What You Need to Know About Diastasis Recti

The body goes through a remarkable transformation during pregnancy, which sometimes includes the separation of the abdominal muscles, a condition known as diastasis recti. We've got the facts about this common postpartum condition.

Midsection Of Woman Standing Against White Background
Photo: Getty Images

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 could explain why my abdomen still looked pregnant months after delivery—and I was surprised to find out that diastasis recti is 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?

Diastasis recti abdominis, as the condition is officially known, is essentially the separation of the right and left sides of the outermost abdominal muscles known as the rectus abdominis. This separation causes a gap in the abdominal wall muscles which can appear as a rounded, protruding bulge or "pooch." The condition is most common following pregnancy, affecting about two-thirds of pregnant people.

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 abdominis is a muscle in two parts that run vertically 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, namely the obliques and the transverse abdominis, which wrap around the sides of the body and provide a sort of internal corset.

When someone is pregnant, the weight of the fetus and expanding uterus 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 this connective tissue, known as the linea alba, to stretch out.

A separation that's less than three-quarters of an inch wide in a postpartum person 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 over a decade: "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. You may notice that when straining, your stomach area tents upwards instead of flattening out. Other symptoms might include lower back pain, constipation, urinary incontinence, and poor posture.

In a very small percentage of people, 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

Pregnant people 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. "People 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. "Those 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 flat 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

During pregnancy, most people will get diastasis recti, but there are things you can do to help keep the muscles from separating, or help repair them after pregnancy. 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 abs and overall body during pregnancy to preapre 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 someone is sure that they are finished with family building," says Byrne.

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