Separation
1 July 2022

Symptoms & Treatment of Diastasis Recti or Abdominal Separation

Diastasis recti is a common condition among pregnant women and postpartum women. This happens when the rectus abdominal muscles (six-pack ab muscles), separate from being stretched during pregnancy. This can cause a woman’s belly to bulge or stick out for months or even years after giving birth. You can repair it with specific exercises to help close the separation.

Diastasis recti is when a woman’s abdomen expands during pregnancy, creating a gap between the abdominal muscles and the abdominal wall.

What is diastasis recti?

Diastasis recti, also known as diastasis rectus abdominis (or diastasis), is the dissection of the rectus abdominal muscles after and during pregnancy. The rectus abdominals runs vertically from the front of your stomach. This is often referred to as someone’s “six-pack abs.” It is divided by the linea alba, a thin band of tissue that runs along the middle. Your uterus expands during pregnancy. The abdominals stretch and the linea alba thins. As the tissue is pushed outward, it becomes wider.

The linea alba can be reattached once your baby is born. It is elastic and can retract back (like a rubber band). The abdominal gap will not close properly if the tissue becomes less elastic from being stretched too much. This is called diastasis recti.

Your belly might appear to protrude just above or below your belly button if you have diastasis. This can make you look pregnant for months or even years after you give birth.

Why does diastasis recti happen?

Your abdomen (abs) is under a lot of stress during pregnancy. The abdominal muscles (left and right) and a thin layer of connective tissue (linea alaba) are the main components. To make space for the baby’s growth, they are stretched outward. Diastasis recti is when the linea alba becomes too stretched and doesn’t reattach. The abdominals remain separated on the left and right sides. This is also known as abdominal separation or ab gap.

Who gets diastasis recti?

Diastasis recti is more common in women who are pregnant or postpartum. However, it can also occur in infants and men. Diastasis recti typically will develop during the third trimester. Because the baby is growing rapidly, there is an increase in pressure on the abdominal walls. Most people don’t notice diastasis recti until after birth.

What is the prevalence of diastasis recti?

Diastasis recti is very common during pregnancy and after delivery. 60% of patients are affected and it is usually resolved within eight weeks after delivery. Around 40% of diastasis recti sufferers still have it six months after delivery.

Symptoms and Causes

What are the symptoms of diastasis recti?

Most people don’t notice diastasis recti symptoms until after they have given birth. Diastasis recti can occur during pregnancy. However, it is difficult to identify because your abdomen is stretched.

Common symptoms of diastasis recti postpartum include:

  • An obvious bulge or “pooch”, will protrude just below or above the belly button.
  • Feeling soft or jelly-like around your belly button
  • When you contract your ab muscles, coning or doming.
  • It is difficult to lift objects, walk or perform everyday tasks.
  • Pain during sex.
  • Hip or pelvic pain.
  • Low back pain
  • Poor posture.
  • When you cough or sneeze, your urine leaks.
  • Constipation.
  • Feeling weak in your abdomen.

How does diastasis recti feel?

Diastasis recti isn’t painful. While you may feel some side effects of diastasis, the actual ab separation doesn’t cause pain. When you do simple tasks like lifting laundry baskets, you may feel weak in your core. When contracting the abdominal muscles, some people feel a jelly-like texture between their left and right abdomens.

How can I tell if I have diastasis recti?

You may have diastasis recti if you notice these signs. A bulge around your midsection is one of the most obvious signs of diastasis recti. This can happen even if you exercise or lose weight during pregnancy. Your belly domes or cones may appear when you sit down on a chair or rise from a bed. Although you can test for diastasis recti yourself, it is a good idea that you consult your healthcare provider about your symptoms.

What are the risk factors of developing diastasis recti?

There are many factors that can increase your chances of developing diastasis recti.

  • Multiple pregnancies, especially back-to-back.
  • Over 35 years of age
  • Multiples (e.g. twins or triplets)
  • A heavy or large baby.
  • Being very small.
  • Vaginal delivery. Pushing can cause abdominal pressure to rise.

DIAGNOSIS and TESTS

How can diastasis recti be diagnosed?

Your healthcare provider will assess if diastasis exists, and if so, where and how severe. Diastasis recti can be found above or below the belly button as well as at the belly button.

To feel for any gaps or muscle tone, your provider may use their fingers and hands to touch the abdomen. For a more precise measurement, some providers may use an ultrasound, measuring tape, or a tool called the caliper. This is usually done at your postpartum appointment.

Diastasis recti is an abdominal gap greater than 2 cm. Diastasis recti can also be measured in finger widths. For example, it could be two or three fingers of separation.

Your healthcare provider might recommend movement for diastasis recti, or refer you to a specialist.

diastasis recti info

How do I test myself for diastasis recti?

You can also test for diastasis recti. Place your feet flat on the ground and place your knees on the back of your head.

Keep your shoulders slightly above the ground and one hand behind you for support. As if you’re doing a sit-up. Take a look at your belly.

Place your other hand just above your belly button, palms down, and your fingers towards your toes.

Feel the gap between your abs with your fingers. Find out how many fingers you can squeeze between the right and left abdomens.

Talk to your healthcare provider if you feel a gap between your fingers of more than two inches. Your healthcare provider should confirm diastasis recti and recommend the appropriate treatment.

TREATMENT AND MANAGEMENT

How do I fix diastasis recti?

You will need to use gentle movements that engage your abdominal muscles in order to fix diastasis recti. Before you begin an exercise program, make sure it is safe for diastasis recti. Talk to a physical therapist or fitness professional who is familiar with diastasis recti. A treatment plan can be created to ensure you are correct in your movements and that you progress to more difficult movements.

Some movements can make the abdominal separation more severe. There are some changes you can make to your postpartum experience:

  • Do not lift anything more than your baby.
  • When you are getting out of bed, roll onto your side. Push yourself up using your arms.
  • Avoid activities that push your abdominals outward, such as crunches or sit-ups.
  • Binding devices (elastic stomach bands) can be used to support the lower back and hold your belly in place. Binders won’t help with diastasis recti or strengthen your core muscles. You can use it to remind you of your diastasis recti and improve your posture.

Is it possible to fix diastasis recti without having to have surgery?

It is possible to repair diastasis recti without having surgery. Diastasis recti is not usually treated with surgery. Before recommending surgery, healthcare providers may recommend physical therapy and at-home exercises for diastasis. If a woman needs diastasis recti surgery (a tummy-tuck), or has a hernia (an organ pushing through the linea alba), then surgery is recommended.

Diastasis Recti diagram

What are the best exercises for diastasis recti?

Deep abdominal exercises are the best for diastasis recti. Deep breathing and slow controlled movements is the key to help with diastasis recti. Many of the most popular abdominal exercises, such as crunches, can make your diastasis worse. Ask your healthcare provider before you begin abdominal exercises to make sure you are not suffering from diastasis recti.

What causes diastasis recti to get worse?

Your diastasis recti can be further damaged if you move your abdominal wall forward. Diastasis can be worsened by everyday movements, such as getting up from a chair or out of bed. As you go about your day, be aware of how your abdominals are being used.

If you have diastasis recti, these exercise movements should not be performed:

  • Any type of crunches or sit-ups.
  • Push-ups and planks, unless modified.
  • Yoga poses such as the boat pose, downward dog and the boat pose are all possible.
  • Double leg lifts, scissors, and other Pilates moves.
  • Any exercise that causes your abdomen to bulge, dome, or cone.

Prevention

How can I prevent diastasis recti?

It is normal for pregnant women to experience some abdominal separation. You can take steps to reduce your chances of developing diastasis recti.

Healthy weight gain during pregnancy. Exercise and healthy eating habits to maintain a healthy weight.

Proper posture is key to deep breathing. Stand straight up with your shoulders back. Deep, exhale to allow your ribs and not your belly to expand.

Safe core exercises: After 12 weeks of pregnancy, and after delivery, avoid crunches and sit-ups that place pressure on your abdomens.

Do not strain when lifting: Lifting grocery bags or children’s toys can cause strain to your abdomen.

Log roll when you get out of bed. If you are pregnant or postpartum roll to one side, and then use your arms to push out of bed.

Outlook

What is the time it will take to heal my diastasis recti?

It takes time to heal diastasis recti. This depends on how severe your ab separation is and how consistent you are in strengthening exercises. As your muscles recover strength, the gap should close after several weeks. You’ll notice more progress if you make lifestyle changes and do exercises that are in good form.

Can I have diastasis recti again?

Yes, it is possible to heal diastasis recti and have it back. The risk of diastasis recti increases with every pregnancy. The linea alba is like a rubber band that is constantly stretched. The rubber band will lose its elasticity over time. After being stretched through multiple pregnancies, the linea alba may lose its original form.

Is it too late for me to get my diastasis recti fixed?

Your diastasis recti can be repaired at any time. You can repair your ab separation with the right exercises even years after having your last child.

Can diastasis recti get worse or have complications?

If left untreated, or in severe cases diastasis recti, complications may include:

  • Umbilical hernia
  • Back pain increases
  • Pain during sex.
  • Urinary incontinence
  • Hip and pelvic pain.

Living With Diastasis Recti

When do I need to see my healthcare provider?

Diastasis recti is an easily treatable condition. For a diagnosis, consult your healthcare provider if you feel pain or have more than two fingers between your abdomens. Your healthcare provider may recommend that you see a physical therapist and strengthen your abdominal muscles.

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