Diastasis recti abdominis (DRA) is a common condition defined by the widening of the gap between the two sides of the rectus abdominis muscles, often called the “six-pack” muscles. This separation frequently causes a persistent abdominal bulge, making individuals look pregnant long after childbirth. DRA is a widespread concern, affecting many women following delivery, creating a soft “pooch” above or below the belly button that is particularly visible when straining.
The Mechanism Behind the Persistent Bulge
The physical appearance of a persistent abdominal bulge results from a structural change in the body’s core support system. The right and left rectus abdominis muscles are connected by the linea alba, a band of connective tissue spanning the midline. This tissue acts as a natural corset that contains the internal organs. During pregnancy, the expanding uterus places significant outward pressure on the abdominal wall, causing the linea alba to stretch, thin, and pull apart. This connective tissue can lose elasticity under prolonged tension and may not fully retract, leaving a permanent gap between the muscles. When the linea alba is compromised, the abdominal wall can no longer effectively contain the internal organs. This lack of containment allows the organs to press against the weakened midline tissue, causing the abdomen to protrude. The bulging becomes most noticeable when intra-abdominal pressure increases, such as when coughing, sneezing, or attempting a sit-up, which causes a cone or dome shape to appear along the midline.
How to Self-Check for Diastasis Recti
People can perform a simple preliminary check at home to assess for abdominal separation. Lie on your back with your knees bent and feet flat. Place the fingers of one hand, palm down, directly on your midline near your navel, pointing toward your pelvis.
Gently lift your head and neck an inch off the floor, as if starting a mini-crunch, while keeping your shoulders relaxed. This movement engages the rectus abdominis muscles, allowing you to feel the muscle edges. Press down gently but firmly to measure the gap’s width and depth.
The width is measured by how many fingertips fit horizontally into the space between the muscle edges. A separation of two or more finger-widths is considered clinically significant. Assessing the depth is also helpful; if your fingers sink in easily, the connective tissue is weak. While this self-assessment indicates the condition, consulting a healthcare provider or physical therapist is necessary for a definitive diagnosis.
Core Management and Rehabilitation Strategies
Addressing a separated abdominal wall requires a targeted approach focused on restoring the function and stability of the deep core muscles. The primary non-surgical treatment is specialized physical therapy designed to strengthen the transverse abdominis, the deepest layer of abdominal musculature that acts as the body’s internal support belt.
Rehabilitation is founded on exercises that engage this muscle, often using specific breathing techniques, such as exhaling while drawing the belly button toward the spine. Beneficial movements include pelvic tilts, heel slides, and modified single-leg extensions, all performed while maintaining a neutral spine and trunk stability. These exercises stabilize the core without placing undue outward pressure on the stretched linea alba.
In early recovery, supportive binders or abdominal splinting may provide external compression while the core muscles regain strength.
Exercises to Avoid
Certain traditional abdominal exercises are contraindicated because they increase intra-abdominal pressure and can worsen the separation. These movements strain the weakened connective tissue, often causing the abdomen to visibly dome or cone along the midline.
Movements to avoid include:
- Standard crunches
- Sit-ups
- Full planks
- Double leg lifts
It is also important to modify daily movements, such as rolling onto your side before pushing up to get out of bed, rather than sitting straight up. Avoiding heavy lifting and minimizing activities that cause outward abdominal bulging prevents further stretching of the midline tissue. A physical therapist specializing in core rehabilitation can create a safe, individualized program.
Associated Health Concerns Beyond Appearance
While the cosmetic appearance of a bulging abdomen is often the primary concern, diastasis recti leads to several functional health issues. The compromised integrity of the abdominal wall weakens the entire trunk, destabilizing the spine and pelvis. This lack of core support frequently contributes to chronic lower back pain, as other muscles overcompensate for the weakened abdomen.
The condition is also associated with poor posture, since the weakened front wall alters torso alignment. Furthermore, because abdominal muscles work closely with the pelvic floor, their separation can contribute to pelvic floor dysfunction. This dysfunction may manifest as urinary incontinence (especially when coughing or sneezing) or, in severe cases, a feeling of pelvic heaviness or pressure.