Have you heard of diastasis recti? Most women do not know that this condition exists, yet it is prevalent. There are more than 3 million people that get diagnosed with diastasis recti each year. That is why it is often referred to as the “unspoken postpartum problem.”
While the condition is not curable and can be a chronic issue for some people, it is treatable. Diastasis recti rarely needs labs or imaging, but you may need a medical diagnosis to receive certain treatments.
At MaternalWell, we want to support you during your motherhood journey, including your physical well-being during and after pregnancy. The following is a guide to help answer any questions you may have regarding diastasis recti. We also provide information about how you can treat this condition.
What is Diastasis Recti?
Diastasis recti is a common condition for women during and after pregnancy. It is the partial or total separation of the large abdominal muscles, which meet at the midline of your stomach. The two large parallel abdominal muscles called the Rectus Abdominis, begin to widen, creating an atypical gap. The separation occurs at the Linea Alba, the mid-line collagen connective tissue located at the front of the abdomen.
Why Does Diastasis Recti Occur?
When you are pregnant, the growing uterus puts pressure on the abdominal muscles, stretching them. The muscles are also more relaxed during pregnancy because of the two hormones, relaxin, and estrogen. Combining stretching and more flexible muscles can cause the two large “six-pack” muscles to become separated by an uncommon distance, the condition known as diastasis recti.
Will I Develop Diastasis Recti?
Most women will have some level of diastasis recti during the third trimester of pregnancy. Certain conditions can increase the risk of the development of an extreme case of diastasis recti.
First, you will be more likely to develop it if you have carried multiples, such as twins or triplets. That is because when you carry multiples, there are more babies expanding your uterus. There is also a higher number of hormones flowing through your body. All of these together create a higher likelihood of developing diastatic recti.
You may also develop diastasis recti if you are fit and have a small stature and then carry a large baby to term. A rapid change in weight, or pressure from a large baby on an abdomen that is used to being tight, can increase the likelihood of diastasis recti.
Other risk factors that increase your chance of developing diastasis recti during pregnancy:
- Being over the age of 35
- Having more than one child, particularly if they are close in age
- Giving birth to a heavy baby
- Doing excessive core exercises after the first trimester
- Having a pronounced “swayback”
- Having poor abdominal muscle tone before pregnancy
- A genetic link of diastasis recti
- Past occurrence of diastasis recti
- Being petite
For most women, diastasis recti occurs after they reach the 20-week mark of their pregnancy. Approximately eight weeks after giving birth, the gap shrinks. However, in almost half of women, an overly broad space between the muscles can persist for months or even years.
About 40% of women have diastasis recti for six months postpartum. In a recent Norway study, about a third of moms still had the condition for a year after giving birth.
How to Diagnose It
The condition diastasis recti is classified as having a space of roughly 2.7 cm (a little more than an inch) or more between your two large abdominal muscles.
If you think you might have diastasis recti but are not sure, it is relatively easy to determine. Follow these steps to find out:
- Lie on your back with your knees bent at a 90-degree angle, with your feet flat on the floor.
- Place your fingers on your belly button, with your palm facing you.
- Raise your head off the ground and place your chin to your chest while contracting your abdominal muscles.
- Do you feel a gap that is two finger-widths or more? If so, you likely have diastasis recti.
The space between your abdominal muscles is only one symptom that this condition can cause. Other symptoms of abdominal separation include:
- Having digestive issues such as constipation or bloating
- Bulging belly
- “Outie” belly button
- Hip, low-back, or pelvic pain
- Urine leaks
- Poor posture
- Pain during intercourse
- Difficult vaginal delivery
- Weakened pelvic alignment
- Trouble moving or breathing normally
Can it Be Prevented?
There are ways that you can help prevent the development of diastasis recti. The key is to protect and strengthen the vulnerable abdomen to protect the muscles from separating.
Protecting the Abdomen
The first step to diastasis recti prevention is by protecting the abdominal muscles. One way to do this is by using the log roll maneuver when getting up from the couch or floor and getting out of bed. The maneuver consists of rolling onto one side, keeping your torso and head in alignment. Then, use your arms to assist in pushing your body up into a sitting position. Using your other muscles can help protect your sensitive core.
Strengthening the Abdomen
You can also strengthen these essential muscles during pregnancy, which can help protect the abdomen from stretching too much when you move. A great way to do this is by utilizing the Dia Method, an exercise program developed by Leah Keller to help postpartum women reverse the effects of diastasis recti.
Leah Keller, initially based in New York but now practicing in San Francisco, ran a private training practice when she encountered postpartum women that had trouble getting rid of their “mommy tummy.” These women had tried traditional core exercises but found that it had an unintended effect- it made their tummy bulge worse. Using her knowledge about diastasis recti rehabilitation, Keller developed exercises to help repair her clients’ abdomens. And they worked! The women were so ecstatic about the results that she began posting her videos online.
The exercises often started during pregnancy help women become aware of their abs and pelvic floor. Through the movements, expectant mothers can connect better to these areas, translating into the delivery room. They will be able to access those muscles while pushing in delivery, opening, and relaxing the pelvic floor, simultaneously. Overall, it can help the physical process of delivering a baby easier on the body.
Doing these exercises during pregnancy can also offer a safe workout for those dealing with lower back pain.
After giving birth, the Dia Method becomes more targeted. The workouts take less than 30 minutes for the entire body, and many can be modified or enhanced as your become stronger. According to Keller, doing the exercises every day provides the best results, but you can still see a difference if you complete them as little as 80% of the time.
The main goal of the Dia Method is activating the transverse abdominal muscle–a thin sheet that is located deep in your core, beneath your obliques. When pregnant, this muscle is responsible for managing the integrity of the abdominal wall. After giving birth, it aids in reestablishing the function and tone you had before carrying your baby.
Dia Method Exercises
The Dia Method program is more than a single workout. It is a system of techniques that incorporate breathing along with nutritional strategies. Its core, however, is a series of exercises that unconventionally target the abs.
For example, instead of completing full planks, the Dia Method suggests doing midfield side planks or a modified plank at an elevated surface, like the counter.
Another essential move does not even seem like an exercise at all. For 10 minutes each day, you would complete this move in various positions:
- Lie on your back and place your fingers on your belly. Take a deep breath and then exhale, pushing your abdominal muscles back toward your spine as far as they can go.
How to Treat It
Exercise is the first treatment to repair diastasis recti. You will first want approval from your doctor to begin an exercise program. There are different at-home workout programs beyond the Dia Method that you can find online.
One such program, called the MuTu System, was developed by a U.K.-based mom and trainer named Wendy Powell. The exercises help strengthen the core, abdominal muscles and avoid activities known to aggravate the problem, such as stomach crunches.
If exercises alone do not help the issue, the next best treatment option is physical therapy. If you would like to find out more about physical therapy, MaternalWell can help! Schedule an appointment with one of our licensed physical therapists to find discuss any issues or concerns you might have.
For severe cases of diastasis recti that cannot be treated through exercise and physical therapy, a more invasive procedure, like surgery, can help. Usually, patients receive a tummy tuck procedure that removes excess skin. Surgery should be viewed as a last resort and only be done once a woman is sure that she is done bearing children.
Exercises That Can Help
The best approach to self-treatment for diastasis recti is through exercise. Here are three that can get you started:
- Umbrella Breathing with Kegel
1. Start in a standing position, but keep your knees slightly bent. Or you may sit on a yoga ball or chair.
2. Picture your ribcage as an umbrella, opening a full 360-degrees as you inhale.
3. Begin your exhale with a kegel. Empty your lower belly, then midsection, followed by your chest, keeping your abdominal muscles engaged upward and inward as you go.
4. Start by completing ten concentrating breaths while standing, and then continue the same breathing pattern for the rest of your exercises.
- Pelvic Tilts on Hands and Knees
1. Start in a hands and knees position with a neutral spine.
2. Take a big inhale, letting air expand the sides of your ribcage. Then exhale, with a kegel, while drawing down your tailbone and underneath your body into a curved spine.
3. Inhale as your body returns to a neutral position. Be sure to relax your glutes and produce movement from your lower abs. Be careful not to arch upwards (also called cow position), which is not advised if you have severe diastasis recti.
4. Complete ten tilts, moving slowly and carefully.
- Toe Taps Lying on Back
1. Begin by lying flat on your back. Bring your legs to a tabletop position, situating your legs directly over your hips. Be sure not to tuck your pelvis or arch your back.
2. Breath into your ribcage and exhale as you tap your right foot to the ground while drawing in your core. Be sure to maintain your pelvic alignment.
3. Inhale as you return to neutral in a slow and controlled manner.
4. Complete ten reps on each side.
Exercises to Avoid
While many exercises can help women suffering from diastasis recti, there are also ones that can cause further separation. Skip any movements or activities that strain the midline or ones that can cause the belly to bulge outward.
Although it may be counter-intuitive, avoid all exercises that traditionally result in a “six-pack.” They include:
- Front planks
- Oblique curls
- Reverse curls
- Some yoga poses (like downward dog)
You may also want to avoid heavy lifting and exercises that require twisting of your spine. That can cause the abdominal wall to work against the pull of gravity, straining it further.
Be sure to exclude backbend or other spinal extension exercises. They can add stress to the abdominal tissues.
Mamas, you are not alone! MaternalWell is available to support you with diastasis recti and throughout your motherhood journey.
Our experienced specialists take a proactive approach to expecting moms’ physical, mental, and emotional health during this sensitive time.
Learn more about diastasis recti by scheduling a virtual visit with one of our licensed physical therapists. We offer affordable and convenient access to excellent professional care through our telehealth platform. We can provide you with care in the comfort of your own home.
Please visit us at maternalwell.com.