Diastasis Recti Abdominis (DRA) is a common physical condition characterized by the separation of the large vertical muscles of the abdomen. This separation is most frequently observed in individuals who are pregnant or have recently given birth, but it can also affect men and children. The condition is not a hernia, but rather a widening of the connective tissue that joins the abdominal muscles. This widening can lead to functional issues and a noticeable change in abdominal contour.
Defining Diastasis Recti Abdominis
The anterior abdominal wall is supported by the paired rectus abdominis muscles, often called the “six-pack” muscles. These two vertical muscle columns run from the lower ribs and sternum down to the pubic bone. They are normally held together at the body’s midline by a dense, collagenous structure known as the linea alba.
DRA occurs when the linea alba stretches and thins horizontally, causing the left and right sides of the rectus abdominis muscles to move apart. This widening is technically referred to as an increased inter-recti distance (IRD). An IRD of 2 centimeters (or greater than two finger-widths) is generally the clinical threshold used to diagnose the condition. The width of the separation often varies along the midline, typically being wider above the navel. When the linea alba loses its integrity, it impacts the entire core structure.
Identifying the Condition
A key sign of DRA is a visible bulge or “pooch” that protrudes along the midline of the abdomen, particularly when the core muscles are engaged. This bulging is sometimes described as “doming” or “coning” when a person performs movements like sitting up.
Beyond cosmetic changes, DRA can lead to functional symptoms, including chronic low back pain and poor posture due to inadequate core support. The condition can also contribute to pelvic floor dysfunction, which may manifest as urinary incontinence or pelvic pain. Individuals might also feel a soft, jelly-like texture or a distinct gap when pressing along the midline of the abdomen.
A simple self-check test can give an indication of muscle separation. To perform this, lie on your back with knees bent and feet flat. Gently lift your head and shoulders just enough to engage the abdominal muscles, while placing the fingertips of the other hand horizontally across the midline of the belly button. If a gap wider than two finger-widths is felt between the muscle edges, it suggests DRA. An official diagnosis and assessment of severity should be done by a medical professional, such as a physical therapist, who may use calipers or ultrasound for a more precise measurement.
Causes and Contributing Factors
The fundamental cause of DRA is a sustained increase in intra-abdominal pressure that overwhelms the connective tissue’s ability to remain taut. Pregnancy is the single most frequent cause, as the expanding uterus exerts significant outward force on the abdominal wall, particularly during the third trimester. Hormonal changes during pregnancy, such as the release of relaxin, also contribute by softening and stretching the collagen fibers of the linea alba.
The risk of developing a pronounced separation increases with factors such as having multiple pregnancies, carrying multiple fetuses, or having a large fetus. DRA is not exclusive to pregnancy; any activity that chronically or suddenly elevates pressure can be a factor. This includes rapid weight fluctuations, improper heavy lifting techniques, or engaging in forceful abdominal exercises like traditional crunches. Chronic straining from conditions like persistent coughing or constipation can similarly place undue stress on the linea alba over time, exacerbating the separation in both men and women.
Medical Management and Treatment Options
For most people, the initial approach to managing DRA involves conservative treatment, with specialized physical therapy being the primary intervention. This therapy focuses on restoring the function and tension of the entire core canister. The goal is to strengthen the deeper core muscles, such as the transverse abdominis, which act like a corset to stabilize the trunk and reduce the width of the gap.
A physical therapist will prescribe targeted exercises emphasizing deep core engagement and proper breathing mechanics, while instructing the patient to avoid movements that cause the abdomen to visibly dome or bulge. This conservative, exercise-based program should typically be followed rigorously for at least six months before other options are considered. External support, such as an abdominal binder or splint, may be used temporarily to assist with postural awareness during the initial stages of rehabilitation.
Surgical intervention is reserved for individuals with severe separation or those who have failed to achieve functional improvement after a dedicated course of physical therapy. Generally, surgery is considered for a documented separation of 5 centimeters or more, accompanied by functional impairment that affects the quality of life.
The most common surgical procedure is a form of abdominoplasty, or “tummy tuck,” which involves surgically stitching the two rectus abdominis muscles back together, a technique called plication of the linea alba. This procedure can be performed using open, laparoscopic, or robot-assisted techniques. Following any intervention, continued maintenance of core strength and proper movement patterns is necessary to prevent recurrence and ensure long-term stability of the abdominal wall.