The term “diastasis recti” scares a lot of new moms, either because they heard that most pregnant women develop it (true) or because they were told it causes a postpartum bloated belly (sometimes true). Although the condition is common, it’s surrounded by a lot of misinformation. So before fretting about diastasis recti, let’s demystify it.
What is diastasis recti?
Diastasis recti is the technical way of saying “abdominal separation.” Everyone has a muscle called the rectus abdominis, also known as the six pack. The rectus abdominis has two halves that run vertically from the sternum to the pelvis. The halves are separated by a band of connective tissue called the linea alba. The tendon-like insertions of the other abdominal muscles—the external obliques, internal obliques, and transverse abdominis—merge to form the linea alba.
A small gap between the two halves of the rectus abdominis is normal. However, when that gap grows and stretches the linea alba, a larger than normal separation can occur. This is called diastasis recti. Although studies vary, many practitioners classify diastasis recti as a separation of at least 2.7 cm, or roughly two to three finger widths.
Though diastasis recti is common during pregnancy, this abdominal separation naturally shrinks for most women within the first eight weeks postpartum. But for some women the gap will remain. One study looked at the prevalence of diastasis recti among first-time pregnant women and found a rate of 60 percent six weeks postpartum compared to 32.6 percent 12 months postpartum.
What causes diastasis recti?
Although defining diastasis recti is fairly simple, elucidating its causes is much more complex, as is figuring out what to do about it.
Unfortunately, a lot of confusion surrounds diastasis recti, leading to unnecessary fear or unhelpful interventions. The cause of this misinformation is a lack of high-quality evidence because of underpowered or conflicting studies, which has complicated efforts to educate women.
That said, most studies agree that pregnancy is the primary cause of diastasis recti. This is because the growing uterus, in addition to hormonal changes, alters the shape of the abdomen, elongates the abdominal muscles, and changes the angles of their attachments. This is why most, if not all, pregnant women develop diastasis recti.
Therefore, abdominal separation only becomes a concern if it persists for months after birth and causes physical or emotional effects. Otherwise, diastasis recti is simply a normal response to pregnancy.
Other than pregnancy, studies have found the following risk factors.
- Multiple pregnancies
- A genetic predisposition to weaker collagen
- Confusingly, both lower- and higher-than-average BMI
- Previous abdominal surgery
- Possibly C-sections, although studies disagree about this
Is diastasis recti a problem?
Physical implications
You would think the studies could agree on whether diastasis recti is an anatomical problem. After all, being able to stick two, three, or four or more fingers between your rectus abdominis muscles seems like a bad thing. However, the evidence is not straightforward. In general, diastasis recti doesn’t cause pain at rest so isn’t in itself problematic. However, some studies link diastasis recti with back pain, but others don’t. Some studies link diastasis recti with pelvic floor problems, but other studies do not find a connection.
However, studies can agree that diastasis recti is associated with low abdominal strength, especially if the gap is large, which can cause other physical problems as different muscles take over to compensate for this lack of muscular support. Additionally, new moms are trying to heal while also carting around ever-growing babies and toddlers; thus, a large diastasis recti and its effect on abdominal strength and stability can negatively impact daily life.
Psychological implications
In addition to remedying possible pain and pelvic floor problems, many moms with diastasis recti seek out care for it for another reason: They don’t like the way their postpartum bellies look. Therefore, one of the primary problems with diastasis recti is psychological, which shouldn’t be discounted.
A stretched-out linea alba can sometimes cause a distended belly that still looks many months pregnant. Still, some recent studies have shown that “not all patients with bulging abdomens had diastasis recti, and vice versa.”
How to fix diastasis recti
Despite the lack of concrete evidence for any particular intervention, most experts agree on best steps for preventing and/or treating diastasis recti.
1. Maintain a healthy BMI.
Since diastasis recti is caused by intra-abdominal forces on muscles and connective tissue, maintaining a healthy BMI mitigates some of this pressure. Obesity, in particular, has been linked to diastasis recti and pelvic floor disorder. This doesn’t mean moms should obsess about every last pound after baby, especially because rapid weight loss can exacerbate connective tissue problems, but it does mean prioritizing a healthy lifestyle both during and after pregnancy, which includes paying attention to diet and exercise.
2. Stay active and strengthen both internal and external abdominal muscles.
The biggest debate in the diastasis recti literature is between practitioners who say women should focus on the internal abdominal muscles, such as the transverse abdominis, and those who say women should focus on shortening the rectus abdominis. Activating the transverse abdominis momentarily increases the size of the gap between the two halves of the rectus abdominis, but it increases tension on the linea alba, which is essential for maintaining core support. Conversely, activating the rectus abdominis, such as in a crunch, decreases the gap, but it might decrease tension on the transverse abdominis. This has led to disagreements about which abdominal muscle is the most important. Meanwhile, a prospective study concluded that exercise won’t close a diastasis recti. The confusion likely results from the difficulty of studying an exercise intervention, especially because diastasis recti is highly variable and can naturally improve over time.
But none of the studies have shown any downside to exercise, as long as the belly doesn’t balloon out when doing it. Therefore, a well-balanced exercise program that includes a wide range of abdominal exercises is the best approach.
3. See a physical therapist.
Although exercise can help with strength and may help narrow the gap, knowing which exercises to do and how they will affect your body can be difficult. Therefore, seeing a women’s health physical therapist or a specially trained personal trainer can be invaluable, even if only to get another set of eyes to make sure you aren’t overextending your abdomen as you strengthen it.
4. Consider surgery.
Sometimes no amount of rest, exercise, or healthy eating will budge a bulging abdomen or help close a diastasis recti. If you still experience discomfort, whether physical or psychological, surgery to manually move the muscles closer together is an option.
5. Live with it.
And finally, the last option is to live with diastasis recti without trying to fix it. Abdominal separation isn’t a problem unless it causes problems. Therefore, if you don’t experience pain and don’t mind the gap, nothing needs to be done.
Although the term “diastasis recti” can sound scary, it’s a normal part of pregnancy. It becomes a persistent problem for some women, and even if not dangerous, it can affect abdominal strength and self-confidence. There is no definitive solution for diastasis recti, but exercise interventions do help many women. Therefore, staying active and trying different types of exercise, often with the help of a professional, is the best means of tackling a loss of strength and confidence.
However, keep in mind that moderate exercise won’t hurt diastasis recti, but overexercising can exacerbate intra-abdominal pressure before strength improves, while also putting too much mental stress on women to achieve a certain look postpartum. Some extra space between the rectus abdominis muscles is normal. Whether this extra space causes problems is highly individual, as are the steps a mother takes to deal with it.