The abdominal wall includes a pair of long, vertical muscles called the rectus abdominis, which are connected along the midline by a band of connective tissue known as the linea alba. Diastasis Recti Abdominis (DRA) occurs when this connective tissue stretches and thins, causing a separation between the left and right sides of the rectus abdominis muscles.
Defining Diastasis Recti
This separation results from the stretching of the linea alba, a collagen sheath formed by the fusion of the aponeuroses of the deeper abdominal muscles. While most commonly associated with pregnancy due to the mechanical stretch from a growing uterus and hormonal changes that soften connective tissue, DRA can also affect men and infants. Causes can include rapid weight changes, obesity, and improper core exercise techniques that place excessive strain on the abdominal wall.
A separation is typically considered diastasis recti when the gap between the muscles is wider than two finger widths, or approximately two centimeters, though diagnostic criteria can vary slightly. Measuring both the width and the depth of the separation is important for assessing the integrity of the linea alba, as the tension in the connective tissue indicates how well the abdominal wall can withstand internal pressure.
The Mechanisms of Progression
Diastasis recti can certainly worsen if the underlying forces contributing to the separation are not managed. The condition progresses when the thinned linea alba is subjected to chronic, repetitive strain that continues to stretch the connective tissue. This strain is most often caused by unmanaged intra-abdominal pressure (IAP).
Activities that cause forceful, outward pressure against the abdominal wall can increase the width and depth of the separation. These activities include improper lifting of heavy objects, chronic straining from coughing or constipation, or specific exercises like crunches and sit-ups. The abdominal wall acts like a balloon; if the pressure inside is repeatedly increased, the weakened point will expand.
This continuous stress causes the connective tissue to lose more of its supportive elasticity, making the separation more pronounced over time. The loss of tension in the linea alba means the core is less able to stabilize the spine and torso. This cycle of poor core stability leading to improper mechanics and increased strain is what drives the condition to a more severe state.
Health Implications of Untreated DRA
The consequences of a persistently compromised core structure extend beyond a cosmetic bulge. A weakened abdominal wall reduces the body’s ability to maintain proper posture and spinal alignment. This loss of support often forces other muscles to overcompensate, frequently resulting in chronic low back pain or hip pain.
The core musculature works in conjunction with the pelvic floor, and the reduced integrity of the abdominal wall places additional strain on the pelvic floor muscles. This connection explains why untreated DRA is often associated with pelvic floor dysfunction, including issues like stress urinary incontinence. Furthermore, the lack of fascial support can increase the risk of an umbilical hernia, where internal tissues push through the weakened abdominal wall near the navel. Digestive issues, such as bloating and constipation, can also arise.
Management Options
Addressing diastasis recti typically begins with non-surgical, conservative methods aimed at restoring core function and stability. Targeted physical therapy (PT) is the first-line treatment and focuses on retraining the deep core muscles, particularly the transverse abdominis. A specialized therapist guides patients through exercises that activate these stabilizing muscles, which helps to reduce the tension on the linea alba without increasing IAP.
It is important to avoid traditional abdominal exercises like crunches or planks, as these movements can exacerbate the separation by forcefully pushing the organs against the weakened midline. Abdominal binders or supportive garments can also be used to provide external support, though they do not strengthen the core muscles themselves. Surgical repair is considered for severe cases where conservative management has failed, or when a co-existing hernia is present. This surgical option involves plicating—or folding and suturing—the stretched linea alba to reconstruct the abdominal wall.