What is Diastasis Recti?

Diastasis recti (diastasis rectus abdominis) is a separation of the abdominal muscles along the midline of the abdomen. This usually occurs in women in the 2nd – 3rd trimester of pregnancy. Diastasis recti can also be present in non-pregnant individuals – both men and women. This abdominal separation is due to an increase in intra-abdominal pressure that exceeds the ability of muscles and fascia to remain intact.   

One example may be that a balloon grows with increased air; however, as the balloon has thinned or becomes less strong, the balloon begins to get weaker and eventually will burst in the weakened area.   

How do I know if I have diastasis recti?  

You will notice a bulging or “doming” in the middle of your abdomen when you contract your abdominals. This occurs anytime you have increased pressure in your abdomen. This happens with sit-ups, crunches, moving in bed, and moving from sitting to standing. Your doctor or physical therapist can assess for diastasis recti.   

You can check for diastasis recti abdominis yourself by doing the following: 

• Lie flat on your back. 
• Place your hands along the middle of your belly. 
• Lift your head and shoulders off the floor.
• Feel to see if there is a separation right down the middle of your abdomen. 
• It is measured by a finger width.  
• It is normal to have 1 – 1 ½ finger width. 
• Greater than that is considered inefficient 
• The space can be as large as 4-5 finger widths.

What causes diastasis recti?

The abdominal muscles that run down the front of the belly are connected by a band of connective tissue or fascia. This is where you will see the abdominal separation, especially in the last two trimesters of pregnancy. As the baby grows, this growth pressure can cause this band to be thin and separate.   

Diastasis recti is present in at least 60% of pregnant women. It does not create pain but can cause weakness, leading to imbalance and pain. 

How do you fix diastasis recti?  

Diastasis recti is managed by preparing the abdomen during pregnancy and efficiently strengthening your core muscles.   

• Preparation includes mobilizing or massaging the outside edge of the muscles on either side of the midline. This allows that abdominal muscle – rectus abdominis – to lengthen, allowing the pressure to spread out over a larger area. Frequently, the diastasis recti occur in women who have nicely developed rectus abdominis before pregnancy – “six-pack muscles.” The strong muscles have difficulty lengthening and allowing growth.  
• Strengthening our core includes multiple muscles throughout the abdomen to give us stability. Those muscles are the deep abdominal muscles, the pelvic floor, the diaphragm, and the back muscles. They create a “girdle of strength” to give stability and ultimately allow our higher-level activities.  

Anyone who has been a mom knows being a mom is a very high-level activity! A new mom has great difficulty finding time to take care of the baby and family. Adding specific time to “exercise” may be extremely difficult.  

One study counted the number of times different professions squatted for their job. As expected, the mom won…hands down. Imagine the number of times a new mom lifts any item: toys, blankets, food, bottles, baby, baby paraphernalia. If that same mom were lifting and squatting using excellent technique, she would perform her exercises all day long! 

What happens if you have diastasis recti? 

A variety of things can occur with diastasis. The list below are conditions that can occur with diastasis recti.  

• Decreased stability and strength of your core muscles – Pelvic floor muscles are an important piece of core strength. 
• Increased risk of having a hernia – A hernia is the separation of your abdominal wall that allows tissue and organs to push through.  
• Stiffness in joints – Lack of core strength may place extra stress on the sacrum, low back, and pelvis, which could create stiffness 
• Difficulty in returning to your pre-pregnancy fitness level – Having diastasis recti will delay returning to pre-baby you because of the instability it creates. Physical therapy and a strong program will allow the return of a new and improved YOU 
• Constipation – Pressure within your abdomen allows your body to move fecal matter through the rectum and out of your body.  
• Low back pain 
• Urinary incontinence – Control of your bladder starts with pelvic floor strength. Physical therapy can determine what exercises you may need to control your urine. It is not normal to leak urine just because you have had a baby! 
• Pelvic Floor dysfunction – Weakness and pain 
• Pelvic organ prolapse – Prolapse is when the wall of the vagina is weak and allows your bladder or your rectum to drop into the vagina. There are different grades of prolapse and physical therapy is an excellent way to prevent and correct prolapse without surgical intervention.

Physical Therapy can help

Physical therapy is a great option to treat and minimize diastasis recti. Surgical intervention is rarely required. The first step to preventing a diastasis recti surgery is to see a physical therapist for treatment. Physical therapy is a conservative path and works very well. If you are unsure of how physical therapy can help, come in for a post-partum assessment. 

• Massage – Teaches you to self-massage the edge of the ab muscles and minimize the risk of diastasis recti 
• Body Changes – Education about body changes associated with pregnancy; what to expect and how to decrease the effect on the mom’s body
• Exercise – Provide appropriate abdominal exercise to strengthen the entire core  
• Pelvic Floor Education – Offers explanations on the role of the pelvic floor after giving birth and how to strengthen pelvic floor muscles
• Posture and Body Mechanics – How to stand, sleep, move and perform lifting required for your new job 
• Schedule – Offer guidance on how to fit in exercises during your day 
• Use of Supports – Review which supports may be best for your situation 
• Maternity SI Belt – An SI belt wraps around your hips and under your baby to give added support while your body can’t. This is not something you will need forever.  
• Abdominal Binders Postpartum – This provides the support that your body cannot offer at this time. The idea is the binder is only used until the core strength is improved and gives the support needed naturally.  
• Pillows – While pregnant and during the post-partum phase, support your belly anytime you are sitting or lying on your side. To do this, use a small pillow or blanket under your belly to unload the extra weight and pressure. As the weight is unloaded or rests on a pillow, there is a relief of tension and pain in low back and shoulders. 

If you believe you may have diastasis recti or are experiencing abdominal muscle separation, our licensed physical therapists can help. Request an appointment online or call the location nearest you for support.

Article By: Amy Holcombe, PT, DPT, CFMT, FFMT 

Amy began her Physical Therapy career 34 years ago. She loves working with the pelvic health population and believes in providing quality therapy that addresses the imbalances and problems that each individual brings to the clinic. She currently specializes in pelvic health for men and women, back pain, posture, manual treatments, strengthening, and incorporating yoga into her clients’ daily exercise. Amy enjoys working with her clients to reach their highest potential and return to their active lifestyles. She currently treats patients at Ivy Rehab Physical Therapy in Kings Mountain, NC.