Diastasis recti is the partial or complete separation of the rectus abdominis, or “six packs,” muscles that meet in the midline of the stomach. It is very common during and after pregnancy. This is because the uterus stretches the abdominal muscles to accommodate your growing baby. One study found that up to 60% of women may experience diastasis recti during pregnancy or after childbirth.
However, the condition is not limited to pregnancy. It can affect anyone, including new-borns and women. In some cases, this can be the result of lifting heavy objects incorrectly or performing excessive or unsafe abdominal exercises. The degree of dilatation required for diagnosis is controversial, as the degree of abdominal protrusion (rather than the degree of dilatation) often defines whether the condition is pathologic. However less than 15-25mm is generally considered abnormal depending on gender, parity and postpartum, the time since birth. In addition, normal width varies depending on the level at which the line is measured (narrowest at the xiphoid, approaching the inferior pubic symphysis, and widest at the level of the umbilicus).
Why Does Diastasis Recti Occur?
Pregnancy puts a lot of pressure on the abdomen. The abdomen consists of left and right abdominal muscles and a thin band of connective tissue in the middle. They push out and stretch to make room for the growing baby. Diastasis recti occurs when the linea alba stretches too far and doesn’t come back together. The left and right sides of the abdominal muscles remain separate. It is also known as “abgap” or abdominal separation.
Who Gets Diastasis Recti?
Diastasis recti is more common in pregnant women and postpartum women (can also be seen in men and babies). Diastasis Recti develops in the third trimester. Since the baby is growing rapidly during this time, there is increased pressure on the abdominal wall. Most people don’t notice diastasis recti until after they give birth.
How Common Is Diastasis Recti?
Diastasis recti is very common in pregnant women and in the postpartum period. It affects 60% of people. It usually resolves on its own within eight weeks of delivery. About 40% of patients with diastasis recti still have it six months after delivery.
What Are the Symptoms?
The most common symptom of diastasis rectus abdominis is pressure or swelling in the stomach, especially when the abdominal muscles are tight or strained.
Additional symptoms:
- Back Pain
- Wrong Posture
- Constipation
- Bloating
- Pregnancy
You may not have any noticeable symptoms during pregnancy as your abdominal muscles will be severed. During the second or in the third trimester of pregnancy, a lump or bump may appear on the abdomen. It can appear above and below the navel. This can be most noticeable when trying to use your abs to stand, sit, or lie down. If you experience severe abdominal, back, or pelvic pain, contact your doctor immediately.
Birth
After childbirth, the most visible symptom is abdominal swelling. Even if you are no longer pregnant, you may still feel this way.
How to Check for Diastasis After Childbirth
- Lie on your back with your knees bent, feet flat on the floor.
- Raise your arms slightly off the ground, support your head with one hand and look at your stomach.
- Use your other hand to walk up and down Navel and along midline abdominal muscles. See if you can insert your fingers into the gaps between the muscles.
- If you feel a gap or distance one in two finger length you probably have a moderate rectal cleft. A few weeks after birth, the distance will start to narrow as your muscles regain strength. Your doctor or physical therapist can check this too.
What Does a Rectus Abdominis Look Like?
A rectus abdominis dissection is not painful. You may feel pain and that is linked to some side effects of diastasis, but just severing the abdomen doesn’t hurt. You can experience basic weakness when performing simple tasks like lifting a laundry basket. Some people experience a jelly-like texture in the space between the left and right abdomen when the abdominal muscles contract.
How Do I Know if I Have Diastasis Recti?
Several common symptoms may indicate that you have right diastasis. One of the most common symptoms of rectus abdominis dehiscence is a bulge in the abdominal area that does not go away even after exercise or muscle wasting weight gain during pregnancy. Another symptom is that when you recline in a chair or get out of bed, your abdomen may feel swollen. You can check for diastasis yourself, but it’s always a good idea to talk to your doctor.
What Are the Risk Factors for Developing Diastasis Recti?
Several factors can increase your risk of developing diastasis recti:
- Multiple pregnancies (especially consecutive).
- Being over 35 years old.
- Having multiple births (e.g., twins or triplets).
- Having a heavy or large baby.
- Being very small.
- Vaginal delivery, as pushing can increase abdominal pressure.
How Is Diastasis Recti Diagnosed?
Your doctor will assess whether diastasis recti is present, where it is located and how severe it is. Diastasis Recti can appear above the belly button, below the belly button, and in the belly button.
Your doctor will use their hands and fingers to feel the abdominal area for gaps and muscle tone. Some doctors may use ultrasound, a tape measure, or a tool called callipers for a more accurate measurement. This test is usually performed at your postpartum appointment before you are released to exercise. An abdomen more than 2 cm wide is considered rectal diastasis. Diastasis in the rectum is also measured in finger widths, for example two or three fingers apart. Your healthcare provider may recommend exercises for diastasis recti or refer you to a specialist for further treatment.
Treatment
1) Physiotherapy
Diastasis recti can be initiated by your doctor by referring the patient to a physical therapist for conservative (non-surgical) treatment. The success rate is questionable and cannot be stated as no identified studies report on the long-term effects of physiotherapy. We suggest that physical therapy can start 6 to 8 weeks after birth, which has been chosen in some studies. Conservative interventions include exercise, postural and back care training, external support with an elastic tubular bandage or corset, and/or aerobic exercise. The approaches are heterogeneous, and it is difficult to compare studies.
In a systematic review that included four studies evaluating the effect of physical therapy for the treatment of diastasis recti, the authors concluded that it was impossible to recommend physical therapy in general or a specific exercise routine because the included studies insufficient were number of patients and were heterogeneously performed with a low level of evidence. A recent randomized controlled trial (RCT) of 175 primiparous women failed to show a difference in the prevalence of diastasis recti between a group of exercises using a 16-week program and a non-exercising control group assessed at 6 and 12 months postpartum. Diastasis recti was not an inclusion criterion. A systematic review found that physical therapy did not result in resolution of the rectus abdominis diastasis in a relaxed state, but that physiotherapy was able to achieve a limited reduction in the distance between the recti during muscle contraction. In several of the studies included in this review, physical therapy was started within the first few months after birth, when diastasis was allowed to resolve naturally. Therefore, it is not possible to conclude whether physical therapy or natural resolution had an effect as the studies did not have control groups.
Long-term follow-up RCT comparing 3 months of intensive physical therapy with surgery in patients with diastasis recti. The study reported pain and limitations in activities of daily living, assessed with a validated pain questionnaire, quality of life with the short form 36 (SF-36). All patients who underwent physical therapy had significantly lower quality of life scores than the baseline population in all eight SF-36 domains at baseline. Physiotherapy greatly improved some parts of various pain from baseline, but patients continued to experience pain during sports and activities of daily living and there was no improvement in ‘current pain’.
2) Surgical Treatment
Surgical intervention may be considered when physical therapy corrects the abnormal enlargement of the linea alba and the Linea alba cannot reduce the symptoms are severe. It is recommended to opt for surgery 6-12 months after delivery as diastole can naturally resolve during this time. Surgical options include open, laparoscopic, and robotic surgery. The plication of the right fascia is performed using all the techniques described. During the open approach, the right anterior fascia is usually curved, while in the robotic laparoscopic approach, the right posterior fascia is curved.
3) Open Surgery
The success rate is generally high, with most studies reporting a 0% recurrence rate 6 months after open surgery. The most used open approach is the classic abdominoplasty with a transverse suprapubic incision. Drawn across the anterior iliac crests to reveal the rectus muscles and linea alba. Other incisions are also possible: medial suprapubic incision, mostly used for other comorbidities (nephrectomy and hernia), left suprapubic incision, lengthened by 2 to 3 cm up; and a central abdominal incision extending from the xiphoid process to the pubic area. Application may be with or without mesh bracing. Meshes are often used when there is a hernia.
Regarding the insertion techniques, the surgeon may use single- or double-layer sutures, interrupted or continuous sutures, absorbable, slowly absorbable, or permanent sutures. Three RCTs were compared. Suturing was performed with one layer of continuous absorbable sutures or two layers of slowly absorbable continuous sutures. The results showed that the procedure significantly reduced pain. Scores on a validated questionnaire on abdominal pain versus physical therapy, with no difference between the two types of plications. There was a significant improvement in quality-of-life scores in all eight domains of the SF-36 compared to baseline measurements and surgical patients. Patients were at the same level as the original population 1 year after surgery. Again, there was no difference between the two sewing techniques.
Can the Right Diastasis Be Corrected Without Surgery?
Yes, it is possible to correct the right diastasis without surgery. Surgery to remove the right diastasis is rarely performed. Medical professionals recommend physical therapy or home exercises to heal stretch marks before resorting to surgical methods. The operation is performed in case of a hernia (if the organ crosses the linea alba) or if a woman is about to undergo rectal diastasis surgery (abdominoplasty)
What Are the Best Exercises for Rectal Diastasis?
The best exercises for diastasis recti are those that engage the deep abdominal muscles. Most diastasis recti exercises involve deep breathing and slow, controlled movements.
Frequent abdominal exercises (e.g., crunches) can relax your abdominal muscles. Before you start abdominal exercises, ask your doctor to check for stretch marks.
What Movements Make Straight Diastasis Worse?
Any movement that causes the abdominal wall to protrude forward can further damage straight diastasis. Daily movements like getting out of bed or a chair can make diastasis recti worse. Try to pay attention to how you’re using your abs throughout the day.
These exercises should be avoided if having diastasis recti:
- Crunches or squats of any kind.
- Planks or push-ups (unless mods are used).
- Downward Dog, Boat Pose, and other yoga poses.
- Leg raises, scissors, and other Pilates moves.
- Any exercise that causes swelling, tightening, or swelling.
How to Prevent Diastasis?
Some abdominal tension is normal and expected during pregnancy. There are a few things you can do to reduce your risk:
- Healthy Weight Gain During Pregnancy: Exercise and eat healthy foods to keep weight gain within a healthy range.
- Correct Posture and Deep Breathing: Stand feet straight, shoulders back.
- Safe exercises for your core: Avoid exercises like squats and crunches that put pressure on your abdomen after 12 weeks of pregnancy and after childbirth.
- Don’t force yourself to lift weights: Some everyday activities, like picking up grocery bags or lifting babies, can put strain on your stomach.
- Get out of bed: If you are pregnant or have just given birth, roll onto your side and use your arms to get out of bed.
