What is Diastasis Recti?

Any woman may experience abdominal separation during their pregnancy to some degree, but up to 60% of women still have diastasis recti after delivery. Many women experience this during and after pregnancy because the growing baby pushes against the abdominal muscles, causing them to slowly push apart. While many cases resolve on their own, it can still be a bit strange to experience. We've put together a brief guide to help you better understand what diastasis recti is and why it happens.

What is Diastasis Recti?

Your abdominal muscles are in your stomach and appear as a "six-pack" when you have a lean body mass. They provide support and stability during activities and are categorized into four groups: external obliques, internal obliques, rectus abdominis, and transversus abdominis.

Diastasis recti, also sometimes referred to as DRAM (diastasis of rectus abdominis muscle), is a condition that affects the area where connective tissues keep your core supported. Specifically, DRAM is the separation of the rectus abdominis muscles, the long muscles that run from your chest to your pelvis. These muscles are always separated with connective tissue called the linea alba down the middle, but diastasis recti occur when they're stretched, and the linea alba pulls apart.

Although diastasis recti can affect anyone, regardless of age and gender, it's most common in pregnant women.

It can sound like something that might cause pain, but ab separation is typically painless as it happens slowly over time. However, some individuals experience discomfort or report an abnormal sensation in their abdomen. If you're experiencing any worrisome symptoms or any degree of pain, don't hesitate to contact your doctor.

How Common is Diastasis Recti?

Diastasis recti is a common condition, especially among pregnant women. It tends to affect about 50% to 60% of women during pregnancy, but some studies have found that 100% of participants experienced abdominal separation in the third trimester. Diastasis recti usually gets less severe or goes away on its own within two months postpartum, but about 40% of women report having it for longer.

In men, it's sometimes mistaken as a "beer belly" and occurs due to weight gain, but checking for diastasis recti and getting treatment is still recommended.

Causes of Abdominal Separation

Diastasis recti in pregnant or postpartum women occurs to accommodate your growing baby. Each month, the connective tissues are stretched more and more to help your abs separate and expand for your uterus. The increased elasticity seems to be associated with increased pregnancy hormones such as relaxin, progesterone, and estrogen. Additionally, weight gain, in general, causes diastasis recti, which is why some men experience it too.

The most common risk factors for diastasis recti include:

• Pregnancy — This is the most common risk factor, especially if you're carrying multiples (twins, triplets, etc.). The growing uterus stretches the abdominal muscles.
• Large Baby — Carrying a large baby can strain your abdominal muscles, increasing the likelihood of separation.
• Petite Frame — Petite women tend to experience diastasis recti more often.
• Age — Mothers over 35 are at a higher risk due to less elasticity in their skin and muscles.
• Multiple Pregnancies — Repeated stretching of the abdominal muscles in successive pregnancies can increase the risk.
• Vaginal Delivery — The act of pushing during vaginal delivery can put pressure on the abdominal wall and cause them to separate.
• Genetics — A family history of diastasis recti or weak connective tissue can make you more prone to developing the condition.
• High Body Mass Index (BMI) — Excess weight, especially around the abdomen, can strain the abdominal muscles.
• Incorrect Exercise — Performing exercises that put too much pressure on the abdominal muscles, like heavy lifting or certain core exercises, can contribute to diastasis recti.
• Rapid Weight Changes — Significant weight gain or loss can stretch and weaken the abdominal muscles.

Symptoms of Diastasis Recti

When your baby is growing in your uterus, it can be difficult to see any abdominal bulge. Your pregnancy belly will outshine any signs of abdominal separation, and you likely won't be able to feel a gap until postpartum.

After delivery, the biggest sign of diastasis recti is a visible separation or gap between the abdominal muscles. Depending on the severity of your separation, the middle of your tummy may protrude quite substantially in the months or even years after giving birth. You may also experience one or more of the following:

• Weakness in your core
• A visible bulge above or below the belly button
• Softness around the middle of your stomach
• A coning appearance when you contract your abdominal muscles
• Difficulty with lifting heavy objects
• Feeling weakness in your core during walking or everyday tasks
• Pelvic pain
• Hip pain
• Lower back pain
• Poor posture
• Weak pelvic floor muscles (urinary incontinence)
• Pain during sex
• Constipation

Diastasis may be the culprit if you notice any of these symptoms and aren't in any physical pain. Luckily, you can test yourself for abdominal muscle separation at home. Still, if you're worried, have a fever or signs of infection, or are experiencing pain, it's important to contact your doctor for diagnostic testing.

Diagnosing Diastasis Recti

It's often fairly easy to know if you have diastasis recti. The muscle separation can cause a slight protrusion around your belly button, so when you look down, you may see your ab muscles in a slightly triangular, tent-like shape protruding away from the body. You can feel your stomach or see your doctor for a physical examination. Some doctors may also use an ultrasound to get a more accurate understanding of the separation.

Feeling Your Abdominal Muscles for Signs of Separation

If you want to check your stomach muscles, you can do so easily in the comfort of your home. Start by lying on your back with your knees bent and feet flat on the floor. Place your fingers just above your belly button, pointing downwards. Then, gently lift your head and shoulders off the floor as if doing a small crunch. This engages your abdominal muscles. Press your fingers down and feel for any gap or separation between the muscles. You may have diastasis recti if you can fit two or more fingers into the gap. Repeat the process at your belly button and a few inches above and below it, as the separation can vary in different areas.

Can You Heal Your Diastasis Recti?

Luckily, you can fix diastasis recti, as the thin band of connective tissue is elastic and tends to come back together slowly. The time it takes can depend on the severity of the separation of the abdominal muscles, which may be impacted by the degree of weight gain during pregnancy. The key is patience and creating a treatment plan for your lifestyle. It will take some time, but surgery is an option if you're not noticing any changes. Always check with your doctor and consider seeing a physical therapist to help you create an effective exercise program.

Treatment Options for Women with Diastasis Recti

Treating diastasis recti involves a combination of exercises, lifestyle changes, and sometimes medical interventions. One of the most effective approaches is engaging in specific core-strengthening exercises designed to gently bring the abdominal muscles back together. In addition to at-home diastasis recti exercises, working with a physical therapist who specializes in postpartum care can be extremely beneficial.

Maintaining a healthy weight, practicing good posture, and giving yourself time to recover without strain can also do wonders in the weeks after giving birth. Be patient and kind to yourself during recovery, and try to focus on spending quality time with your newborn.

In severe cases, your doctor may recommend diastasis recti surgery. This can be achieved through a tummy tuck or abdominoplasty. If you aren't seeing any success with exercises to help reestablish core strength, talk to your doctor about your options.

Things That Make Abdominal Separation Worse

Exercises for diastasis recti are great, but there are some instances where you can worsen the separation. Avoid doing any exercises that push your abdomen outwards (e.g., crunches and sit-ups), and try to roll onto your side when getting out of bed to avoid unnecessary pressure on the area. During the postpartum period, avoid lifting anything heavier than your newborn and give yourself time to rest and heal before jumping into abdominal exercises.

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