Diastasis recti postpartum is a common condition where the rectus abdominis muscles, often called the “six-pack” muscles, separate. This separation occurs along the linea alba, a connective tissue that runs down the center of the abdomen. During pregnancy, the expanding uterus stretches this tissue, causing it to thin and widen. This anatomical change is a natural part of pregnancy as the body adapts to accommodate a growing baby.
Symptoms and Self-Assessment
Symptoms of diastasis recti include a visible bulge or “pooch” in the middle of the abdomen, particularly when engaging core muscles. This bulge can appear above, at, or below the belly button. Other signs include a sensation of core weakness, lower back pain, or a “jelly-like” feeling in the abdominal midline.
To perform a self-assessment, lie on your back with knees bent and feet flat on the floor. Place three fingers, palm facing you, just above your belly button. Gently press down. Lift your head and shoulders slightly, as if beginning a small crunch, ensuring your neck remains relaxed.
Feel for a gap between the two sides of your abdominal muscles as they contract, noting both the width in finger-widths and the depth your fingers sink. Repeat this check at your belly button and a few inches below it, as the separation can vary along the midline. A gap of two finger-widths or more, or approximately 2.7 centimeters, is generally considered diastasis recti.
Safe Core Strengthening Exercises
Targeted exercises focusing on the transverse abdominis, the deepest abdominal muscle, can help support the abdominal wall and reduce the separation. These movements emphasize controlled engagement and proper breathing. Remember to breathe through each exercise, exhaling on exertion, and avoid any bulging or “coning” of the abdomen.
Diaphragmatic breathing, also known as 360 breathing, is a foundational exercise. Lie on your back with hands on your lower ribs and belly. Inhale deeply, allowing your ribs to expand outwards, then exhale slowly, gently drawing your belly button towards your spine. This technique helps activate the deep core muscles and manage intra-abdominal pressure.
Pelvic tilts are another beneficial exercise. Lie on your back with bent knees and feet flat. As you exhale, gently flatten your lower back into the floor by tilting your pelvis upwards, engaging your lower abdominal muscles. Inhale as you slowly return to a neutral spine position. This movement helps establish a connection with the deep core.
Heel slides engage the transverse abdominis while maintaining spinal stability. From a supine position with bent knees, exhale and draw your core inward. Slowly slide one heel away, keeping your lower back pressed into the floor and your pelvis stable. Inhale as you return the heel to the starting position, alternating sides.
Glute bridges support core recovery by strengthening the glutes and engaging the deep abdominals. Lie on your back with knees bent and feet hip-width apart. Exhale as you lift your hips off the floor, forming a straight line from your shoulders to your knees, ensuring your core remains engaged without doming. Slowly lower your hips back down on an inhale.
Movements to Avoid
Certain movements and daily activities can place excessive pressure on the abdominal wall, potentially worsening diastasis recti or delaying healing. Avoid any exercise or position that causes a visible “coning” or “doming” along the midline of the abdomen. This visual cue indicates that the abdominal muscles are not adequately supporting the internal pressure.
Traditional core exercises like crunches, sit-ups, and double leg lifts should be avoided as they can forcefully push the abdominal muscles outward. Planks may also cause coning if the deep core muscles are not sufficiently strong to maintain a flat abdomen; in such cases, modifications like incline planks are advisable. High-impact activities such as running or jumping can also create undue pressure if proper core engagement and breathing techniques are not consistently applied.
Daily movements also require mindful attention. When getting out of bed, roll onto your side first, then use your arms to push yourself up, rather than sitting straight up. Similarly, when lifting heavy objects, including your baby, exhale and consciously engage your deep core muscles before the lift to provide internal support.
When to Seek Professional Help
While gentle exercises can aid in recovery, professional guidance is sometimes beneficial, especially if you experience any of the following:
- If the abdominal gap shows little to no improvement after several weeks of consistent, targeted exercises.
- If the separation appears to widen.
- Persistent pain in the lower back, hips, or pelvic region, which can result from weakened core support.
- Functional issues like urinary incontinence.
- A feeling of pressure or bulging in the pelvic area (pelvic organ prolapse).
- Difficulty performing everyday tasks due to core weakness.
A pelvic floor physical therapist is the healthcare professional equipped to assess and address diastasis recti and related postpartum concerns. A consultation typically involves a thorough assessment of your abdominal and pelvic floor muscles, followed by the development of a personalized exercise plan. For severe cases that do not respond to conservative management, surgical repair, known as abdominoplasty, may be considered as a last resort.