Diastasis rectus (technically, diastasis rectus abdominis or DRA) is an anatomic term describing an abnormal distance separating the two rectus muscles of the muscular abdominal wall. This condition is extremely common postpartum, impacting an estimated 65% to 100% of pregnant and postpartum women.
A persistent separation of 1.5 to 2 centimeters or more between the "six-pack" muscles is generally considered abnormal and in need of treatment. The condition usually resolves with consistent treatment.
Symptoms:
Most of the symptoms of diastasis recti will be absent during the first half of your pregnancy. Some women may begin to notice symptoms towards the end of the second trimester or the beginning of the third trimester. Other women don't notice a change in their abdominals until after delivery.
By the postpartum period, new mums experiencing diastasis recti should be able to see a visible bulge or ridge where the abdominal muscles are separated. Conversely, when lying on your back, this area between the muscles around the belly button will recess.
Causes:
Elevated intra-abdominal pressure is a key culprit behind diastasis recti. When you’re pregnant, your abdominal muscles stretch to accommodate your growing uterus, which causes the connective tissue to become thin. The pregnancy hormones relaxin, progesterone, and estrogen also contribute to the relaxing of the tissues. As this continues to progress, a partial or complete separation of the rectus abdominis can occur.
Although diastasis recti is most prevalent in pregnant and postpartum women, it’s important to note that it can also occur in postmenopausal women and in men. In these cases, the main causes are straining, rapid shifts in body weight, heavy lifting, and exercises such as crunches.
Diagnosis:
Many women can see the separation in their midsection. However, in order to receive proper treatment, it’s important to consult your doctor for an official diagnosis. Your doctor will do a thorough physical exam to determine if you have diastasis recti, and if so, how severe it is. Your DRA can be open (the separation is above and below the navel), below the navel, or above the navel. Some doctors will use imaging with ultrasound or CT scan to aid with the diagnosis.
Treatment:
The treatment for diastasis recti focuses on rehab exercises to repair the separation. It also includes education about exercises to be avoided that may make the separation worse until you are fully healed. Know though that even with physical therapy your abdominals may not return completely to their pre-pregnancy state, as the stretching endured during pregnancy may never fully bounce back.
Exercises to Avoid:
When it comes to exercises to avoid, new mothers should always avoid excessive abdominal exercises, particularly crunches. In addition to sit-ups, other exercises to avoid include:
Abdominal twists:
Any exercises that require you to be on your hands and knees without abdominal support or strength.
Any heavy lifting activities that bulge out the stomach (like in a Valsalva maneuver)
Backward bends that stretch the abdominal area
Yoga poses that stress the abdominals (not modified)
Exercises to Perform:
While it may seem limited, there are effective exercises you can safely perform with diastasis recti. Consistent practice of these exercises will give you the best results. Treatments consist of deep abdominal exercises performed with a neutral spine (this is usually lying down with knees up) that stimulate control and use of the transverse abdominis.
Essentially, the abdominals are tightened, squeezing toward the spine, with progressive strength, and held for longer and longer periods, starting with around 10 seconds each. Ideally, these holds are done for a total of 10 minutes daily. Pelvic floor exercises, such as Kegel’s and pelvic tilts, help as well. Performing these moves with proper form is critical. That’s why it’s a good idea to consult with a physical therapist who can supervise your workouts and your recovery progress.
Prognosis:
While most pregnant women have DRA right after childbirth, by six months postpartum only 40% do. Additionally, the success rate is even higher for those that do the prescribed exercises, which can show improvement by around four weeks but may take twelve or more weeks for satisfactory recovery. In fact, multiple studies have shown that the vast majority of the people who go through a treatment protocol improve their diastasis recti.
Diastasis recti can make your belly appear pregnant well after childbirth, but rest assured that getting treatment can help. So, if you have diastasis recti, talk with your doctor about your concerns to make a treatment plan, which likely includes a referral to a physical therapist who can help you begin to feel stronger and more confident about your postpartum body.