All About Diastasis Recti

Article Summary:

• Diastasis recti is the separation of abdominal muscles in the front of your belly, and it is common during and post pregnancy.
• Exercises may help prevent and heal diastasis recti, but first consult with your healthcare provider.
• For most women, diastasis recti will heal on its own or with the help of physiotherapy. Rarely, surgery is needed.

What Is Diastasis Recti?

Diastasis recti abdominus (DRA) is defined by the medical community as the separation of the two long recti muscles that run vertically along the front of your belly.¹ This happens when the muscles are stretched and spread apart.¹ As the uterus expands to accommodate the growing baby, it puts pressure on these muscles, which may cause them to separate.¹ Some pregnant women may experience pain while others have no symptoms at all.¹

In the later part of pregnancy, the uterus may actually appear to stick out in the new gap between the muscles.^{1, 2} Treatment for DRA is not typically needed for pregnant people and will often heal on its own once the baby is born.²

Who Gets Diastasis Recti?

Diastasis recti is a common condition during and after pregnancy.³ One study of first-time mothers found that diastasis recti appeared toward the middle of the second trimester, was common at 6 weeks postpartum, but was also still a possibility at 12 months postpartum.³ Another study indicated that DRA was incredibly likely at the 35^th gestational week but lessened by the 6^th month postpartum.³

Mothers who have had multiple pregnancies or have been pregnant with twins (or more!) are more likely to experience abdominal separation because the muscles have been stretched multiple times.²

How to Prevent Diastasis Recti

Exercise may be the best way to prevent abdominal separation; it helps maintain tone, strength and control of the abdominal muscles.³ Similarly, pregnant women who exercise during and after their pregnancies are more likely to have exercised before they became pregnant, and therefore may already have abdominal muscles with a fair amount of conditioning and strength, especially compared to those who are sedentary.³

Try these core exercises that may help prevent diastasis recti:⁴

Opposite Arm and Leg Extension

This toning exercise helps to strengthen the core muscles of the body by involving balance. Begin on all fours, with your knees on the ground, your palms flat on the floor directly under your shoulders, your back straight, hips level and core tightened. On an inhale, lift one leg to reach straight back behind you while lifting the opposite arm to reach in front of you. On an exhale, bring the raised knee and elbow to meet comfortably near your core while you squeeze your abs and round your back. Repeat on each side for as many repetitions as are recommended by your doctor.

Modified Crunch

Lie on your back with your knees bent, your feet flat on the floor and a hand on either side of your waist below your ribcage. Inhale deeply so that your belly expands and hold your breath for a beat. Raise your head and shoulders off the floor, and slowly exhale as though you’re blowing out a candle while contracting your abdominal muscles. Return to your starting position and repeat.

If you’re already pregnant, speak with your doctor or a pelvic floor physiotherapist before adding diastasis recti exercises to your routine to ensure that you’re doing them correctly and that you’ll be able to do them safely.

How Is Diastasis Recti Treated?

For some, diastasis recti may heal on its own after pregnancy, but physiotherapy (treatment for mobility and muscular issues) and exercise are the primary means of treatment.^1,2 In very rare cases where this is not effective, surgery may be required.²

Types of surgery may include:^{1, 5}

• Laparoscopic surgery is done via very small incisions and is considered minimally invasive.
• Open surgery uses one or more long incisions along the belly to manipulate the muscles.
• Robot-assisted surgery is performed with robotic arms and surgical tools controlled by a doctor.
• Tummy tuck, also called abdominoplasty, can help to tighten belly muscles and remove excess fat and skin from the belly, but it is considered a cosmetic procedure.

These surgical options are uncommon, but it may be helpful to know that there are options available. Your doctor will almost certainly suggest physiotherapy as a first line of treatment.¹ If your symptoms are not bothering you, you may not even need treatment.¹

Diastasis Recti Exercises for Recovery

Physiotherapy helps teach postpartum mothers to retrain and strengthen their muscles and may be instrumental in helping to heal diastasis recti.⁶ These exercises teach mothers how to control their breathing and muscles so that they can engage them properly during rehabilitation.⁶ Physiotherapy for diastasis recti is designed specifically to engage the abdominal area and can help minimize abdominal separation.⁶

One study aimed at diastasis recti healing had postpartum participants perform a wide range of exercise variations (that primarily involved isometric holds) including glute bridges, planks and dead bugs.⁶ The results of this study showed that mothers who participated in an abdominally focused exercise program starting as early as two days after delivery, three times a week for six weeks (in addition to a home routine) saw a decrease in the distance between their separated abdominal muscles and an increase in core strength.⁶

Try these basic postpartum exercises for strengthening your abdominal muscles, after first speaking to your doctor or pelvic floor physiotherapist:¹

Pelvic Tilt with Heel Slide

Lie on your back with one knee bent and the corresponding foot on the floor. The other leg should be straight out in front of you. Contract your abdominal muscles so that you can feel your hips and pelvis rock back, and try to maintain this tightness throughout. Bend the knee of the leg that’s on the floor and slide your heel across the floor towards your body. Repeat these 8 to 12 times on each side.

Standing Wall Plank

Stand facing a wall and place both palms flat against the wall with your arms straight out at shoulder height. Tighten your core and imagine trying to pull your belly button toward your back. Step your feet back making sure your feet are about 30 centimetres (or 12 inches) away from the wall, and lean forward into the wall with your body in a straight line and your belly flexed. Hold this position for 3 to 5 seconds, making sure not to hold your breath. Then return to your starting position. Repeat these 8 to 12 times. If you don’t find this challenging enough, step a little farther back from the wall so that you feel greater engagement in your abdominals.

The fourth trimester, or the twelve weeks immediately following the delivery of your baby can be a challenging time, especially for new parents. Make sure you’re taking time to care for yourself, recognize your feelings and don’t be afraid to ask for the help you need, especially while your body is healing.

1. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions
2. https://medlineplus.gov/ency/article/001602
3. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-5.html
4. https://blog.nasm.org/womens-fitness/how-to-prevent-diastasis-recti-with-crunches
5. https://www.ncbi.nlm.nih.gov/books/NBK573063/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136546/