What is diastasis recti?
Diastasis recti is a separation of the abdominal wall muscles. It occurs when two halves of the rectus abdominis, also known as the six-pack muscles, spread sideways due to an overstretching and thinning of the connective tissue that runs along the midline of the abdomen. Diastasis recti occurs in a majority of pregnancies, and it can linger for months and even years postpartum. The most identifiable symptom of diastasis recti is a protruding abdomen, sometimes referred to as a “pooch.” For this reason, medicine has often relegated diastasis recti to a mere cosmetic concern and overlooked the real health implications of diastasis recti and how it impacts the function of the core, pelvic floor, low back, and hips.
Although pregnancy is the primary cause of diastasis recti, anything that bulges the abdomen forward forcefully and repeatedly can overstretch the connective tissue, causing the abdominal muscles to separate.
In this article we discuss diastasis recti symptoms, how to tell if you have this condition, and what you can do to start resolving and repairing diastasis recti.
How common is diastasis recti?
Diastasis recti occurs in about 60% of first-time, singleton pregnancies, and if often persists during the postpartum period. Diastasis recti can spontaneously resolve without intervention, but diastasis recti persists a full year after the pregnancy in about ⅓ of cases. Diastasis recti can contribute to pain, dysfunction and biomechanical compensations that need to be addressed.
Diastasis recti symptoms: what are the most common symptoms of diastasis recti?
Understanding the symptoms of diastasis recti is the first step in seeking treatment and finding relief. Often the symptoms of diastasis recti can go overlooked for years, and some women notice a worsening or recurrence of symptoms around the menopause transition. It is never too late to resolve diastasis recti. Connective tissue is resilient and responds well to therapeutic exercise years and even decades after injury.
Here are some of the most common diastasis recti symptoms, and what is really causing them.
The “Mommy Pooch”
One of the most noticeable symptoms of diastasis recti is a bulging or protruding midsection, especially when straining or contracting the abdominal muscles. A persistent "mommy pooch" can be a telltale sign of diastasis recti. This aesthetic symptom can be a frustrating and embarrassing issue for some.
Understanding why it occurs and how to treat it is essential. During pregnancy, the abdominal muscles stretch to accommodate the growing uterus and baby. After giving birth, the muscles may not return to their original position, leaving a persistent gap in the center of the abdominal wall. In some cases, the gap closes on its own postpartum, but when the gap exceeds 2.5 cm, therapeutic intervention for diastasis recti is recommended.
The protruding belly can be especially noticeable during physical activity, when sitting up from a back-lying position, or when performing common abdominal exercises. With proper treatment and management, diastasis recti can improve and the symptoms can be relieved, allowing you to feel confident and comfortable in your postpartum body.
Back Pain
One of the most common diastasis recti symptoms is lower back pain. When the abdominal wall muscles separate, support is lost in the front and center of the body, compromising our posture and how our body distributes load. This can lead to a compensation pattern in which we chronically overrecruit the back muscles. When this occurs, the lower back tends to become overly tight along with the hamstrings, leaving us in pain.
Dealing with back pain as a new mother or seasoned parent can be miserable. Coupled with diastasis recti, it can entirely disrupt your life. From lifting, feeding, and carrying a newborn or toddler, to lugging around car seats, strollers, and big bags, to diaper changes and the countless other responsibilities that come with parenthood - it is almost impossible to go a moment without using our core muscles.
When our abdominal muscles are compromised due to diastasis recti, our back muscles end up taking the brunt of all this lifting. With proper treatment and core strengthening, back pain symptoms from diastasis recti can improve and even resolve completely.
Core Weakness
Core weakness is a common diastasis recti symptom. Weakness or instability in the core can make it difficult to perform everyday activities such as lifting, bending, or even getting out of bed. The inability to engage the core properly is due to the separated abdominal muscles being unable to contract and support the spine effectively. The loss of core integrity can also result in a lack of support for the spine and internal organs, leading to instability, especially when performing physical activities.
Women with diastasis recti and core weakness may experience difficulty while lifting, twisting, or bending. They may also have trouble engaging the core properly during abdominal exercises. Core weakness can limit the ability to perform everyday tasks and impact overall quality of life.
Treatment for diastasis recti and core weakness can include therapeutic exercises that activate the transverse abdominis to strengthen the deep core. With proper treatment, the symptoms of core weakness can improve, allowing you to regain strength and stability in your core.
Incontinence
Women with diastasis recti may experience urinary or fecal incontinence, which is the inability to control one's bladder or bowel movements, causing unintentional loss of urine or feces. Stress incontinence is leakage when you cough, laugh, or sneeze. As you can imagine, this leaking can be embarrassing and impact the quality of life.
If you are experiencing stress incontinence and have undergone (about) 6 weeks of healing after delivery, a great option is to begin pelvic floor physical therapy. The therapeutic core exercises called Core Compressions that form the foundation of Every Mother are proven to improve stress urinary incontinence. By performing pelvic floor exercises correctly, you can reconnect with your body and take control of your bowel and bladder again. If pelvic floor physical therapy is ineffective, a urologist or urogynecologist can offer other treatment options.
Constipation
On the opposite end of the spectrum from incontinence, constipation can also be a symptom of diastasis recti. The rectus abdominis muscles support the abdominal organs and help with bowel movements. When these muscles separate, it can affect the proper functioning of the digestive system, leading to constipation.
Here are a few reasons why constipation may occur as a symptom of diastasis recti:
- Weak abdominal muscles: Separation of the rectus abdominis muscles can cause weakness in the abdominal wall, making it difficult to contract the muscles necessary for bowel movements correctly.
- Pressure on the organs: The bulge caused by diastasis recti can pressure the internal organs, including the large intestine, which can lead to difficulty passing stools.
- Altered anatomy: The altered anatomy caused by diastasis recti can disrupt the normal functioning of the digestive system, leading to issues such as constipation.
Constipation can be a frustrating and painful experience, and it is vital to seek medical attention if you are experiencing persistent symptoms. Treatment options for constipation related to diastasis recti may include physical therapy, lifestyle changes, therapeutic exercise, and in rare cases, surgery.
Painful Sex
Pain during sex, or dyspareunia, is persistent or recurring pain just before, during, or after sex. One of the more common causes of chronic pain during intercourse stems from core weakness and pelvic instability. Other muscles compensate when the hips and pelvis are hypermobile due to weak, overstretched abdominal and pelvic floor tissues. This overcompensation can lead to spasms, joint misalignment, and patterns of chronic tightness (hypertonicity) that cause pain. Other common symptoms of a tight pelvic floor include tailbone pain, urinary urgency and frequency, and constipation.
Pain is the body’s way of telling us a problem exists that needs to be resolved. If painful sex continues postpartum, see an OB/GYN or primary care physician and request a referral to a pelvic floor physical therapist. Physical therapy presents a host of interventions to restore balance and freedom from pelvic pain, including targeted core strengthening, manual release techniques, and biofeedback tools to gain control over both engagement and release of the deep core muscles.
How to Tell if You Have Diastasis Recti
It is a good idea to perform a diastasis recti self-check if you are experiencing any of these symptoms. Diastasis recti can occur in 3 areas: above the belly button, below the belly button, and at the belly button. A self-check will give you the proper information to confirm diastasis recti and the severity of the condition.
To conduct a diastasis recti test on your own, follow these four steps and watch the video here.
- Lie flat on your back with your knees bent.
- Place your fingers on your belly button, pointing towards your pelvis, and press down.
- Lift your head up about an inch while keeping your shoulders on the ground.
- If you have diastasis recti, you will feel a gap between the muscles that is an inch wide (~ 2 finger-widths) or greater.
When is Diastasis Recti Clinically Significant?
The width and depth of the separation between the left and right rectus abdominis muscles typically measure the severity of diastasis recti. A separation of 2.5 centimeters or more is considered clinically significant. It is important to note that the degree of severity can also depend on other factors, such as the thickness of the muscle, the elasticity of the connective tissue (indicated by how deep the fingers sink into the gully), the presence of hernias, and the patient's overall health. For more information, a diastasis recti measurement chart is available here. Ultimately the degree to which diastasis recti impacts your daily life and well-being is a personal decision, and if it bothers you it is worth exploring treatment options.
Are There Other Common Diastasis Recti Symptoms or Complications?
If left untreated or in severe cases of diastasis recti, complications can arise. The most common severe complications include umbilical hernias, debilitating back pain, and severe incontinence.
An umbilical hernia is a type of hernia that occurs when a portion of the intestine bulges through the abdominal wall near the belly button. Umbilical hernias are most common in infants, but in adults, they can cause discomfort and become more extensive, making it difficult to perform daily activities.
Depending on the size and symptoms, surgery can resolve umbilical hernias. It is essential to seek medical attention if you experience pain, swelling, or a noticeable bulge near your belly button, as these can be signs of an umbilical hernia.
Can diastasis recti symptoms be resolved without surgery?
In most cases, diastasis recti can be reversible without surgery. While surgery quickly repairs the cosmetic symptom of diastasis recti, the more debilitating symptoms remain unresolved, leaving you at further risk of suffering complications and re-opening your diastasis recti down the line.
The key to fixing diastasis recti lies in the therapeutic activation of the transverse abdominis, your deepest abdominal muscle, and proper coordination with the diaphragm and the pelvic floor to effectively manage intraabdominal pressure. This muscle activation protects the integrity of the abdominal wall during pregnancy. Moreover, this same muscle engagement works efficiently after giving birth to restore strength, form, and function.
You may consider starting to incorporate simple, safe exercises for diastasis recti into your routine to strengthen your core and avoid further damage. A great place to start is Every Mother’s clinically proven program that can resolve diastasis recti through proper engagement and coordination of deep core muscles such as the transverse abdominis and the pelvic floor.
Learn more about Every Mother’s program here!
Every Mother’s app-based exercise program delivers personalized exercise protocols for every stage of motherhood. Whether you’re training to build strength for birth, to enhance postpartum recovery, to heal diastasis recti, to address symptoms of pelvic floor dysfunction, or to improve health during perimenopause and beyond, our clinically proven online program offers evidence-based coaching and support from pelvic floor physical therapists each step of the way. Get started today.
Sources:
- Leopold, Madeline, et al. “Efficacy of a Core Strengthening Program for Diastasis Rectus Abdominis in Postpartum Women: A Prospective Observational Study.” Journal of Women’s Health Physical Therapy, vol. 45, no. 4, 2021, pp. 147–63. Crossref, https://doi.org/10.1097/jwh.0000000000000214.
- Sharma, Geeta, et al. “Postnatal Exercise Can Reverse Diastasis Recti.” Obstetrics & Gynecology, vol. 123, no. Supplement 1, 2014, p. 171S. Crossref, https://doi.org/10.1097/01.aog.0000447180.36758.7a.
- Sperstad, J. B. (2016, September 1). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine. https://bjsm.bmj.com/content/50/17/1092
- Flattening The “Mummy Tummy” With 1 Exercise, 10 Minutes A Day. (2017, August 7). https://www.npr.org/sections/health-shots/2017/08/07/541204499/flattening-the-mummy-tummy-with-1-exercise-10-minutes-a-day
