Diastasis recti (DR) is the widening of the gap between the two vertical bands of the rectus abdominis muscle, often called the “six-pack” muscles. This condition occurs when the connective tissue joining these muscles stretches and thins. Understanding the mechanism of this abdominal separation is necessary to determine if a cesarean section directly causes DR, a common concern among people who have given birth.
What is Diastasis Recti and What Causes It
Diastasis recti is a physiological change that occurs during pregnancy, not an injury sustained during childbirth. The rectus abdominis muscles are joined at the midline by the linea alba, a band of connective tissue designed to stretch to accommodate the growing fetus. The primary mechanical force behind the separation is the tremendous increase in intra-abdominal pressure from the expanding uterus. This pressure, combined with pregnancy hormones, causes the linea alba to thin and widen, allowing the abdominal wall to expand outward. While DR affects nearly all pregnant women by the third trimester, it persists in up to 60% of women postpartum.
Certain factors increase the likelihood of developing a noticeable separation that does not resolve on its own. These risk factors include advanced maternal age, having multiple pregnancies close together, carrying a multiple gestation (like twins or triplets), or delivering a baby with a high birth weight.
The Relationship Between C-Section and Abdominal Separation
A cesarean section does not cause diastasis recti, as the separation occurs during pregnancy. The C-section is a surgical procedure that happens after the stretching of the midline connective tissue has already occurred. Surgeons typically use a low, horizontal incision and carefully separate the rectus abdominis muscles to access the uterus, rather than cutting through the muscle belly itself.
The primary concern is not that the surgery creates the separation, but that it complicates the recovery of the pre-existing condition. The trauma of the surgical incision and resulting scar tissue can affect the function of the deep core muscles, leading to restricted movement and delayed activation of the abdominal wall. This often makes the healing of DR more challenging and prolongs the recovery timeframe compared to a non-surgical birth.
Addressing Diastasis Recti After Delivery
Management of diastasis recti focuses on conservative, non-surgical approaches regardless of the delivery method. The goal is to restore the function of the deep abdominal muscles, especially the transverse abdominis, which stabilizes the core. Specific, core-safe exercises are the gold standard for recovery and can effectively reduce the inter-recti distance.
It is necessary to avoid exercises that place excessive, outward pressure on the abdominal wall, which can worsen the separation. High-pressure movements should be avoided until the core has regained sufficient strength. Daily movements must also be modified, such as rolling onto the side to get out of bed instead of sitting straight up.
Pelvic floor physical therapy is a highly effective treatment option, providing a tailored program focusing on proper breathing and deep core activation. For those who have had a C-section, gentle scar tissue massage is also important to mobilize the fascia and improve muscle function around the surgical site. Surgical repair, typically through an abdominoplasty, is reserved for severe cases where conservative treatment has failed to provide functional improvement.