Diastasis Recti

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What is Diastasis Recti?

Diastasis Recti (DR) is a condition that involves the abdominal muscles to partially or completely separate. The specific muscle is the Rectus Abdominis, also known as the “six pack muscle”, which runs vertically along the abdomen area. Diastasis Recti involves separation of this muscle from the right side and the left side. This creates a space between the muscle, which resembles a “pooch” that is most noticeable when trying to sit up in bed.

It is common in: 

• pregnant women
• women that deliver a high birth weight baby or multiples
• women that have had multiple pregnancies (especially close in age) 

This occurs from the expanding uterus accommodating for the growth of the baby or babies. 

The weight gain during pregnancy puts more pressure on the abdominal muscles. This causes the muscles to stretch. As the pressure increases, the stretch can lead to separation, or “diastasis”, between the muscles.

Also, it is also common in: 

• middle-aged to older men with abdominal obesity 
• people that lift heavy weights with poor form
• people that perform excessive abdominal exercises incorrectly

Normal Abdomen vs. Diastasis Recti
 

Click to learn how to engage the transverse abdominis.

How Do I Know if I Have Diastasis Recti? What Does it Feel Like?

Diastasis Recti can be diagnosed by a doctor or physical therapist by measuring how far the abdominal muscles have separated. This measurement is done by using finger widths, a measuring tape or caliper, or performing an ultrasound.

A common way to self-diagnose diastasis recti is by contracting your abdominal muscles, such as trying to sit straight up from lying on your back. A pooch or bulge in the middle of your abdomen area is a common symptom of Diastasis Recti. If there is a bulge in the middle of your abdomen area, move one hand above and below your belly button to see if any fingers fit in the gap between the muscles. In most cases, the gap will narrow as the muscles regain strength within a few weeks postpartum.

However, clinical diagnostics performed by a doctor or physical therapist will be more effective in confirming diastasis recti and the degree or severity of separation.

Can 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
• constipation
• incontinence 
• shortness of breath

Diastasis recti can even lead to a condition called abdominal hernia, in which the organs begin to push through, if the separation in the abdominal muscles continues to worse.

Things to Avoid with Diastasis Recti

If pregnant, specific exercises or movements that involve strain to the abdominal muscles should be avoided. These include:

• heavy lifting
• traditional crunches or sit ups
• sitting straight up from a reclined or flat position

Can You Prevent Diastasis Recti During Pregnancy?

There are studies that show that women who exercises regularly during pregnancy have a lower incidence of Diastasis Recti. It is important to discuss appropriate pregnancy exercise with your Obstetrician or Gynecologist. 

Does Physical Therapy Help Diastasis Recti?

A physical therapist can provide instruction and guidance with correct ways to transfer and pregnancy-safe exercises to maintain a strong core throughout pregnancy.

In postpartum, specific exercises and abdominal movements can be used to assist the muscles in coming together to reduce the separation. Most doctors or obstetricians will refer patients with diastasis recti to a physical therapist if the separation is: 

• lasting longer than 8 weeks 
• contributing to lower back pain
• constipation
• poor posture
• difficulty lifting your growing baby

How Long Does it Take for Diastasis Recti to Heal? What is the Fastest Way to Heal?

For most women, diastasis recti improves with specific pelvic floor and abdominal exercises within 12 weeks postpartum. However, complications such as lower back or pelvic pain, pelvic floor dysfunction, or abdominal hernia may lead to a longer healing time. Depending on the severity of you diastasis recti, it may take 6-12 months to completely heal. However, physical therapy with specific core and trunk stabilization exercises can reduce this time.

How Do I Know if I Need Surgery?

In severe cases or cases that don’t respond to physical therapy and conservative measures, surgery may be performed. This is known as abdominoplasty, (or “tummy tuck”) to surgically bring the left and right side of the muscles together.

By: Demetria Juber, PT, DPT

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