What is Diastasis Recti?

Diastasis Recti (DR) is a gap between the right- and left-sided abdominal muscles that causes a bulging and “pooched” appearance of the abdomen. Muscle separation occurs when the main connective tissue of the abdomen, called the linea alba, becomes weakened as a result of stretching and thinning.

Pregnant women’s bodies produce hormones that cause the linea alba to soften and stretch. These hormones include estrogen and relaxin. This is a totally normal process and must occur to make room for a growing uterus and baby.

What are the risk factors for diastasis recti?

  • Being pregnant with twins or triplets
  • Being petite
  • Carrying a large baby 
  • Having been pregnant more than once
  • Becoming pregnant over the age of 35
  • Excess weight gain during pregnancy
  • C-section
  • Constipation
  • Long 3rd stage of labor (pushing)

How common is diastasis recti?

Between 1/3 to 2/3 of pregnant women develop DR to some degree. Both the risk and severity of DR increase during subsequent pregnancies. In a recent Scandinavian study, the incidence of DR during the postpartum period was 60% at 6 weeks, 45% at 6 months, and 33% at 12 months.

Interestingly enough, DR can also occur in newborn babies and men. Risk factors in men include obesity and having had a previous abdominal surgery.

What are the symptoms of diastasis recti?

Symptoms can include low back pain, pelvic pain, constipation, bloating, problems with posture, urine leakage, and difficulty using the abdominal muscles (i.e. when pushing during labor).  Some women have no symptoms outside of cosmetic appearance. DR is the main reason why some women continue to look like they are pregnant for months and months after they give birth.

How is diastasis recti diagnosed?

You can “self-diagnose” by lying on your back, doing a mini-crunch, and then looking and feeling for a mid-abdominal bulge or separation.  In DR there is a greater than 2 cm separation between the right- and left-sided abdominal muscles. Any gap that is more than two finger widths on self-exam needs to be evaluated by a doctor or physical therapist.  It’s becoming increasingly common for doctors and specialists to diagnose DR using ultrasound.

How is diastasis recti treated?

Mild cases of DR generally resolve on their own during the first 6 postpartum months. The three main treatments for moderate to severe DR are exercise, physical therapy (PT), and surgery. Additionally, Postpartum Recovery Garments are often covered through insurance and can improve comfort while providing abdominal support.

Exercises and PT can be started during the postpartum period once the body has healed from delivery. It’s important that women work with trainers and physical therapists who understand DR and have experience helping others with this condition. Treatment includes exercises of the abdominal core and pelvic floor muscles.  Physical therapists sometimes use a special belly splint during exercises to protect and hold the recti muscles together.

It’s important to know that women with DR need to be careful to avoid many common core-strengthening exercises, including sit-ups, crunches, planks, and pushups, as these exercises can actually make the condition worsen. Significant pain and/or concerns about the physical appearance of DR can be indications for surgical repair.  Surgery involves the folding and sewing together of the abdominal muscles. This procedure, called an abdominoplasty, is also known as a “tummy tuck.”

Can diastasis recti be prevented?

One of the best ways to prevent DR is to make sure to strengthen your core abdominal muscles and pelvic muscles prior to becoming pregnant.

Doctor Jessica Madden, Aeroflow Breastpumps Medical Director

About the Author

Dr. Jessica Madden is a board-certified pediatrician and neonatologist who has been taking care of newborn babies for over 15 years. She is currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. She also provides in-home newborn medicine and lactation support to new mamas and is currently working to become an IBCLC.

Information provided in blogs should not be used as a substitute for medical care or consultation.

Diastasis recti (DR) is defined as the widening and thinning of the linea alba. The linea alba is a layer of connective tissue between the right and left muscle bellies of the rectus abdominis muscle. DR is not an actual separation or a "split" in the abdominal muscles, only a thinning and stretching of the fascia at the midline. 

DR occurs because of a normal and even necessary stretching of the abdominal wall during pregnancy. In some women, DR can take months to years to resolve, even if you're doing everything right. This is because making changes in connective tissue takes a lot longer than making changes in muscle. 

Interestingly, diastasis recti is often seen in infants. It is usually not a concern and will disappear over time as their abdominal muscles become stronger.

How Common is Diastasis Recti?

Some studies show that DR is present in 100% of pregnant women in the 3rd trimester, and 36% up to 12 months postpartum. How long it sticks around might have a lot to do with genetics. You haven't necessarily done anything wrong if you have DR that won't go away! However, if your diastasis recti is bothersome or lingering, there may be more you can do to strengthen the area and encourage the gap to close. 

Additional risk factors may include: 

  • Being pregnant with multiples
  • Having been pregnant more than once
  • Becoming pregnant over the age of 35
  • Excess weight gain during pregnancy
  • Long 3rd stage of labor (pushing)
  • Excessive abdominal muscle overload during the third trimester

What are the Symptoms of Diastasis Recti?

Some women experience discomfort at the midline of the abdominals, though many have no symptoms outside of cosmetic appearance. Diastasis recti can limit your ability to maintain strength as you transfer load across the midline, which can pose a problem in single-arm activities like carrying a car seat, and in things that require rotation, like running.

There is a small correlation of DR with pelvic organ prolapse and the severity of lower back pain. The cause and effect relationship is not clear, however.

How is Diastasis Recti Diagnosed?

Diastasis recti can be self-diagnosed with a simple hands-on technique. Evaluation by your care provider may also include ultrasound imaging. 

When evaluating for DR, you’ll want to assess both the width and the depth of the midline. The width at the midline is considered normal up to 2 centimeters between muscle bellies, or just under two finger-widths. If you’re noticing a distance that’s two or more finger-widths above or below the navel, you’ll want to get it checked by your care provider or a physical therapist to be sure you’re moving in the right direction. 

Here’s how you can check for diastasis recti yourself. While lying on your back:

  • Feel the tissue right under the middle of your ribcage. This usually feels the closest to your "normal." Start with two fingers lined up horizontally, and adjust how many fingers you’re using based on what you find.
  • While relaxed, work your way down your abdomen with your fingers horizontally. Take note of how wide that space is between your muscles, and also how deep your fingers sink before you feel tension.
  • Move into a “curl-up,” or a tiny crunch. Feel your way down your entire abdomen again, noticing both width and depth. 
  • If you notice more than two finger-widths between the muscle bellies, consult with your care provider or a postpartum physical therapist. 

How is Diastasis Recti Treated?

DR rehabilitation has changed a lot in recent years. Women used to be told to avoid all abdominal exercises that involved the core – never sit up, plank, crunch, twist, or squat again. Seriously, though, let’s think about those “rules” in the context of caring for a newborn… they are just not possible! 

Current recommendations emphasize building a strong and functional core. This means generating tension at the midline and focusing on building control and strength of the deep core muscles. It’s no longer about completely avoiding these muscles; it’s about getting them strong and functional again.

Try this to start building tension: exhale and draw-in your pelvic floor and deep core (like you’re pulling your belly button slightly in without moving your spine), then do the mini curl-up assessment again. Now feel your midline all the way down. Is there a change in width or depth/tension? Ideally, you’ll feel more tension, or resistance, even though the width may not change much. This type of tension is the goal with diastasis recti rehab and strengthening the core. Whether you can or can’t find tension on your own, it’s still a good idea to see your care provider or a postpartum physical therapist to be sure you’re moving well in all your daily tasks and during exercise. 

In some particularly stubborn cases, abdominoplasty surgery can help with restoring muscle alignment. It’s always a good idea to connect with a physical therapist beforehand so that you’re moving well and starting to build some strength before you go into surgery. Physical therapy can also help you build strength and get back to your normal life safely and efficiently after surgery. 

Additionally, postpartum compression garments are often covered through insurance and can improve comfort while providing abdominal support as you’re building strength. 

What Exercises are “Safe” with Diastasis Recti?

Almost any exercise can be done well, but you’ll want to pay close attention to how you’re doing each move. Don't be afraid of the Do's and Don'ts lists you might find on the internet!

In place of those outdated lists, some questions to ask yourself are:

  • Can I do this without pain, leaking, or pressure in the vagina or pelvis?
  • Can I do this in a controlled manner without holding my breath?
  • Can I do this with minimal doming, coning, or bulging at the midline? (ie: maintaining an intentional draw-in throughout the movement.)
  • Can I maintain tension in the linea alba throughout the movement?
  • Can I maintain my form throughout the movement?

If you can answer YES to each of these questions, you are very likely moving in the right direction. It is still recommended to consult with a postpartum physical therapist for evaluation and individualized treatment options to create the program that’s right for you. 

Can Diastasis Recti be Prevented?

There is some evidence to show that a strong and functional core before and during pregnancy is valuable in limiting the severity of diastasis recti. If you’re exercising during pregnancy, you’ll want to review the questions listed above and try to avoid exercises that cause doming, coning, or bulging out at the midline. This is usually a sign that your muscles are working too hard, and it’s a great time to modify or try something different. 

It’s also important to keep in mind that up to 100% of women have some degree of diastasis recti by the time they reach the end of pregnancy. Our bodies make this change to allow our little ones to grow. Do your best with the considerations listed above – but don't obsess. If you’re pregnant or postpartum and have concerns related to DR, please see your care provider and a physical therapist to help you create a plan that works for you.

About the Author

Dr. Samantha Spencer, PT, DPT, is a Medical Advisor with Aeroflow Breastpumps. Dr. Spencer is a physical therapist who specializes in pelvic and perinatal care in the Asheville, NC, area where she offers in-home physical therapy to prenatal & postpartum individuals. She also developed the Strong Beyond Birth 28-Day Course to guide and support moms as they return to exercise, and offers virtual consultations to women everywhere.

Information provided in blogs should not be used as a substitute for medical care or consultation.