Diastasis recti (DR) is the separation of the rectus abdominis muscles, commonly known as the “six-pack” muscles, which occurs when the connective tissue between them, the linea alba, stretches and weakens. This separation can lead to a visible bulge in the abdomen, often persisting long after pregnancy. It is never too late to address and fix diastasis recti, regardless of how long the condition has been present. Treatment options are available at any stage, though healing requires time and consistent effort.
Assessing the Severity and Status
Determining the current state of the abdominal separation is the first step toward effective treatment, as severity guides the appropriate path forward. A simple self-check involves lying on your back with knees bent and feet flat. While supporting your head with one hand, lift your head slightly to engage the abdominal muscles. Use the fingers of the other hand to feel for a gap along the midline of the abdomen, both above and below the belly button.
A separation is classified as diastasis recti if the gap is two finger-widths or wider. Beyond measuring the width, it is important to assess the depth or tension of the connective tissue between the muscles; a soft, deep gap suggests severe weakening. For a precise diagnosis, consultation with a specialized physical therapist or physician is recommended.
Professionals often use diagnostic tools like ultrasound to measure the inter-rectus distance, confirming a clinical separation of greater than 2 centimeters. Assessment includes looking for functional symptoms, such as chronic lower back pain, poor posture, or signs of pelvic floor dysfunction, including urinary leakage. The overall severity score, which includes both the physical gap and the presence of symptoms, determines whether conservative or surgical methods are necessary.
Non-Surgical Rehabilitation Strategies
For the majority of individuals, non-surgical methods focusing on core stabilization provide the most accessible and effective path to improvement, even years after the initial separation. The goal of rehabilitation is not necessarily to completely close the gap, but to restore tension and function to the linea alba by strengthening the deep abdominal muscles. This process is primarily achieved by activating the transverse abdominis (TA), which acts like an internal corset to stabilize the core and provide support.
A specialized physical therapist can teach targeted exercises that safely engage the TA, such as abdominal bracing, pelvic tilts, heel slides, and the bird dog movement. These exercises focus on controlled breathing and movement, where the abdominal wall is drawn inward on the exhale to encourage the muscles to approximate. Consistency in performing these specific, low-impact movements daily is more important than the intensity of the workout.
It is equally important to know which movements to avoid, as they can increase intra-abdominal pressure and worsen the separation. Exercises that cause the abdominal wall to bulge outward, such as traditional crunches, sit-ups, planks, and double leg lifts, must be temporarily avoided. Maintaining mindful posture during daily activities like lifting or getting out of bed prevents further strain on the compromised connective tissue.
Surgical Intervention Options
When conservative efforts fail to improve symptoms or when the separation is exceptionally wide, surgical correction becomes a necessary option. Surgery is typically reserved for severe cases, often defined by a separation of 5 centimeters or more, or when a symptomatic umbilical or ventral hernia is present alongside the diastasis recti. The most common surgical approach is a procedure known as abdominoplasty, or a “tummy tuck,” which allows the surgeon to visualize and repair the muscle separation.
The surgical fix involves a procedure called plication, where the separated rectus abdominis muscles are manually stitched back together along the midline using strong sutures. This effectively restores the integrity of the abdominal wall, providing a permanent repair and a flatter abdominal contour. This plication can be performed through an open incision, often incorporated into the abdominoplasty, or through minimally invasive laparoscopic techniques.
Patients are generally advised to wait until they have completed their family planning before undergoing this elective surgery, as subsequent pregnancies could potentially compromise the repair. Recovery from surgical plication typically involves a restriction on heavy lifting and strenuous activity for six to twelve weeks to allow the internal sutures and tissues to heal completely. Surgical intervention offers a reliable solution for functional problems like chronic back pain and core instability that may not respond to physical therapy alone.