What is Diastasis Recti?

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.

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. 

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.

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. 

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. 

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. 

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.