Diastasis recti — also known as abdominal separation — occurs when the band of connective tissue in the center of the abdomen softens, causing a separation of the abdominal muscles.
Staci Wietfeld, PT, DPT, of Avera Therapy, outlined what to look for and how to treat diastasis recti.
Is Abdominal Separation After Pregnancy Common?
The most common group to experience diastasis recti is pregnant women, and it is largely a post-partum concern because softened tissue is less noticeable during pregnancy while the baby is present.
“Pregnancy causes a stretching of those tissues. The linea alba (the connective tissue running from the sternum to the pubic bone in the center gap of the abdomen) thins and softens,” said Wietfeld. “When the baby’s born, instead of that tissue immediately recoiling back, it can stay a little bit separated.”
Most pregnant women experience diastasis recti, but it usually resolves through natural healing in those tissues, while some women see a more prolonged weakness or softening in that area.
Both men and women can experience abdominal separation. Outside of pregnancy, diastasis recti can happen due to obesity, especially if someone carries their weight in the abdomen, overstretching those abdominal tissues.
It is also seen in weightlifters, particularly if they have been using bad technique that puts excessive pressure on the abdomen.
Beyond that, diastasis recti can happen when someone who has severe constipation is doing a lot of straining.
How is Diastasis Recti Diagnosed?
While diastasis recti can be measured by a visual ultrasound, it is most often measured clinically with palpation (using the hands).
“You’re feeling for the presence of that separation or softened area,” said Wietfeld. “You feel from the firm muscle side on the right to the firm muscle side on the left, and what you’re left with is a little soft valley, or divot. You can measure how wide and deep that is with fingers.”
Generally, a gap that is narrower than two fingers’ width is considered normal, while a muscle separation greater than two fingers’ width may require attention.
What Does Diastasis Recti Look and Feel Like?
Often patients are alerted to diastasis recti when they are doing something that requires abdominal effort, such as bending down and lifting a child. They may experience a pulling sensation in their abdomen when they lift weights or when they sit up to get out of bed.
“They might notice a pooching or a bulge — we call it a doming or a coning in the center of their abdomen,” said Wietfeld. “Since there’s a ligament and not a muscle there, if that’s soft and you put pressure behind it, it looks like a little bulge.”
Does Diastasis Recti Hurt?
While pain does not always accompany diastasis recti, it can crop up due to the tissue being part of one’s core stabilization.
“Someone who has a really weak abdominal muscle and maybe a little separation might have some back pain,” said Wietfeld. “They might have some incontinence. They might have some abdominal pain.”
However, abdominal separation has less to do with pain and more to do with your core not feeling as strong and stable as it needs to be, according to Wietfeld.
How Do You Treat Diastasis Recti?
In very rare instances, surgery is considered, but for the majority of cases, diastasis recti can be healed with conservative management.
“For postpartum women, we expect a continued healing over three to six months postpartum, just with natural tissue improvement,” said Wietfeld.
Those with unresolved separation can work with physical therapists to learn helpful exercises and understand which activities to avoid, such as sit-ups that keep pulling those muscles apart.
Physical therapy exercises might include the following:
- Movement that keeps the spine in a natural curved position
- Abdominal bracing — engaging core muscles to stabilize the spine and improve posture
- Deep breathing through the diaphragm (belly), which strengthens core muscles and improves stability
- Modified lifestyle activities that help avoid bearing down or doing pressure activities without support
Get Help Treating Diastasis Recti
If you notice bulging or feel your abdominal muscles have lost firmness, have a conversation with your doctor about whether physical therapy may be appropriate.
A physical therapist can help you create a safe exercise program that doesn’t strain your abdominal muscles.
Read more: Starting Exercise After Pregnancy
Can You Prevent Diastasis Recti?
You can do a few things to help with prevention:
- Maintain good body weight.
- Use good form and technique with lifting activities.
- Pay attention to how you’re healing post-pregnancy or post-abdominal surgery to flag anything early.
With exercise programs, prevention involves breathing through resistance activities and properly engaging the core instead of holding your breath.
“Our abdominals, our pelvic floor and our back muscles should all work together in a coordinated effort as opposed to letting an undue amount of abdominal pressure push into that tendon and reduce its strength,” said Wietfeld.
