Rectus diastasis is a common condition where the two halves of the outermost abdominal muscles, the rectus abdominis, separate along the midline connective tissue known as the linea alba. While it can occur in newborns and men, it most frequently develops during pregnancy as the abdominal cavity expands. The condition often results in a visible bulge or “pooch” in the center of the abdomen, particularly when engaging the core muscles. Rectus diastasis is treatable through conservative measures like physical therapy or, in more severe cases, surgical intervention.
What Rectus Diastasis Is and How It Is Diagnosed
The abdominal wall includes the rectus abdominis, the most superficial layer commonly known as the “six-pack” muscles. These two vertical muscle strips are joined in the center by the linea alba, a band of connective tissue. Rectus diastasis occurs when the linea alba stretches and widens, increasing the distance between the left and right rectus muscles. This widening, or inter-rectus distance (IRD), is considered diagnostic when it measures 2 centimeters or greater. The primary cause is excessive intra-abdominal pressure, most often from late-stage pregnancy, significant weight gain, or improper lifting mechanics.
A simple self-check can suggest the presence of a diastasis. Lie on your back with your knees bent and feet flat on the floor. Place your fingers just above or below your navel, pointing toward your feet, and slightly lift your head and shoulders off the floor, engaging your abdominal muscles. If you feel a gap of two or more finger-widths between the muscle edges, you may have a diastasis. For an accurate measurement, a healthcare professional, such as a physical therapist or doctor, will use palpation, a caliper, or an ultrasound to precisely measure the IRD, often at the navel. Professional diagnosis also helps rule out other conditions like a ventral hernia, which sometimes mimics a diastasis.
Targeted Physical Therapy and Core Rehabilitation
The initial approach to addressing rectus diastasis is conservative management through targeted physical therapy. This non-surgical path focuses on restoring function to the entire core system, including the deep stabilizing muscles. A specialized Pelvic Floor or Women’s Health Physical Therapist creates a tailored program that directly addresses the weakened connective tissue.
Rehabilitation focuses on activating the transverse abdominis, the deepest abdominal muscle that acts like an internal corset. Exercises begin with gentle isometric contractions, such as drawing the navel toward the spine without tilting the pelvis. This activation is coordinated with diaphragmatic breathing techniques, where the individual learns to regulate intra-abdominal pressure. Proper breath control is a fundamental skill that helps create tension across the stretched linea alba, which is necessary for healing.
It is important to avoid traditional core exercises like crunches, sit-ups, and full planks, especially early in recovery, as these can increase pressure and worsen the separation. Instead, a therapist guides the progression from static holds and gentle movements, such as pelvic tilts and supine marches, to more functional exercises. The goal is to safely strengthen the core without causing the abdomen to bulge or “dome” outward. Supportive garments, such as abdominal binders, may be recommended as an aid during activity to provide external support, but they are not a substitute for muscle strengthening.
Lifestyle Adjustments During Recovery
Healing rectus diastasis requires consistent effort beyond formal exercise sessions. Managing intra-abdominal pressure during daily activities is a continuous part of the recovery process. One important habit is using the “log roll” technique when getting in and out of bed or rising from a reclining position. This involves rolling onto your side before using your arms to push your torso up, which prevents the severe strain that a vertical sit-up motion places on the midline.
Proper body mechanics are necessary when lifting any heavy object, including a child. Avoid twisting while lifting and engage the deep core muscles before initiating the movement. Poor posture, such as slouching, places undue strain on the abdominal wall, so maintaining a neutral spine with the rib cage stacked over the pelvis is encouraged throughout the day.
Managing constipation is also a significant factor, as straining during bowel movements sharply increases intra-abdominal pressure. Ensuring adequate hydration and consuming fiber-rich foods supports regular bowel movements, minimizing this strain. Proper nutrition, including protein and micronutrients like zinc, is important to support the rebuilding of the connective tissue.
Surgical Options for Severe Diastasis
Surgery is considered when non-surgical treatments fail to resolve symptoms after a dedicated period, typically 6 to 12 months of consistent physical therapy. It is also indicated for severe cases, often defined as a separation of 4 to 5 centimeters or more, or when the diastasis is accompanied by significant functional impairment. Functional issues that warrant surgical consideration include chronic lower back pain, pelvic floor dysfunction, or a coexisting umbilical or epigastric hernia.
The surgical procedure to correct rectus diastasis is called plication, where the separated muscles are sutured back together at the midline. This is most often performed as part of an abdominoplasty, or “tummy tuck,” which allows the surgeon to remove excess skin and tighten the entire abdominal wall. The repair can be done using either an open approach or minimally invasive techniques like laparoscopy. Plication restores the anatomical integrity of the core, improving abdominal contour and alleviating associated symptoms. Recovery from surgery is significantly longer than physical therapy, requiring weeks of restricted activity to allow the internal sutures to heal and the abdominal wall to strengthen.