Diastasis recti, commonly known as abdominal separation, is a condition where the rectus abdominis muscles spread apart. This separation occurs along the linea alba, a connective tissue band along the midline of the abdomen. While frequently associated with pregnancy, this condition can affect anyone, including men and infants. Many wonder how this separation can be addressed.
Understanding Diastasis Recti
Diastasis recti involves the widening of the gap between the left and right sides of the rectus abdominis muscles. These muscles are connected by the linea alba, a flexible band. Increased intra-abdominal pressure can stretch and thin this connective tissue, leading to separation.
Pregnancy is a primary cause, as the expanding uterus places significant pressure on the abdominal wall, stretching the rectus abdominis muscles. Hormonal changes during pregnancy also soften the connective tissues, making them more pliable. While common postpartum (affecting approximately 60% of women), it can also arise in men due to factors like excessive weight, improper heavy lifting, or certain abdominal exercises that create undue strain. Newborns, especially premature ones, can also present with diastasis recti due to underdeveloped abdominal muscles.
Individuals can identify diastasis recti. A visible bulge or “pooch” above or below the belly button is a common sign, often more pronounced with exertion (e.g., getting out of bed or doing a mini-crunch). Other symptoms include a soft or jelly-like feeling around the belly button, lower back pain, poor posture, and difficulty with daily tasks requiring core engagement. For a self-check, lie on your back with knees bent and feet flat, lift your shoulders slightly, and feel for a gap between the abdominal muscles along the midline. If two or more fingers fit into the gap, it may indicate diastasis recti, and professional assessment is recommended.
Conservative Approaches to Repair
Addressing diastasis recti often begins with conservative, non-surgical methods to strengthen the core and improve abdominal integrity. Physical therapy plays a central role in this approach. Specialized physical therapists can assess the degree of separation and develop tailored exercise programs.
These targeted exercises concentrate on activating the deep core muscles, especially the transverse abdominis, which helps draw the rectus abdominis muscles closer. Pelvic floor exercises are also beneficial, as they work synergistically to support the trunk. Conversely, exercises like crunches, sit-ups, and planks without proper engagement can worsen the condition by increasing intra-abdominal pressure and should be avoided.
Safe exercises include:
Pelvic tilts
Heel slides
Toe taps
Modified side planks
Lifestyle modifications also contribute to recovery. Maintaining good posture, learning proper lifting techniques, and avoiding activities that strain the abdominal wall are important. Rolling onto one’s side when getting out of bed, for instance, can help protect weakened muscles. Supportive garments, such as abdominal binders or corsets, can provide temporary comfort and support. These garments offer external support but do not directly “fix” the underlying muscle separation.
Surgical Solutions for Diastasis Recti
When conservative methods do not sufficiently improve diastasis recti, or in severe cases with functional issues, surgical intervention may be considered. Surgery decisions depend on separation extent, associated symptoms (like hernias), and patient health and goals. Some experts recommend waiting 6-12 months postpartum before considering surgery.
The most common surgical approach for repairing diastasis recti is often performed as part of an abdominoplasty. The procedure stitches the separated rectus abdominis muscles back together, tightening the abdominal wall. Excess skin and fat removal often accompanies this, improving abdominal contour. For less severe cases, or when a full abdominoplasty is not desired, minimally invasive options like laparoscopic or endoscopic repair are considered. These involve smaller incisions and potentially faster recovery.
Recovery after surgical repair involves a period of healing, with activity restrictions for healing. Recovery time varies based on the type of surgery, with abdominoplasty recovery ranging from 4-8 weeks, while laparoscopic recovery may be 4-6 weeks. Patients can expect an improved abdominal profile and enhanced core function after successful surgery.
Beyond Aesthetics: The Functional Importance of Repair
Diastasis recti extends beyond a cosmetic concern, impacting core function. The separation of the rectus abdominis muscles compromises the integrity of the entire core, essential for stabilizing the trunk during movement and daily activities. A weakened core can lead to instability and inefficiency in movement.
This compromised core strength can manifest as lower back pain due to inadequate spinal support. Poor posture can also result as abdominal muscles struggle to maintain proper alignment. Functional issues include pelvic floor dysfunction, such as urinary incontinence or pelvic organ prolapse. Digestive issues like bloating and constipation may also arise from compromised intra-abdominal pressure and slowed food movement.
Whether through conservative approaches or surgical repair, addressing diastasis recti can alleviate these functional problems. Restoring core stability and muscle integrity reduces back pain, improves posture, and enhances pelvic floor control. Successful management of diastasis recti enhances physical comfort and improves quality of life.