Understanding Diastasis Recti : Part 1 (2022)

Diastasis Recti is a topic I have been wanting to write about for a very long time now because it can have such a huge impact on the lives of so many women I treat.

However, I have felt that my personal understanding of the condition needed to continue evolving to be able to present a more helpful and comprehensive dialogue for those who may be searching to find answers for themselves or their patients.

Our current culture seems to place a HUGE amount of undue pressure on women to regain their pre-baby body, fast. Without understanding the potential impacts, many new mamas are returning to traditional fitness and 'core strengthening' exercises (including running, crunches, sit-ups and planks) before their bodies are ready. Unfortunately this can increase the risk of pelvic floor dysfunction (including prolapse and incontinence) and actually worsen abdominal separation. Getting the 'all clear' from your GP at your 6 week check up does NOT mean you can immediately return to all physical activity. In fact, the hormonal effects of pregnancy alone can last up to 12 months postpartum (or until you are finished breastfeeding), which means the body is less able to handle increased physical stress at this time.

What I find is often missing from discussions of Diastasis Recti (DR) is the emotional impact that this later diagnosis can have for a lot of women - whether it is related loss of confidence in their body image, grief at no longer being able to perform the activities they love, feeling ‘broken’, frustration at being misdiagnosed for so long, or the slow healing process (a similar pattern for all pelvic floor issues that I've seen). For anyone experiencing these DR-related impacts, please know that you are definitely NOT alone in these feelings. And also that your tummy does not define you. Not now, not ever.

I hope that this blog gives you a bit more insight into the whole-body perspective of this very common condition so you can start moving forward in your personal journey to healing.

Understanding Diastasis Recti : Part 1 (1)

What is it?

Diastasis Recti refers to the unnatural separation of the abdominal muscles via stretching or thinning of the connective tissue in the midline (Linea Alba). While this is very normal to occur during pregnancy to allow for a growing baby (100% of women will have some separation at 37 weeks gestation), it is when the muscles remain apart after baby is born that this can become a concern. A distance of 1-1.5 finger widths between the muscle bellies is considered “normal” and greater than this would be considered a diastasis, however the prognosis of healing will be affected not just by the distance of separation, but also the amount of tension remaining in the linea alba.

Understanding Diastasis Recti : Part 1 (2)
(Video) Diastasis Recti Recovery Part 1: Breathing and Bracing Strategies

Image from www.mutusystem.com

*Just to be clear, even though DR is often referred to as a ‘separation’, this does not mean that there is an opening in the abdominal wall, rather that the muscle bellies are sitting a bit further apart. There is still intact connective tissue between the muscles, however it may be thinner than before - unlike an hernia which refers to an actual tear or hole in the connective tissue.*

The most common symptoms of Diastasis Recti are the appearance of a belly bulge, a feeling of core ‘weakness’, and compromised function of the deep core and pelvic floor muscles (which stabilize the pelvis and the spine) leading to hip, pelvic, and back pain or pelvic floor issues.

However, Diastasis Recti is not always visible or symptomatic. For example, I have known some women with 4cm separations postpartum to have a ‘flat’ stomach (as defined by societal expectations), be pain-free and still be able to perform very physically strong feats. Therefore, I don’t believe the end goal of healing is just about the width of separation, but how all of the muscles in the body function as a whole.

Lets start with a short anatomy lesson! You have four layers of abdominal muscles:

  1. Rectus abdominus (10 on the diagram)- colloquially referred to as your ‘six pack muscles’, these are the most superficial (closest to the surface of the body) and run top to bottom.

  2. External obliques (11) - these are more of a diagonal orientation

  3. Internal obliques (12) - on the opposing diagonal to the External obliques

  4. Transversalis abdominus (13) - the darling of physiotherapy and the Pilates world, which is often referred to as your TA, TrA or TVA and is considered to form the deep stabilizing core layer.

Understanding Diastasis Recti : Part 1 (3)
(Video) C-Section Recovery: How to Assess Diastasis Recti Part 1

(Illustration by Peter Bachin)

Most muscles in the body attach (via fascia or tendon) to a solid bony structure which allows them to be able to generate force or movement. However, we don’t have any bones at the front of the abdomen, so instead, the abdominal muscles overlap via layers of fascia and connective tissue (9) to form a thicker midline structure - the Linea Alba or LA (25) - which runs from your breast bone (the xyphoid process) to your pubic bone, providing a strong lever from which these muscles can generate force to move or stabilize the spine and abdominal contents.

What causes it?

While DR is usually thought of as only associated with pregnancy, abdominal separation can occur in women who have never been pregnant, and even men. Recently I’ve encountered three men - all fairly young and fit, in their mid 20s to late 30s - with 3 finger-width separation of their abdominal muscles and varying levels of firmness of the fascia. Including my husband! (Don’t tell him I told you).

This is due to forces that pull the muscles apart via muscle tension or positioning, or push it out and stretch the fascia from the inside due to increased pressure inside the abdomen (intra-abdominal pressure / IAP). Including:

  • Over-corrected sitting and standing posture - a habit of thrusting the ribs with chest out, shoulders back. Although we are often taught is a good posture - this actually creates excessive tension on the linea alba - pulling it apart - AND generates more IAP!

Understanding Diastasis Recti : Part 1 (4)
  • Very tight abdominal musculature - which can increase IAP and also pull away (think tight oblique muscles pulling on a diagonal away from the midline)

  • Shortened psoas major - this will often appear as rib thrusting when lying down on your back with the legs out straight (this was the most noticeable factor amongst the three aforementioned men with DR) and means that even just lying flat on your back, doing nothing(!) can actually contribute to a diastasis

Understanding Diastasis Recti : Part 1 (5)
(Video) How To Check Diastasis Recti Abdominal Separation

Do your ribs do this when you lie down?

  • Tight shoulders and chest muscles which will lift the ribcage and create a lateral pull on the LA every time you reach overhead

  • Constantly increased intra-abdominal due to chronic digestive upsets and bloating

  • Repetitive increased intra-abdominal pressure via habitual movement and exercises (think repetitive sit ups, straining on the toilet, breath holding, or ALWAYS sucking in your stomach)

Understanding Diastasis Recti : Part 1 (6)
Understanding Diastasis Recti : Part 1 (7)
(Video) What is Diastasis Recti & How to Fix It - Ask Doctor Jo

When you think you're doing this...

...But you're actually doing this!

What does this all mean?

All of these factors can cause stretching and thinning of the Linea Alba before babies. But when combined with the pregnancy-related hormonal softening of the connective tissue, plus the added pressure, growth and load of a baby, it makes postpartum diastasis recti much more likely. While the extent of diastasis recti is also affected by some genetic factors (such as your particular collagen makeup), I propose that addressing these factors before and even during pregnancy would be helpful to decrease severity of postpartum DR. —> If anyone is interested in setting up a clinical trial with me, let me know! :D

If you do have a DR postpartum, just working to strengthen the deep core abdominal muscles (eg. pelvic floor and TrA) may give you limited results without addressing these other non-pregnancy related factors. In fact, you might be actually working against yourself while simultaneously trying to bring these muscles ‘back together’.

Keep an eye out for Part 2 of this Understanding Diastasis Recti series - how YOU can start resolving DR and restoring your core function.

And if you can’t wait till then, I highly, HIGHLY recommend getting your hands on a copy of Katy Bowman’s book Diastasis Recti - available in both eBook and hardcopy format. (Note: I do get a small affiliate percentage for any books and products purchased through this link, but even if I didn’t I would still recommend it anyway). This is the first book written on DR which takes a whole body perspective, with progressive exercises and is very easy to understand.

Understanding Diastasis Recti : Part 1 (8)

*Prices in the NM bookstore are all in USD and do not include international postage.

For anyone in Australia who is wanting to buy one - I do have a limited number of hardcopies available for purchase ($24 AUD inc GST + domestic shipping if required) to save you international postage rates. Contact me at info@bodyandbirthphysio.com if you would like a copy.

#DiastasisRecti #diastasis #abdomialseparation #core #pregnancy #postnatal

(Video) Your Guide to Treating Diastasis Recti (PART 1)

FAQs

How do you know when diastasis recti is healing? ›

If your diocesan. Recti is less than two fingers width wide. You no longer have diastasis recti but

How long does it take to correct diastasis recti? ›

It usually resolves itself within eight weeks of delivery. About 40% of those who have diastasis recti still have it by six months postpartum.

How do you read diastasis recti? ›

Two it's more like one and a half and then I'm going to check in three spaces at my navel. And then

What are the levels of diastasis recti? ›

An observed separation of <3. cm between the rectus muscles is labeled mild diastasis, 3–5 cm separation of the rectus muscles moderate diastasis and more than 5 cm severe diastasis (25).

How do I get rid of belly fat with diastasis recti? ›

A tummy tuck can also help both men and women repair diastasis recti (abdominal separation), which can flatten the belly while also preventing & reducing lower back pain. Liposuction. As you know, it's impossible to lose weight only in one area of the body, which is why liposuction is such a useful option.

Will losing weight help diastasis recti? ›

Brown explains, no amount of weight loss can fix the physical problem of having two muscles stretched apart. They must be sewn back together, which is why diastasis recti repair is best performed by a board certified plastic surgeon.

What makes diastasis recti worse? ›

Make sure to avoid certain activities and exercises that may make diastasis recti worse. These include crunches, ab twists, planks, backward bends that stretch the abdominal area, certain yoga poses, or any type of heavy lifting activities that bulge out the stomach.

Does diastasis recti cause big belly? ›

The most common symptom of diastasis recti is a belly bulge. But there may be other symptoms, such as poor posture and belly pain due to the weakened core muscles. In some cases, diastasis recti will resolve on its own. Treatment, if needed, can include exercise, surgery, or nonsurgical options.

Can I do squats with diastasis recti? ›

Q: Can you do squats with diastasis recti? A: Yes, if you do them correctly and you have a solid connection to your core. Keep in mind, as mentioned above, that diastasis is caused (and continues) when we have continuous or repetitive forward, forceful pressure out on the abdominal wall.

Can you heal diastasis recti years later? ›

In Short, YES. The vast majority of these symptoms can be improved and often fully resolved through correct training of the deep core muscles, coupled with healthy posture, breathing, and alignment in daily life.

How do I close my diastasis recti gap? ›

The key to healing diastasis recti is rebuilding your core from the inside out. You need to strengthen the transverse abdominis (TVA) muscle, which is the deepest abdominal muscle and can provide support for those muscles that have been stretched.

When is diastasis recti considered closed? ›

But, it is commonly cited to be within a normal range when the gap is up to 15mm at the base of the sternum, 22mm at 3cm above the belly button, and 16mm at 2cm below the belly button (Beer et al 2009). Therefore, aiming to “fully close” a Diastasis is not the aim. A gap of some degree is “normal”.

What happens if diastasis recti goes untreated? ›

If left untreated, diastasis recti can potentially lead to poor core stabilization, pelvic floor dysfunction, and back or pelvic pain.

What exercises fix diastasis recti? ›

The Best Exercises for Diastasis Recti

Byrne suggests abdominal compressions, pelvic tilts, toe taps, heel slides, single-leg stretches, and bridges with belly scooping. Always keep the belly pulled in, rather than doing any movement that pushes it out (and causes the telltale bulge on the midline).

How many fingers is severe diastasis recti? ›

If you feel a gap of at least two finger widths between the muscles as they contract, you have a diastasis. A gap as wide as four or five fingers is considered severe. Repeat the procedure below and above your belly button because the separation may be wider in different places.

Does diastasis recti get worse with weight gain? ›

Answer: Diastasis Recti

Diastasis Recti - the separation off your mid line paired abdominal muscles should not get worse with age but rather with decreased physical activity and weight gain.

Why is my stomach fat split in two? ›

What causes diastasis recti? Diastasis recti occurs when too much pressure is put on your abdominal muscles. This can cause them to stretch and separate. The separation in the muscles allows what's inside of the abdomen, mostly the intestines, to push through the muscles.

Can I do planks if I have diastasis recti? ›

In general, loading of the rectus abdominis, twisting of the trunk, traditional core exercises like sit ups and crunches, planks, and heavy lifting are contraindicated (not recommended). That said, this condition is unique to each individual.

Can a waist trainer fix diastasis recti? ›

There will be some natural shrinking of a diastasis recti in the months post pregnancy, but a waist trainer is unlikely to assist in this process. If you sustain a bad cut, it makes sense to have the two sides stitched together to allow proper healing.

Does diastasis recti get worse over time? ›

Over time, Diastasis Recti can worsen as the separation increases. This results in the internal abdominal organs, such as the uterus and intestines, having less protection in the front to hold them in place. Other complications of Diastasis Recti include: lower back pain.

Do belly bands help with diastasis recti? ›

Using a wrap can compress and support your muscles as they move back into place. A postpartum belly wrap isn't a cure for diastasis recti. If you still have an obvious gap between your muscles after eight weeks, you may have a condition called diastasis recti.

Does bending over cause diastasis recti? ›

Bending over the stroller with a forward flexion is a no-no for those suffering from diastasis recti, and an important position to avoid even with a healthy core.

Does coughing worsen diastasis recti? ›

Anything that puts pressure on your abdominals—overexertion, doing the wrong exercises the wrong way, straining during bowel movements, coughing, or sneezing—can, over time, turn risk into reality. With diastasis recti, there's less abdominal support to hold your organs in place.

Can I lift weights with diastasis recti? ›

Lifting weights with diastasis recti is generally safe as long as you modify the exercises to prevent any sort of bulging (aka hernia) or coning of your abdomen.

Is diastasis recti hard or soft? ›

In order for the separation to be considered diastasis, it must be at least two fingers wide, and/or soft and squishy underneath. Depth matters more than width, as does the firmness of the tissue. If you do have diastasis recti, this space will feel soft and squishy, and it will be easy for your fingers to sink in.

Will a tummy tuck fix diastasis recti? ›

While a small group of Corpus Christi women with separated abdominal muscles may have the condition naturally resolve itself within a year, or may attempt to speed up that process with physical therapy, a tummy tuck is the only proven medical way to repair diastasis recti.

Is diastasis recti a hernia? ›

Is Diastasis Recti a Hernia? While diastasis recti and abdominal hernias may look similar, they are not the same. Diastasis recti is not a protrusion of intestines or abdominal tissues like a hernia; it is a bulge of muscle due to the stretched connective tissue.

Is stair climbing Good for diastasis recti? ›

Until these muscles are properly retrained, avoid sit-ups or crunches, lunges, high impact such as running, repetitive stair climbing and the adductor or inner thigh machine at the gym. Plank exercises often worsen the separation until the gap is closed and should be avoided.

Does running help diastasis recti? ›

Summary. Yes, you can run and effectively heal your diastasis recti as long as you take it slow, focus on building solid core stability, and perfect your running form. Make sure that you're constantly monitoring your DR symptoms.

Does diastasis recti cause digestive problems? ›

Diastasis recti is not just a cosmetic issue. The abdominal muscles, which normally work together, can weaken significantly once they are stretched apart, leading to problems such as lower back pain, stress incontinence, digestive disorders, and hernia.

How can I fix diastasis recti naturally? ›

Rehabilitation of a diastasis will start with gentle exercises: deep abdominal exercises, coordinated breathing and isolated movements. But one should quickly graduate to full body exercise and higher load activities. In particular, the tension encourages the linea alba to heal, so don't be afraid of adding challenge.

Who is more prone to diastasis recti? ›

You might be more likely to develop diastasis recti as a result of pregnancy if you have carried multiples or a large baby to term and are of small stature and fit or are age 35 or older. If you think you have diastasis recti, talk to your health care provider.

Is 1 finger gap diastasis recti? ›

A two-finger (or one inch) width gap is clinically diagnosed as Diastasis Recti. One-finger width is considered normal.

Is a 2 finger gap diastasis recti? ›

Diastasis recti = a muscle separation or gap between the rectus abdominis muscles of 2 or more finger spaces or a distance of 25 mm (just less than 1 inch). This means the tissues joining the rectus abdominis muscles have stretched apart. The wider the gap, the larger the separation of these two muscles.

Can diastasis recti open again? ›

Answer: Diastasis Recti

A tummy tuck seldom becomes undone. Having a pregnancy afterwards can (but does not always) lead to a return of abdominal laxity. Gaining and losing a lot of weight can also affect tummy tuck results. But there are some issues with the advice you have been given from the diastasis program.

Does coning always mean diastasis recti? ›

Coning is when the center connective tissue of the abdomen, the linea alba, protrudes outwards beyond the rest of the abdominal wall. This tends to occur due to diastasis recti, or the normal occurring separation of the six pack abs during pregnancy.

How often should I do diastasis recti exercises? ›

With these tips in mind, here are Darmanin's go-to exercises to help improve diastasis recti. By doing these strength exercises 3 to 4 times a week, Darmanin said you should start to see improvements in the gap between the ab muscles and pain symptoms within 6 to 8 weeks.

Does diastasis recti need to be fixed? ›

If your diastasis recti is severe, or if it's not improving to your satisfaction after exercise, you may consider going under the knife to correct it. But "only consider surgery if conservative treatment of therapeutic exercise and physical therapy has failed," Butts says.

Can you fix diastasis recti after 20 years? ›

“Can you heal diastasis recti years later?” Many moms think they've left it too late to make a difference. But don't worry, the short answer to, 'can I heal years later? is “Yes!” You can always improve your core function and the tension and stability of your abdominal muscles.

What does pain from diastasis recti feel like? ›

Diastasis Recti Symptoms

A visible and palpable (detected by touch) separation of the rectus abdominis muscle. Feelings of “flabbiness” in the abdominal muscles. Pelvic-floor muscle dysfunction that causes urinary or bowel problems (incontinence, leakage, constipation, etc). Low back or pelvic or hip pain.

Can diastasis recti heal completely? ›

In Short, YES. The vast majority of these symptoms can be improved and often fully resolved through correct training of the deep core muscles, coupled with healthy posture, breathing, and alignment in daily life.

When is diastasis recti considered closed? ›

But, it is commonly cited to be within a normal range when the gap is up to 15mm at the base of the sternum, 22mm at 3cm above the belly button, and 16mm at 2cm below the belly button (Beer et al 2009). Therefore, aiming to “fully close” a Diastasis is not the aim. A gap of some degree is “normal”.

What makes diastasis recti worse? ›

Make sure to avoid certain activities and exercises that may make diastasis recti worse. These include crunches, ab twists, planks, backward bends that stretch the abdominal area, certain yoga poses, or any type of heavy lifting activities that bulge out the stomach.

What does your stomach look like if you have diastasis recti? ›

The most common symptom of diastasis recti is a pooch or bulge in your stomach, especially when you strain or contract your abdominal muscles.

Can I do squats with diastasis recti? ›

Q: Can you do squats with diastasis recti? A: Yes, if you do them correctly and you have a solid connection to your core. Keep in mind, as mentioned above, that diastasis is caused (and continues) when we have continuous or repetitive forward, forceful pressure out on the abdominal wall.

Does diastasis recti cause big belly? ›

The most common symptom of diastasis recti is a belly bulge. But there may be other symptoms, such as poor posture and belly pain due to the weakened core muscles. In some cases, diastasis recti will resolve on its own. Treatment, if needed, can include exercise, surgery, or nonsurgical options.

Can I lift weights with diastasis recti? ›

Lifting weights with diastasis recti is generally safe as long as you modify the exercises to prevent any sort of bulging (aka hernia) or coning of your abdomen.

Can diastasis recti open again? ›

Answer: Diastasis Recti

A tummy tuck seldom becomes undone. Having a pregnancy afterwards can (but does not always) lead to a return of abdominal laxity. Gaining and losing a lot of weight can also affect tummy tuck results. But there are some issues with the advice you have been given from the diastasis program.

Does a waist trainer help diastasis recti? ›

There will be some natural shrinking of a diastasis recti in the months post pregnancy, but a waist trainer is unlikely to assist in this process. If you sustain a bad cut, it makes sense to have the two sides stitched together to allow proper healing.

Is a 2 finger gap diastasis recti? ›

Diastasis recti = a muscle separation or gap between the rectus abdominis muscles of 2 or more finger spaces or a distance of 25 mm (just less than 1 inch). This means the tissues joining the rectus abdominis muscles have stretched apart. The wider the gap, the larger the separation of these two muscles.

What foods to avoid if you have diastasis? ›

Diastasis Recti Exercises to Avoid

Skip any movement or exercise that places strain on the midline or causes the belly to bulge outward, like sit-ups and planks.

What should I avoid if I have diastasis recti? ›

Sit ups or Crunches and Diastasis Recti

You should not be doing any ab exercises like sit-ups, crunches or roll ups. This is because when you are in a back lying position, your shoulders are off the floor and it will be impossible to completely engage your transverse muscles.

Does bending over cause diastasis recti? ›

Bending over the stroller with a forward flexion is a no-no for those suffering from diastasis recti, and an important position to avoid even with a healthy core.

What happens if diastasis recti goes untreated? ›

If left untreated, diastasis recti can potentially lead to poor core stabilization, pelvic floor dysfunction, and back or pelvic pain.

How do I close my diastasis recti gap? ›

The key to healing diastasis recti is rebuilding your core from the inside out. You need to strengthen the transverse abdominis (TVA) muscle, which is the deepest abdominal muscle and can provide support for those muscles that have been stretched.

Can you fix diastasis recti without tummy tuck? ›

Can you get diastasis recti surgery without a tummy tuck? Theoretically, yes you can, however, in practice, rectus repair is mostly done as part of a full tummy tuck.

Videos

1. What is Diastasis Recti: The Truth (Part 1) | Interview With MUTU System
(MUTU System)
2. Diastasis Recti: Part 1
(myPelvicFloorMuscles)
3. Core 101: Identifying Diastasis Recti - Understanding Modifications: Video 1
(Brien Shamp)
4. Diastasis Recti Healing Exercises Part 1 (TIGHTEN TUMMY MUSCLES AFTER BABY)
(Bump and Beyond)
5. Diastasis Recti and the Rectus Abdominis With Jamie Wheaton BMR PT 20160406 1633 1
(manitobafitness)
6. PostNatal Series - Class 1 of 8 - Diastasis Recti Self-Assessment
(PILATESOLOGY)

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