Diastasis recti (DR) is a common condition characterized by the widening of the gap between the two sides of the rectus abdominis muscle. This separation occurs when the linea alba, the connective tissue running down the center of the abdomen, stretches and thins. The condition is highly prevalent, affecting over 60% of women during or after pregnancy, but it can also occur in men and infants. A persistent gap can result in a visible bulge or “pooch” and may contribute to issues like lower back pain and core weakness. Treating this condition often involves a multidisciplinary approach, starting with conservative management before considering surgical options.
Initial Assessment and Diagnosis
The journey to diagnosing diastasis recti begins with a consultation with a Primary Care Physician (PCP), an Obstetrician/Gynecologist (OB-GYN), or a Midwife. These professionals perform a physical examination to check for the separation of the abdominal muscles, often during the standard six-week postpartum check-up.
The most common diagnostic technique involves a simple physical test. The patient lies on their back and gently lifts their head and shoulders, causing the rectus muscles to contract. The healthcare provider uses their fingers to measure the width and depth of the gap, or inter-rectus distance (IRD), along the midline of the abdomen. A separation greater than two centimeters, or roughly two finger-widths, is considered clinically significant.
A thorough assessment also involves ruling out other abdominal wall issues, such as a hernia. If the physical exam is inconclusive or when surgical planning is necessary, imaging studies may be used for a more objective measurement. An abdominal ultrasound is a common tool for precisely measuring the distance between the muscles and confirming the integrity of the abdominal contents.
Non-Surgical Treatment Providers
Non-surgical treatment is the first-line approach, and specialized Physical Therapists (PTs) are the primary providers. Women’s Health Physical Therapists or pelvic floor specialists possess the expertise to design a targeted rehabilitation program. Their initial focus is a comprehensive core assessment to understand the patient’s existing muscle function and identify compensatory movement patterns.
A key component of physical therapy is the re-education of the deep core muscles, particularly the transverse abdominis, which acts like an internal corset. Patients are taught gentle, controlled movements that engage this deep layer, often starting with exercises like deep belly breathing with an abdominal contraction. The goal is to restore functional strength and stability to the entire core unit, including the pelvic floor.
The therapist also provides detailed guidance on exercises and movements to avoid, as many traditional core exercises can worsen the separation. Movements that cause the midline of the abdomen to bulge or “dome,” such as crunches and sit-ups, are restricted, especially in the early stages of recovery. Avoiding these high-pressure movements protects the connective tissue from further stretching, allowing the targeted deep core work to be more effective.
Physical therapists also advise on the proper use of supportive garments or abdominal binders. These can provide external support and improve posture during the healing process. While these garments offer temporary assistance, they are always used in conjunction with active exercise to ensure the muscles learn to support the body independently. The program progresses from basic activation to more complex, functional movements as the patient’s core strength improves.
Specialists for Surgical Repair
Surgical repair may be considered when conservative management with physical therapy fails to alleviate symptoms or when the abdominal separation is severe. The specialists who perform this procedure are typically Plastic Surgeons, or sometimes General Surgeons, especially if a complex hernia is present. Surgery is reserved for cases involving persistent symptoms like chronic lower back pain, significant functional impairment, or a large, unresponsive gap.
The most common surgical technique to correct diastasis recti is called rectus abdominis plication, which involves stitching the separated muscles back together at the midline. This procedure is often incorporated into an abdominoplasty, or “tummy tuck,” which also removes excess skin and fat from the abdomen. The surgical approach aims to restore the integrity and tension of the abdominal wall, resulting in a flatter abdominal contour and improved core stability.
Some patients may be candidates for minimally invasive approaches, such as laparoscopic repair, which uses smaller incisions. Following the procedure, a period of recovery is required, often involving the use of a compression garment for several weeks to support the newly tightened abdominal wall as it heals.