Diastasis recti is a common condition involving the separation of the abdominal muscles. It occurs when the expanding abdomen creates a gap in the rectus abdominis muscles. This condition affects many women after childbirth, though it can also impact others.
Understanding Diastasis Recti
Diastasis recti refers to the widening of the gap between the two sides of the rectus abdominis muscles, commonly known as the “six-pack” muscles. These muscles run vertically along the front of the stomach and are connected by a band of connective tissue called the linea alba. During conditions that cause significant abdominal expansion, such as pregnancy, this linea alba can stretch and thin, leading to the muscles separating. While some degree of abdominal separation is expected, especially after pregnancy, the linea alba may not always retract to its original position, causing a persistent gap.
Identifying Severe Diastasis Recti
Severe diastasis recti is characterized by a significant separation of the rectus abdominis muscles. An abdominal gap wider than 2 centimeters, or two or more finger spaces, generally indicates the condition. Severe cases are sometimes defined as a gap of 5 centimeters or wider.
Visual signs can also indicate severe separation, such as a visible bulge or “pooch” that protrudes, particularly above or below the belly button. This bulge may appear like a ridge running down the midline of the abdomen. A common sign is “doming” or “coning” of the abdomen, where the belly forms a noticeable bump or hill along the midline when abdominal muscles are contracted, such as during a sit-up or when straining. This doming indicates that intra-abdominal pressure is not being managed effectively.
A self-check method can help individuals assess their abdominal separation. Lie on your back with knees bent and feet flat on the floor. Place one hand behind your head for support and the other hand with fingertips across your midline, pointing towards your pelvis, just above your belly button. Slowly lift your head and shoulders slightly off the ground, as if performing a mini-crunch, keeping your shoulders on the ground. While lifting, gently press your fingertips into your abdomen to feel for a gap or softness between the muscles.
If you feel a gap that is two fingers wide or greater, or if your fingers sink in at least to the first knuckle, it suggests the presence of diastasis recti. This process should be repeated at, above, and below the belly button to assess the full extent of the separation.
Causes and Related Symptoms
Excessive inner-abdominal pressure is a primary cause of diastasis recti. Pregnancy is a common factor, as the expanding uterus stretches the abdominal muscles and connective tissues, often aided by hormones like relaxin and estrogen which soften tissues. Multiple pregnancies, pregnancies spaced closely together, or having a large baby can increase the risk of developing the condition. Rapid weight gain or loss can also contribute to the stretching of the linea alba. Improper core exercises, such as traditional sit-ups or crunches, can worsen the separation by placing undue pressure on the abdominal wall.
Severe diastasis recti can lead to a range of symptoms beyond the visible abdominal bulge. A weakened core often results in lower back pain due to insufficient support for the spine. Poor posture may develop as the body compensates for weakened abdominal muscles.
Pelvic floor dysfunction, including urinary incontinence, is also commonly associated with diastasis recti because the core and pelvic floor muscles work together to stabilize the body. Digestive issues, such as bloating or constipation, can occur as the weakened abdominal muscles may not effectively support internal organs. In some instances, the significant gap can increase the risk of a hernia, where internal organs protrude through the weakened abdominal wall.
Managing and Addressing Severe Diastasis Recti
Diagnosis of diastasis recti typically involves a physical examination by a healthcare provider. Some providers may use tools like ultrasound or calipers for accurate measurements of the inter-recti distance (IRD). Ultrasound is often preferred due to its non-invasive nature and ability to assess muscle function, precisely measuring the gap between muscles.
Non-surgical management options are often the first approach, with specialized physical therapy being a primary intervention. Pelvic floor physical therapists can teach specific exercises that focus on strengthening the deep core muscles. Exercises such as pelvic tilts, abdominal bracing, and specific breathing techniques can help improve core strength and reduce the abdominal bulge. Avoid exercises that worsen the condition, such as traditional sit-ups or crunches. Abdominal binders or support garments may also be recommended to provide support during physical activity.
When non-surgical methods do not provide sufficient improvement or for very wide separations, surgical intervention may be considered. Surgical correction aims to repair the separation of the rectus abdominis muscles. This procedure is often performed as part of an abdominoplasty, commonly known as a tummy tuck. During an abdominoplasty, the surgeon tightens the abdominal muscles by stitching them back together and can also remove excess skin. Laparoscopic repair is another surgical approach. Surgical repair can improve core strength, flatten the abdominal wall, and address associated issues like hernias.