Diastasis recti (DR) is a common condition defined by the separation of the rectus abdominis muscles, often called the “six-pack” muscles, along the midline of the abdomen. This occurs when the linea alba, the connective tissue joining these muscles, stretches and thins due to internal pressure. While DR can affect men and infants, it is most prevalent in postpartum individuals, with up to 60% of women experiencing separation. The condition is not just cosmetic; it can lead to functional issues like back pain and core weakness. Fortunately, a range of treatment options exists, spanning from specialized physical therapy to surgical repair.
Confirming the Condition
Verifying the presence and severity of diastasis recti is the first step toward effective treatment. A simple self-check involves lying on your back with knees bent and feet flat, placing fingers horizontally across the midline near the belly button. Gently lift your head and shoulders slightly to engage the abdominal muscles. Count how many fingers fit snugly into the depression between the taut muscles; a gap wider than two finger-widths (approximately two centimeters) is generally considered DR.
If you feel a deep or wide separation, or experience persistent symptoms like low back pain or a visible bulge (coning or doming) when straining, consult a specialist. The depth and tension of the connective tissue are important indicators of functional integrity. A physical therapist specializing in women’s health or a physician can use methods such as ultrasound to provide a precise diagnosis.
Non-Surgical Rehabilitation Strategies
For most mild to moderate cases, specialized physical therapy (PT) is the primary and most effective non-surgical treatment. Rehabilitation focuses on restoring the function of the deep abdominal muscles, particularly the transverse abdominis (TA). The TA acts as an internal corset, stabilizing the spine and narrowing the inter-recti distance.
Rehabilitation typically begins with proper breathing techniques, specifically diaphragmatic breathing, coordinated with core engagement. You should inhale deeply, and then, as you exhale, gently draw the navel toward the spine without forcefully sucking in. This action helps recruit the TA and regulate intra-abdominal pressure, which is necessary for healing the stretched connective tissue.
The next step involves mastering gentle, foundational movements that activate the deep core system, such as pelvic tilts and heel slides. Pelvic floor engagement is also integrated because the pelvic floor and the transverse abdominis work together as an integrated unit. A qualified physical therapist will guide you through functional movement retraining. The goal is to build a reflexive, stable core that can handle the demands of daily life.
Movements and Activities to Avoid
During rehabilitation, it is essential to avoid movements that increase intra-abdominal pressure and cause the abdominal wall to bulge outward. This outward pressure, often called “doming” or “coning,” places stress on the already thinned linea alba, potentially worsening the separation.
Traditional abdominal exercises involving forward spinal flexion are typically contraindicated. These include full crunches, sit-ups, and intense V-ups, which aggressively shorten the rectus abdominis and push abdominal contents outward. Similarly, full planks and push-ups should be avoided until a physical therapist has cleared them, as they generate high pressure that strains the midline.
Heavy lifting without proper core engagement is another significant risk factor. Holding your breath and bearing down (the Valsalva maneuver) dramatically increases pressure on the abdominal wall. It is important to exhale during the exertion phase of any lift to help manage this pressure.
Activities that involve aggressive twisting or intense stretching of the abdominal wall, such as certain yoga poses, should also be modified or temporarily eliminated. Even everyday actions require modification; you should roll onto your side before pushing yourself up to a seated position to avoid straining the core muscles.
Surgical Options for Correction
When conservative treatment fails to resolve functional issues, or for severe cases typically defined by a separation greater than four centimeters, surgical intervention may be recommended. The definitive surgical procedure is abdominal wall reconstruction, most commonly performed as part of an abdominoplasty, or “tummy tuck.”
The procedure’s core component is plication, which involves using strong, non-absorbable sutures to stitch the separated rectus abdominis muscles back together along the midline. This creates an internal “corset” that restores the structural integrity of the abdominal wall, significantly improving core function and resolving associated issues like low back pain. The surgeon performs the plication after lifting the skin and fat, and then removes any excess skin before redraping the remaining tissue.
While the traditional approach is an open abdominoplasty, minimally invasive techniques are also used for less severe separations. Recovery involves a period of restriction, with most patients resuming light activity within two to four weeks. Full recovery and the return to strenuous exercise typically take between three and six months, and patients are advised to maintain a stable weight to ensure the long-term integrity of the repair.