Diastasis recti, often called abdominal separation, is a common condition where the abdominal muscles spread apart. While it can affect various individuals, it is particularly prevalent among those who are pregnant or have recently given birth. This article explores how to identify diastasis recti and the different strategies, both conservative and surgical, that can help resolve it.
Understanding Diastasis Recti
Diastasis recti involves the partial or complete separation of the rectus abdominis muscles, commonly known as the “six-pack” muscles, along the linea alba. The linea alba is a band of connective tissue that runs down the midline of the abdomen, joining the left and right sides of these muscles. When this tissue stretches and thins, the gap between the muscles widens.
Increased inner-abdominal pressure is a primary cause. During pregnancy, the expanding uterus places significant pressure on the abdominal wall, stretching the rectus abdominis muscles and the linea alba. Hormonal changes, specifically the release of relaxin and estrogen, also contribute by softening connective tissues, making them more prone to stretching. While some separation is expected during and after pregnancy, it becomes a concern when the linea alba does not sufficiently retract postpartum.
Beyond pregnancy, other factors can contribute in both men and women. These include improper lifting techniques, chronic straining, or certain abdominal exercises that create excessive intra-abdominal pressure. Significant weight fluctuations, obesity, and inherited muscle weakness can also play a role.
Recognizing Diastasis Recti
Identifying diastasis recti involves observing specific signs and performing a simple self-check. The most common indicator is a visible “pooch” or bulge in the midline of the abdomen. This bulge becomes more pronounced when straining, such as when sitting up, coughing, or lifting, and can appear anywhere from the breastbone to the belly button or below it.
To perform a self-check, lie on your back with your knees bent and feet flat on the floor, placing one hand behind your head for support. With the other hand, place your fingertips flat against your abdomen at your belly button. Gently lift your head and shoulders a few inches off the floor, as if starting a crunch, and press your fingertips into your midline. Feel for a gap or separation between the abdominal muscles. If you can fit two or more fingers into the gap, it may indicate diastasis recti.
While a self-check provides an initial indication, seeking professional diagnosis from a healthcare provider is advisable. A physical therapist or doctor can accurately assess the width and depth of the separation. Professional assessment helps differentiate diastasis recti from other conditions, such as hernias, and guides appropriate treatment strategies.
Conservative Management Strategies
Non-surgical approaches are the first line of intervention for diastasis recti, aiming to improve muscle function and reduce the separation. These strategies focus on strengthening the deep core muscles and modifying daily activities. A specialized physical therapist, including a pelvic floor physical therapist, can provide guidance and personalized exercise programs.
Targeted exercises play an important role in conservative management. Exercises engaging the transverse abdominis, the deepest abdominal muscle, are beneficial as they help stabilize the core and draw the rectus abdominis muscles closer. Examples include pelvic tilts, deep belly breathing, and core activation exercises where you gently draw your belly button towards your spine while exhaling. Conversely, exercises that increase intra-abdominal pressure and cause outward bulging, such as traditional crunches, sit-ups, and planks, should be avoided as they can worsen the separation.
Lifestyle adjustments also contribute to recovery. Maintaining proper posture helps align the abdominal muscles and reduces strain. Practicing proper breathing techniques, avoiding straining during bowel movements, and using safe lifting practices can help manage internal abdominal pressure. For instance, “log rolling” to get out of bed—rolling onto your side and using your arms to push up—helps protect the abdominal muscles from undue stress.
Supportive garments, such as belly bands or compression wraps, can offer temporary support and comfort. While these garments do not cure diastasis recti, they can provide stability and help manage symptoms during recovery and daily activities. They serve as an aid rather than a solution, complementing a structured exercise and lifestyle modification plan.
Surgical Repair Considerations
Surgical intervention for diastasis recti is considered for severe cases where conservative methods have not yielded sufficient results, or when functional issues persist. The most common surgical procedure is an abdominoplasty, often called a “tummy tuck.” During this procedure, the separated rectus abdominis muscles are surgically brought back together and reinforced with sutures, closing the gap and tightening the abdominal wall.
Criteria for considering surgery involve the severity of muscle separation, the presence of associated functional problems like lower back pain, abdominal weakness, or pelvic floor dysfunction, and the completion of family planning. While diastasis recti is not a dangerous condition, surgery can improve both the aesthetic appearance of the abdomen and functional stability. It is performed when abdominal protrusion impacts a person’s quality of life.
Recovery from surgical repair involves a period of healing, with specific instructions for activity restrictions and wound care. Considerations include surgical risks, such as infection or scarring, and the need for a recovery period. Surgical repair is presented as an option for specific circumstances, providing a definitive solution for significant and persistent muscle separation that has not responded to other forms of management.