If your tummy still looks pregnant months after delivery, diastasis recti might be to blame. We've got the facts about this common postpartum condition.

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Months after I gave birth to my twins, a mom from a local multiples group introduced me to the words "diastasis recti" in casual conversation. As she explained the postpartum abdominal condition, I realized it explained why my tummy still looked pregnant months after delivery—and it's actually quite common.

So what does diastasis recti look like, and is there any way to prevent it? Here's a primer on everything you need to know about diastasis recti symptoms, risk factors, treatment, and more.

What is Diastasis Recti?

About two-thirds of pregnant women have diastasis recti abdominus. In short, it's a gap between your right and left abdominal wall muscles and a weakening of the connective tissue holding them together. This can result in a rounded, protruding belly "pooch" before or after delivery.

What Causes Diastasis Recti?

You can thank pregnancy hormones and your expanding uterus for diastasis recti, says Kevin Brenner, M.D., F.A.C.S., a board certified plastic and reconstructive surgeon based in Beverly Hills.

To understand how it forms, you need to visualize the all-important core, a complex muscular system that supports most of the body's movements, including sitting, walking, and picking up your child. The rectus abdominus is a muscle in two parts that run side by side from the sternum to the pubic bone. The sections come together at the midline in a network of connective tissue and lay atop the other core muscles, while the obliques and the transverse abdominus wrap around the sides of the body and provide a sort of internal corset.

When a woman is pregnant, the weight of the child pushes downward on the pelvic floor and outward against these muscles, says physical therapist Fatima Hakeem, director of rehabilitation services at the Woman's Hospital of Texas, in Houston. Diastasis recti occurs when a stretched midsection further separates the rectus muscle, like "a zipper that's undone," says Hakeem. Pregnancy hormones might also encourage the connective tissue to stretch out.

A separation that's less than three-quarters of an inch wide in a postpartum woman is considered normal. Anything greater classifies as diastasis recti, although the focus shouldn't be entirely on the size of the separation, says Cynthia Chiarello, Ph.D., assistant professor of rehabilitation and regenerative medicine at Columbia University Medical Center, in New York City, who has been studying the condition for ten years: "It also depends on how your abdominal wall is functioning."

Diastasis Recti Symptoms

A belly bulge is the telltale sign of diastasis recti; its usually most noticeable when you're contracting or straining muscles in your abdomen. Other symptoms might include lower back pain, constipation, urinary incontinence, and poor posture.

In a very small percentage of women, diastasis recti is associated with the bladder, uterus, rectum, or other pelvic organ slipping down (known as a prolapse), or with an abdominal or umbilical hernia, in which the midline connective tissue actually rips or tears, potentially causing organs to breach that hole.

Risk Factors for Diastasis Recti in Pregnancy

Women may be more likely to develop diastasis recti in the following situations:

  • They're petite
  • They're pregnant with multiples
  • They've had more than one pregnancy
  • They're pregnant later in life
  • They have poor muscle tone
  • They have a sway-back posture

Your medical history could play a role as well. "Women who had diastasis recti from a previous pregnancy will most likely develop the condition again," says Helene Byrne, a prenatal and postpartum health and fitness expert and founder of BeFit-Mom. "Women with a history of umbilical or ventral hernia, and pelvic instability, are at greater risk for developing it."

How to Check for Diastasis Recti

Wondering how to tell if you have diastasis recti? It's easy to perform a self-test. Simply lie on your back with your knees bent and feet on the floor. Put one hand on your belly, with your fingers on your midline at your navel. Press your fingertips down gently, and bring your head (shoulders stay on the ground) up into a mini crunch-like position. Feel for the sides of your rectus abdominis muscles, and see if and how far they are separated. Separation is commonly discussed in terms of finger widths—for instance, two or three (or more) fingers' separation—and it might indicate diastasis recti.

Diastasis Recti Prevention

Protecting your vulnerable abdomen can help keep the muscles from separating. During pregnancy, always use the log roll maneuver when getting out of bed or up from the couch or floor, says Ben Butts, P.T., director of rehabilitation services and performance therapy at Providence Saint John's Health Center in Santa Monica, California. That means rolling onto one side with your torso and head aligned, then using your arms to help push yourself up to a sitting position.

There are also helpful exercises you can do while you're pregnant, according to Leah Keller, who developed the Dia Method/Every Mother, meant to strengthen the pregnant abdominals and overall body for labor and postpartum recovery.

How Can I Treat Diastasis Recti?

Exercise can be used to repair diastasis recti and should be undertaken as the first approach to healing; just be sure to get the go-ahead from your doctor first. At-home workout programs strengthen the core while avoiding exercises that can exacerbate the problem, such as crunches—a major diastasis recti no-no. Physical therapy may also be recommended as a diastasis recti treatment.

If severe, diastasis recti may be corrected through surgery, generally done as a tummy tuck with excess skin removal. But think of that as a last resort. "Surgical repair of diastasis recti should only be done after a woman is sure that she is finished with family building," says Byrne.