Diastasis recti — another name for separation of the outermost abdominal muscles — mostly affects women during pregnancy and/or in the 12 months after childbirth. (1) However, moms-to-be and new moms are not the only ones who develop diastasis recti — it can also occur in men and even children. In fact, every person is born with some degree of diastasis recti because the abdominal muscles are separated at birth and then later in childhood join closer together as the body develops.
A high percentage women who have had a baby will have some degree of diastasis recti afterward. Roughly one-third of new moms suffer from abdominal separation a year after delivery and up to 60 percent in the first couple months postpartum, according to one study from Norway. (2) However, many people dealing with diastasis recti are not aware of it, although they probably notice that their core feels weak and their back tends to ache due to having poor posture and hunching over.
While some people might choose to undergo surgery to repair diastasis recti, this isn’t always necessary considering natural treatments can also be effective. As we’ll cover much more below, the goal of diastasis recti “repair” is to strengthen your core and pull the separated muscles in the outer abs back together. This can be done by carefully performing certain exercises, either with or without guidance from a physical therapist.
What Is Diastasis Recti?
Diastasis recti (also called rectus diastasis) is a condition that’s characterized by separation of the the two large, parallel bands of muscles that meet in the middle of the abdominal muscles. (3) The word diastasis means separation, while the word recti refers to the rectus abdominis muscles (the outermost abdominal muscles).
When many people think of the “abdominals” or simply the “abs,” they are referring to the rectus abdominis muscles. These are the muscles that extend vertically on each side of the anterior (“front”) wall of the abdomen. Diastasis recti is essentially stretching of the tissue called the linea alba. The linea alba helps join muscles in the core together near the center of your belly, but can sometimes become overly stretched, thin and weak. In people without diastasis, their rectus abdominal muscles are close to one another on either side of the belly button and there isn’t much of a gap between them.
Not only can diastasis recti cause someone to feel insecure about how they look, but it’s also a bigger problem because it weakens the entire core (including the abs, back and oblique muscles). When the linea alba stretches too much, overall stability and strength of the entire abdominal wall is decreased. This can wind up leading to lower back pain, poor posture, incorrect form when exercising, and many other related conditions.
Symptoms and Signs
How do you know if you have rectus diastasis? The most common diastasis recti symptoms include:
- Visibly having abdominal muscles that look separated and pulled out to the side, with an extended space between the innermost muscles that might bulge out. Some other signs of a diastasis are a bulging belly “pooch,” an outie belly button, or a “half football bulge” when you get up off the floor after lying on your back.
- Back pain, especially in the low or mid back. The hips can also experience pain if the core is not strong enough to properly distribute your body weight and maintain good posture.
- Suffering from abdominal or umbilical hernias. Hernias and diastasis recti seem to be closely related, and some think that an umbilical hernia is a side effect of diastasis recti in certain people.
- Poor posture, such as hunching over, shrugging the shoulders, and having forward head posture.
- Experiencing pelvic floor problems, such as having trouble controlling urination (for example, some people find that they pee uncontrollably when laughing or sneezing).
- Digestive issues, including constipation and bloating. A weak core can contribute to reduced control of the bowels and displacement of the intestines. The belly might look most distended and bloated at the end of the day after eating.
- Trouble breathing and exercising.
- Reduced range of motion.
- People with diastasis recti are also more likely to have an “outie” belly button, since this can be caused by having weak tissue surrounding the belly button area.
Causes and Risk Factors
What causes diastasis recti? The underlying reason that abdominal muscle separation develops is due to too much stretching in both a forward and sideways direction. This weakens connective tissue in the core that joins the outermost muscles. There are a number of reasons this can happen, one of which is pregnancy, due to the belly expanding. But surprisingly, doing lots of core exercises can also cause the outer ab muscles to become overly stretched. This doesn’t mean you should avoid doing ab workouts, but you should know the signs of diastasis recti and adjust your workout routine if needed.
The most common diastasis recti causes and risk factors include: (4)
- Pregnancy. (5) Diastasis recti can initially develop in the second trimester, peak in the third trimester and remain during the postpartum period. Hormones such as relaxin that are released during pregnancy can weaken the connective tissue in the abs. The ab muscles are also stretched and thinned due to the belly growing rapidly, and pressure is also increased in the entire abdominal region. A couple of months following birth the abdominal muscles may come together a little and diastasis recti may improve, but usually it won’t be totally repaired without performing specific exercises. Diastasis is more common in women who are pregnant with twins or triplets or who have multiple pregnancies, especially if they are close together or if the woman already had an underlying abdominal problem for other reasons.
- Obesity or weight gain, especially gaining in the belly/abdominal area. The more times that a woman is pregnant, usually the worse her diastasis recti will get.
- Being over the age of 35.
- Abdominal injury, trauma or surgery.
- Doing lots of repetitive core exercises, such as crunches and Pilates.
- Exercises and sports that cause you to continuously arch your back and twist the sides of your ribs, such as tennis, golf, gymnastics, yoga, biking and even swimming. Certain types of weight-lifting may also contribute to diastasis recti, especially in men.
- Receiving steroid injections in the abdominal region, which can cause weakening.
- Being very naturally flexible, which can cause too much stretching and thinning of connective tissue.
If you visit your doctor for help with repairing diastasis recti, he or she will want to observe the appearance of your abdominal area and talk to you about any symptoms you’re experiencing. Even before you head to a doctor, you can perform diastasis recti tests on yourself in order to determine if you might have the condition.
Here is how to test yourself for diastasis recti:
- Observe the “distance” or space between the two muscles in your abs. Use your fingers to determine how much separation there is between the two muscles that run down your abs vertically. If you can fit more than one finger between these muscles, you probably have some separation. Diastasis is estimated to be any space between the ab muscles that’s more than 2.7 centimeters. Only being able to fit one finger indicates that your core is relatively strong.
- Check your belly button to see if it’s protruding or feels like it’s “pulsing.”
- Notice if you have any bulging in the middle of your abs. In severe cases, bulging may even take the shape of a football and noticeably protrude outward.
- Lay down on your back and then lean forward using your core muscles to get up. Contract your abs by moving your ribcage closer to you pelvis and pulling your belly button down. Notice any bulging and pulsing or if you can feel a noticeable gap.
- Determine if the connective tissue in your abs feels weak and thin. Press down on the tissue with your fingers. If they feel soft and you can press down pretty far, this is another sign of diastasis recti. You want to feel like your core muscles are “shallow” and strong enough so that you can’t press down far.
Once diagnosed, how do you fix diastasis recti? Treatment options that can help with diastasis recti repair include:
- Physical therapy. Performing specific exercises can help to strengthen the core without further thinning or stretching the muscles.
- In some cases, surgery. Should diastasis recti be fixed with surgery? It isn’t always necessary to have surgery to repair the condition; however, it may be recommended if someone has a severe case in which abdominal connective tissue has torn away from the muscles it usually connects to. Surgery is sometimes also needed if someone has developed abdominal hernias that are cutting off normal blood supply. Surgery performed to correct diastasis is called a “abdominoplasty” or “a tummy tuck.”
- Cosmetic surgery to remove loose, thin skin in the abdominal region is also an option. This might be done after pregnancy or weight loss, but usually is only performed for cosmetic reasons.
- Depending on who you ask, some midwives and physical therapists may recommend using a “tummy splint” or binder after pregnancy to support the core muscles. However, there are mixed opinions about whether this is helpful or not. Splints may be most helpful if you’re sick and dealing with coughing or sneezing that is putting pressure on your abs.
Diastasis Recti Repair
1. Decrease Abdominal Pressure
Diastasis recti is believed to be mostly due to abdominal pressure, so you want to avoid doing anything that makes this pressure worse. It might seem counterintuitive, but certain abdominal movements like crunches, sit-ups and planks can actually aggravate diastasis instead of making it better. How so? These exercises can further increase pressure in the abdominal region and push your organs outward instead of back together. They may make muscle separation worse if you’ve already got thin, weak rectus abdominis muscles.
Here are tips for reducing pressure on your abdominals:
- Avoiding any core movement like crunches, bicycle crunches, roll-ups, pull-ups, planks or sit-ups that isolate the abdominal muscles.
- Don’t perform any upper body twists that have you extend your arm away from your body. You should also avoid Pilates and certain yoga movements that can stretch the outer abs, including downward dog, side planks, and triangle pose.
- Be careful when going from a laying down posture to getting up. It’s safest to roll over onto your side, then use your arms to help push yourself up to a sitting position.
- Don’t lift very heavy weights or objects until after you heal.
- Focus on full-body, compound movements that build strength all over. An example of this is squats.
2. Physical Therapy
As mentioned above, doing the right exercises aimed at strengthening the abdomen is important, since some movements can actually have the opposite effect: exacerbating diastasis recti. In order to recover from diastasis recti, you’ll have to be patient, since most people will need to commit to regularly completing core exercises for about 12–18 weeks (or three to four months or more) to see the best results.
If you can afford it, it’s a good idea to visit a physical therapist who specializes in women’s health and conditions like diastasis recti. Alternatively, you may be able to find specific classes for new moms offered in your area that are led by a knowledgeable personal trainer or physical therapist, or you can look to online classes and videos to save money and time.
It’s generally recommended that if you’re a woman who’s recently given birth and you want to begin working on correcting diastasis recti, make sure you wait at least six weeks after labor. It’s also recommended that you get clearance from your doctor first before you begin exercising again. Even though a six-week wait is standard, some women choose to start performing exercises carefully and slowly before this point. Many pregnant women can even safely perform basic exercises throughout their pregnancy to help prevent diastasis recti.
You can learn how to correctly perform exercises while working with a professional, then keep practicing on your own. Many physical therapists, doctors and midwives recommend several types of diastasis recti training programs that can help safely realign the abdominal muscles. Examples of popular programs include: the Tupler Technique, Keller’s Dia Method, and the MuTu System. The Tupler technique is unique because it involves performing specific exercises while wearing a belly splint in order to help hold your ab muscles together. Other physical therapists/trainers recommend using a prop called the Parasetter when doing diastasis exercises that can help you breath more easily, or using a rolled up yoga blanket or towel between your shoulder blades.
3. Specific Core-Strengthening Exercises
At home you can practice a basic exercise for about 10 minutes per day to help correct diastasis recti by engaging the right core muscles. Isolating the deepest muscles of the core, called the transverse abdominis (or TvA muscles), is an important step in resolving diastasis recti. The transverse abdominis is a muscle layer at the front and side abdominal wall that is layered below the internal oblique muscle. The TvA muscle acts as a stabilizer for the entire low back and core, almost like an internal “corset” that holds everything in place.
- Start by sitting on the floor with your legs crossed with your hands on your belly. Take a big breath so your belly expands. When you exhale try to suck your belly muscles in toward your spine and hold this position. Keep your fingers over your belly to feel the muscles engaged. Keep breathing as you hold in, drawing your ab muscles in further and further.
- You can also do the exercise above while sitting on your knees, standing with knees slightly bent, on all fours, or lying on your side in the fetal position. Make sure to keep your back flat and belly engaged. You may want to change positions several times while you work on completing this exercise for 10 full minutes.
- Another way to perform diastasis recti exercises is while lying on your back (similar to bridge pose, if you’re familiar with yoga). Hold a yoga block or squishy ball above your chest, keeping your arms straight. Squeeze in as you imagine wrapping your front ribs together, and engaging your pelvic floor muscles. Lift your hips off the ground. Draw in your abs and keep breathing. Exhale and lift up, then inhale as you lower back down. Repeat for up to 10 minutes per day, taking breaks as needed.
- In addition to the exercises described above, you can practice “Bracing and Hollowing” to engage your TvA muscles. When bracing, you contract the muscles of your abdomen and hold them tight without moving, sucking in, or expanding your abdomen. Imaging someone is about to bunch you in the stomach and your “bracing” by flexing your ab muscles. Hold this position for six to 10 seconds, release and repeat several times. Hollowing refers to sucking in and compressing the abdomen. You pull your belly button back toward your spine and hold for six to 10 seconds, then release and repeat.
1. Regular Exercise
In order to prevent and help correct abdominal muscle separation, getting regular exercise that addresses the whole body is recommended. In fact, most experts tell us that the very best way to prevent diastasis recti during or after pregnancy is to exercise and gain core strength before getting pregnant.
Ideally your exercise routine should help improve your overall strength, coordination and flexibility, which is why a combination of cardio/aerobic exercise and resistence-training is best. I also recommend adding interval training to your workouts to boost your metabolism and improve physical performance.
In addition to formally exercising for about 30–60 minutes most days of the week, try to sneak more general movement and activity into your routine. For example, “exercise hacks” to implement include:
- Walking to work, if possible.
- Walking to do errands.
- Having “walking meetings” at work.
- Taking your dog for a daily stroll outside.
- Meeting up with friends for a workout instead of brunch.
2. Hernia Prevention
Is a diastasis recti a type of hernia? How are the two conditions different?
Hernias and diastasis recti are not the same thing, although having an umbilical hernia puts you at a higher risk for having diastasis recti. When the tissue in the abdomen isn’t just stretched but is also torn, a hernia can develop. An umbilical hernia is when your intestine or other tissues inside your abdominal cavity bulge through the weak spot around the belly button, leading to a pronounced “outie” belly button. In addition to protruding outward, the belly button area may also become swollen and a bit painful. This is common is newborn babies but less common in children and adults. (6)
Weakness in the abdominal muscles is a risk factor for both umbilical hernias and diastasis recti. Some of the underlying causes of umbilical hernias can include: obesity, multiple pregnancies, abdominal surgery, and having fluid in the abdominal cavity (called ascites). Sometimes hernias are not preventable, but lifestyle changes may be able to reduce your risk. Try improving your diet, losing weight if you need to, being more active, managing stress, changing medications to reduce fluid retention if needed, and changing your sleep position if you’re experiencing abdominal pressure/pain.
3. Maintain a Healthy Weight
Carrying excess weight will aggravate low back pain and may worsen diastasis recti. Work on eating a nutrient-dense anti-inflammatory diet, staying active, sleeping enough, and reducing stress so you can slowly and safely reach a healthy weight.
4. Prevent Constipation
Constipation can be caused by diastasis recti, but it can also contribute to the problem and stretch connective tissue in the abdomen due to straining and pushing. Ways to help prevent or treat constipation include: eating a high fiber diet, avoiding inflammatory foods and allergens, drinking plenty of water, regularly exercising, taking probiotics, and managing stress. If you can’t poop easily, you can decrease straining when passing a bowel movement by taking a magnesium supplement, which can help loosen stools, and squatting down over the toilet to engage the right muscles.
Diastasis recti isn’t necessarily dangerous or a very serious condition, but it’s smart to treat it since it can lead to postural problems and other symptoms. Talk to your doctor, chiropractor or a physical therapist if you’re experiencing lots of pain in your abdominals or back. Always get medical help if you have a severe case of diastasis recti or notice lots of swelling in your abdomen that lasts more than several days, severe gastrointestinal issues, or other signs of a hernia. You should visit your primary doctor or even a general surgeon to have a CT scan if you have a true concern about having a hernia, since this may require a medical intervention.
- Diastasis recti (also called rectus diastasis) is a condition that’s characterized by separation of the the two large, parallel bands of muscles that meet in the middle of the abdominal muscles.
- Causes of diastasis recti include: pregnancy, obesity, abdominal surgery, certain injuries, or repetitive movements that overly-stretch the ab muscles.
- Signs and symptoms of diastasis recti can include having a protruding belly “pooch,” a bulging outie belly button, low back pain, hernia, pelvic floor dysfunction, and digestive issues.
- Some ab exercises and other movements can exacerbate diastasis recti, including too many crunches, sit ups, or anything that involves too much twisting or rib thrusting.
5 Natural Ways to Help Prevent and Treat Diastasis Recti
- Physical therapy
- Specific core exercises
- Avoiding anything that adds abdominal pressure (including some core movements, obesity and constipation)
- Maintaining a healthy weight
- Treating hernias