What Is Diastasis Recti?

Diastasis recti, also known as diastasis recti abdominus (DRA), is a condition where the connective tissue that divides the large abdominal muscle in the front of your torso becomes stretched. When this happens, a ridge or bulge appears down the middle of your belly. DRA is associated with abdominal muscle weakness and contributes to symptoms like incontinence (leaking urine) and back pain.

Diastasis recti often occurs during and after pregnancy. It affects at least 90% of people shortly after they give birth and often heals on its own. However, research suggests that 60% of people still have DRA six weeks after giving birth, and 39% remain affected six months post-delivery. It can also appear postmenopause and in people who have never been pregnant.

The most common treatments include physical therapy and surgery. While some risk factors are out of your control, other factors can lower your risk of developing diastasis recti.

Diastasis Recti Symptoms 

The primary symptom of diastasis recti is a visible bulge or ridge that spans from the bottom of the breastbone to the belly button.

Other symptoms of DRA include:

• Abdominal pain and discomfort
• Coning of the abdomen when muscles are contracted
• A visible bulge or “pooch” below the belly button
• Lower back pain
• Urinary incontinence (urine leakage)
• Fecal incontinence (feces leakage)
• Pelvic organ prolapse (when weakened pelvic muscles cause an organ to drop lower in the pelvis) 

Causes and Risk Factors

Your abdomen is largely made up of the rectus abdominis. This muscle begins at the joint between your pelvic bones and runs vertically up your torso. It connects to the lower end of your sternum (breast bone) and is divided into two halves by a thin band of connective tissue known as the linea alba.

Diastasis recti is caused by increased pressure on your abdominal wall. For example, during pregnancy and weight gain in the abdominal area, the rectus abdominus muscle is pushed outward and stretched. This causes the linea alba to stretch and creates a bulge or gap between the left and right sides of the rectus abdominis.

Pregnancy is a common risk factor for diastasis recti, especially multiple pregnancies or giving birth to multiples, like twins or triplets. Hormone changes during the second and third trimesters of pregnancy also contribute to abdominal separation. Increases in the hormones relaxin, estrogen, and progesterone loosen muscles, joints, and ligaments, including the linea alba. This, combined with the added abdominal pressure from the growing fetus, widens the muscle gap. 

Obesity and rapid weight gain are also risk factors. Excess fat accumulation in the abdominal area can place greater pressure on the abdominal wall.

DRA is common in newborns due to weakness in the abdominal area, but it usually resolves on its own.

Diagnosis 

Your healthcare provider will take your medical history and ask you about your symptoms to determine if you have diastasis recti. They will also do a physical exam to rule out other conditions that create a bulge in the abdomen, such as a hernia, which is when tissue bulges through a weakened area of the abdominal wall.

As part of the physical exam, your healthcare provider will ask you to lie on your back and gently lift your head, as if you’re doing a slight abdominal crunch. They will then feel your abdomen, specifically around your belly button, for gaps and muscle tone. 

If your provider feels a gap between your abdominal muscles, they will measure the distance. They may use a measuring tape, an instrument known as a caliper, or an imaging test known as an ultrasound. Diastasis recti is generally diagnosed when the distance between the left and right sides of the abdominal muscle measures greater than two centimeters, or two or three finger widths.

You can also check for diastasis recti yourself:

• Lie on your back and gently lift your head into a subtle crunch position.
• Use your pointer and middle finger to feel your abdomen in the area around your belly button.
• If you feel separation and depression in that area, reach out to your healthcare provider to see if you could benefit from an assessment by a physical therapist.

Treatments

Diastasis recti may resolve on its own, but it’s a lasting condition for many people. Treatment focuses on restoring core strength, improving symptoms, and closing the abdominal gap. 

Physical Therapy 

While physical therapy can help resolve symptoms of diastasis recti, such as lower back pain and urinary leakage, data on the effectiveness of exercise for fixing abdominal separation is lacking. 

There isn’t an established exercise program for DRA. However, exercises like belly breathing, planks, glute bridges, and leg raises can strengthen the abdominal muscles. Research suggests that exercises like these may also help narrow abdominal separation.

Always consult a physical therapist for exercise recommendations. 

Surgery

Surgery may be considered if physical therapy doesn’t repair the abdominal separation. Surgery offers high success rates: Most studies report no reappearance of abdominal separation six months after surgery.

During the procedure, a surgeon will close the gap with sterile surgical threads known as sutures.

Surgery to repair diastasis recti might include:

• Laparoscopy: This is a minimally invasive procedure in which a surgeon makes one or two small cuts in your belly. The surgeon then inserts a laparoscope—a tube with a camera—to see inside your abdomen and close the gap.
• Abdominoplasty: An abdominoplasty, also known as a tummy tuck, is a cosmetic procedure that removes extra skin and fat from the abdomen.
• Open surgery: This procedure involves making larger cuts in your abdomen to repair the separation and is often combined with abdominoplasty.

Prevention

Experts don’t agree on the best way to prevent diastasis recti. In addition, certain factors may be out of your control, such as carrying twins or triplets. 

However, understanding the risk factors can help you reduce your risk of developing DRA. Here are a few recommendations:

• Strengthen your core muscles before and during pregnancy.
• Maintain a healthy weight. 
• Avoid holding your breath or bearing down, especially during exercise.

Related Conditions

Diastasis recti is associated with weak abdominal muscles. This weakness can contribute to other health issues, including:

• Urinary stress incontinence: This is a sudden, involuntary loss of urine that may happen when coughing, laughing, sneezing, straining, or exercising.
• Lower back pain: This can range from a dull and constant ache to sudden and sharp pain. You may feel it daily or only after activities that strain on the back, such as lifting and bending.
• Hernia: While the reasons aren’t well understood, people with diastasis recti are 20 times more likely to develop a hernia than people without DRA. A hernia is a bulge formed in the lining of the abdomen. It pushes through a weak spot in the connective tissue that covers the abdominal muscle. Hernias may or may not cause pain, but they typically need surgery to repair.

Living With Diastasis Recti  

Diastasis recti may resolve on its own. However, it may persist, especially after pregnancy. It can also appear postmenopause and in people who have never been pregnant.

Many people with diastasis recti report abdominal weakness and instability. They may also feel discomfort or pain. As a result, they might avoid everyday activities like lifting heavy loads or playing with their children.

People with DRA might also struggle with body image and self-esteem. For example, they might feel shame or sadness because their bodies don’t look and function the way they did before.

Particular exercise interventions can strengthen core muscles and reduce physical symptoms, and surgery offers high success rates. However, it’s also important to address emotional symptoms and educate people with diastasis recti on how treating DRA can improve their overall quality of life.