Diastasis Recti and Abdominal Separation

Your body can change in strange and fascinating ways during pregnancy. A lot happens as your baby grows and your uterus expands, including the stretching of the muscles in your abdomen. In some moms-to-be, some of these muscles, known as the rectus abdominis muscles, separate a little too much toward the end of pregnancy or in the days and weeks after delivery. This condition is known as diastasis recti. Keep reading to learn more about what diastasis recti is, how to know if you have it, and some possible diastasis recti treatment options.

What Is Diastasis Recti?

Diastasis recti, known more formally as diastasis recti abdominis, is a condition that can happen when the rectus abdominis muscles (think the right and left sides of a six pack) separate from each other — such as during pregnancy when the uterus grows and in the first few weeks after giving birth — and don’t return back to their original position. This vertical separation might not be obviously visible before or after pregnancy, but after you give birth you may notice a bulge in your abdomen when these muscles are tensed. For example, this bulge might show itself when you sit up from a lying position. Diastasis recti can sometimes lead to issues such as back pain.

Symptoms of Abdominal Separation

Diastasis recti usually appears as a bulge in the middle of your abdomen where your rectus muscles have separated and which becomes apparent when you try to flex or tighten your abdominal muscles. It might not be immediately obvious that you have diastasis recti when you’re pregnant, or even immediately after. However, your healthcare provider might be able to detect it in your third trimester during a physical exam. As you lie on the exam table and gently flex your abdominal muscles, your provider may feel a separation. In some cases, an ultrasound may also be performed. The condition itself is normally painless, but it can sometimes lead to some lower back pain during and after pregnancy, or make it difficult to do everyday tasks that involve lifting things or bending in certain ways, because the muscles have stretched, and therefore weakened. If, after delivery, you suspect you might have developed diastasis recti, you can do a self-check before seeing your healthcare provider for a diagnosis.

How to Check if You Have Diastasis Recti

Here is one method of checking if you have abdominal separation: 1) Lie on your back with your knees bent, and gently raise your head and shoulders, as if doing a gentle sit-up. 2) With your abdominal muscles flexed or squeezed in this position, you might feel a gap in the center of your abdomen, somewhere between your pubic bone and your rib cage. 3) If you feel a gap that is wider than two finger widths (between the left and right rectus muscles), you might have diastasis recti.

Causes of Diastasis Recti

There isn’t a wealth of information about what exactly can cause this condition, but your pre-pregnancy weight and pregnancy weight gain are not thought to have much of an impact on whether or not you develop this condition if you’re in the normal BMI range. But there are a few other factors that may make you more likely to develop diastasis recti:

• Being pregnant with twins or other multiples

• Giving birth to a particularly large baby (weighing more than nine and a half pounds at birth is considered above-average weight)

• Being petite or having a small frame

• Being older than 35

Treatment of Diastasis Recti

It’s important to remember that diastasis recti is a muscular condition that may or may not require treatment. If you’re diagnosed with diastasis recti, your healthcare provider may refer you to a physical therapist who will advise you on appropriate post-pregnancy exercises that can strengthen your ab muscles again, as well as provide a timeline for when you can start to exercise again after giving birth. It's possible that your healthcare provider may recommend surgery for your diastasis recti. Your provider will give you more personalized advice if physical therapy hasn’t fixed the problem.

Prevention of Diastasis Recti During Pregnancy

During your pregnancy, you'll want to check with your healthcare provider before beginning or continuing any exercise program, but there are a variety of exercises you can do during pregnancy to help strengthen your abdominal muscles. For example, with your provider’s OK, try kneeling on all fours and pull your ab muscles inward toward your back while inhaling and exhaling. Keep your back straight while doing this. It’s also important to practice good posture and maintain a healthy body weight during your pregnancy. This helps alleviate some of the pressure that might lead to back pain as your belly grows. Kegel exercises can also help prevent or alleviate the back pain that may be associated with diastasis recti, and can possibly help with other issues you may experience before and after delivery, such as any urinary or bowel incontinence or painful sexual intercourse. If you’re not familiar with Kegels, here's what to do: simply squeeze the pelvic floor muscles as if you were trying to stop a flow of urine. Hold for about 10 seconds, and then release. Build up the number of repetitions you do until you can do about 10 or 20 repetitions at a time, a few times a day. Your healthcare provider can help you master Kegels, so ask for help if you need it. Done regularly over time, Kegels can help you build the strength of your pelvic floor muscles, and this may help relieve some of the associated symptoms of diastasis recti.

You’ll no doubt be amazed at what your body has achieved over the past several months as you hold your newborn baby. It’s impressive, and you should be proud. Still, over time you’ll become familiar with your post-baby body and the ways it has changed. If you think you might have diastasis recti, check in with your healthcare provider for specific advice to help these weakened muscles get stronger. Be patient with yourself and your body, and give yourself the time to deal with this abdominal muscle separation and to heal and recover from childbirth.