Diastasis recti (DR) is a common physical change that often occurs during and after pregnancy, characterized by the separation of the abdominal muscles. This condition is a natural consequence of the body making space for a growing uterus. While widely associated with childbirth, DR is not limited to postpartum individuals and can affect others, including men and newborns, under certain circumstances.
Defining Diastasis Recti
Diastasis recti is a separation between the two halves of the rectus abdominis muscle, commonly known as the “six-pack” muscles. These muscles run vertically along the front of the abdomen and are joined at the midline by a band of connective tissue called the linea alba. A separation is defined as a widening of this tissue, which stretches and thins due to increased pressure inside the abdomen.
The rectus abdominis muscles do not tear; rather, the space between them increases, stretching the linea alba. This widening creates the noticeable bulge or “pooch” that often protrudes down the midline of the belly. A separation is considered clinically relevant when the gap measures greater than 2 centimeters, or about two finger-widths.
Prevalence and Risk Factors
Diastasis recti is a highly prevalent condition, particularly among women who have experienced pregnancy, but it does not affect everyone. Studies indicate that approximately 60% of women have DR six weeks after childbirth. While many cases resolve naturally within the first year postpartum, about a third of women still have a separation at 12 months.
The likelihood of developing this separation increases with certain factors that place greater strain on the abdominal wall. Advanced maternal age, over 35, is associated with a higher risk. Carrying multiples, such as twins or triplets, or having multiple pregnancies spaced closely together also increases the chance of stretching the connective tissue.
Other contributors include poor core strength before pregnancy and excessive abdominal exercises like crunches during the later stages of pregnancy. The condition can also affect individuals who have never been pregnant, such as men and people with obesity, due to sustained, high intra-abdominal pressure. Outside of pregnancy, DR is associated with significant weight changes or improper movement mechanics.
Recognizable Indicators and Self-Assessment
The most common physical sign of diastasis recti is a visible bulge or ridge running vertically down the center of the abdomen. This protrusion often becomes more pronounced when engaging the abdominal muscles, such as when trying to sit up from a lying position. This phenomenon is often described as “doming” or “coning.”
Beyond the cosmetic appearance, DR can be accompanied by functional issues. These include lower back pain, hip or pelvic pain, and poor posture due to reduced core stability. Some individuals may also experience symptoms of pelvic floor dysfunction, such as urinary incontinence.
A simple self-assessment can be performed by lying on your back with your knees bent and feet flat on the floor. To check for a separation, place your fingers horizontally across your midline, either at, above, or below the belly button. Gently lift your head and shoulders a small amount, just enough to feel the abdominal muscles contract. If you can fit two or more fingertips into the gap between the firm muscle edges, it indicates the presence of diastasis recti.
Management and Recovery Options
The primary approach to managing diastasis recti involves conservative treatment, with physical therapy considered the standard first line of care. Specialized physical therapists, particularly those focusing on pelvic health, can create a tailored exercise program designed to restore core function. These exercises focus on engaging the deep abdominal muscles, specifically the transverse abdominis, which acts like a natural corset.
Safe exercises typically include deep abdominal breathing, modified planks, and pelvic tilts. These strengthen the core without placing undue strain on the weakened midline. It is advised to avoid activities that increase intra-abdominal pressure and cause the abdomen to bulge, such as traditional crunches, sit-ups, and heavy lifting, especially in the initial recovery period. Consistent therapy can lead to significant functional improvement, often within 8 to 12 weeks.
For severe cases that do not respond to months of dedicated conservative management, surgical repair may be considered. This option is typically reserved for individuals with a large separation or those with a concurrent umbilical hernia. The surgical procedure, often performed as part of an abdominoplasty (tummy tuck), involves physically stitching the separated muscles back together.