What to know about diastasis recti

For the exercises in this article, BabyCenter partnered with Every MotherOpens a new window, a provider of exercise programs for expecting mothers, new moms, moms with diastasis recti, and more. We may earn a commission if you click on one of the links to their site.

What is diastasis recti?

Diastasis recti is a thinning and widening of the linea alba (the connective tissue that joins the two sides of your rectus abdominus muscles). The rectus abdominis muscles – the ones associated with the "six pack" look – are a pair of long, flat muscles that run vertically down each side of your abdomen. These muscles hold in your internal organs and stabilize your core.

As your belly expands during pregnancy, the connective tissue that joins the two sides of the muscle thins and widens, making room for your growing baby. (Pregnancy hormones play a role by relaxing the connective tissue.) This change in the connective tissue and increased distance between the two sides of the recti muscles is called diastasis recti.

Genetics and how many pregnancies you've had both play a role in whether you'll develop diastasis recti. You're also more likely to have diastasis recti (or have more severe diastasis recti) if you:

• Are having twins or multiples
• Are carrying a big baby
• Are older than 38
• Have had a C-section or other abdominal surgeries
• Are overweight or obese
• Have a job that requires heavy lifting
• Have a connective tissue abnormality

After pregnancy, this separation can remain, and the middle portion can bulge upwards or sink inwards whenever you contract your tummy. In addition, there may be weakness in the muscles of the abdominal wall that can make your belly protrude. Diastasis recti causes some women have a bulging postpartum belly.

Most new moms find that their diastasis distance shrinks over time. If this doesn't happen in three to six months, you may have a gap that won't close without additional help.

How common is diastasis recti?

Diastasis recti is very common. One Scandinavian studyOpens a new window of 300 first-time pregnant women found that 33 percent of them had the condition at 21 weeks of pregnancy, and 60 percent of them had it at 6 weeks postpartum. By 6 months postpartum, the percentage dropped to 45 percent. At one year postpartum, 33 percent of women still had diastasis recti.

Other researchersOpens a new window found that 100 percent of the 84 first-time pregnant women they studied had diastasis recti by week 35 of pregnancy. By 4 to 6 weeks postpartum, about half of them had it, and at 6 months postpartum 39 percent did.

"A thinning and widening of the linea alba connective tissue during pregnancy is normal," says Catherine Cram, M.S., an exercise physiologist and owner of Prenatal and Postpartum Fitness ConsultingOpens a new window, a company that provides evidence-based fitness information to pregnant and postpartum women and their healthcare providers.

"For most women, the abdominal wall returns to near-normal function within the first year postpartum," Cram explains. If yours doesn't, Cram recommends asking your healthcare provider for a referral to a physical therapist who specializes in women's health.

What are the symptoms of diastasis recti?

If you have diastasis recti, you may notice that it becomes prominent when you're straining – while you're coughing or sitting up, for example. It may disappear or cave in when you lie down or relax your abdominal muscles.

"Not everyone with diastasis recti has symptoms, and most women with a mild to moderate separation don't need treatment unless they're noticing a functional change or pain and discomfort," says Cram.

There's some debate about what other conditions may be associated with diastasis recti, but many women who have a large diastasis may experience the following:

• Back pain or pain that radiates to the hips/legs
• Abdominal pain and discomfort with movement
• Sacroiliac pain (the sacroiliac joints sit where the pelvis and lower spine meet)
• Pelvic instability and pain
• Abdominal muscle weakness and inability to contract abdominal muscles effectively
• Urinary incontinence and/or bowel incontinence
• Pelvic organ prolapse
• Hernias
• A pinching or painful spot along the abdominal wall with movement

Is there a diastasis recti test?

You may notice a separation or bulge yourself. But you'll need the help of a physical therapist who specializes in women's health to properly assess diastasis recti. They can tell you whether the degree of separation is at the point where treatment or surgery is needed.

For help finding a physical therapist to evaluate and treat diastasis recti, use The Academy of the American Physical Therapy Association's PT Locator toolOpens a new window, which lists physical therapists specializing in pregnancy and postpartum issues by location. (A physical therapist can also help women who still look pregnant and have trouble strengthening their core, even if they don't technically have diastasis recti.)

Diastasis recti exercises

After you have your baby, it's important to rebuild your core strength and improve your abdominal muscle strength with a gentle exercise routine. But first get the go-ahead from your doctor (this is always the case, but it's especially important if you have diastasis recti).

Your doctor may refer you to a physical therapist specializing in women's health. While certain types of core exercises can help heal diastasis recti, they're not all equally effective. The therapist can help you identify the best exercises for you and monitor your progress.  

The three exercises below from Every MotherOpens a new window coordinate engagement of the transverse abdominis, the pelvic floor, and the diaphragm. These exercises were provided by Leah Keller, CPT, creator of Every Mother's EMbody ProgramOpens a new window.

Double Arm Waist Anchor

This exercise is a great replacement for crunches. Instead of using your head and shoulders to challenge your core, this move uses a pair of light weights and two straight arms as a lever. (Don’t have dumbbells handy? Two water bottles work, too!)

1. Lie on your back with your knees bent and your feet flat on the floor.
2. As you exhale, extend your arms toward the ceiling, directly above your shoulders (as shown in the first image above). 
3. Inhale as you slowly lower your arms overhead toward the floor, keeping your ribs anchored and pelvis neutral and maintaining the natural curve in your low back (as shown in the second image above). Only lower the weights as much as you comfortably can while maintaining control.
4. When your arms are near the bottom of your range of motion, exhale as you perform a Kegel and flatten your abdominal muscles firmly toward the spine. Continue exhaling and engaging the core as you lift your arms back up until they’re straight above your hips.
5. Repeat this slow, controlled exercise for two full minutes, inhaling as you lower your straight arms overhead towards the floor, then exhaling as you engage the deep core and pelvic floor, flattening your abdomen towards the spine to stabilize as you lift the weights back up.

Core Compressions in Tabletop

Before starting this exercise, it helps to practice some diaphragmatic breaths. To do so, place your hands on the floor directly below your shoulders, with your knees directly below your hips. Keep your back flat and your head in line with your spine. With your shoulders relaxed, take a few deep, full breaths; as you inhale, allow your belly to drop and your abdominal muscles to relax. With each exhalation, gently hug your belly up toward the spine. 

After doing a few of these breaths, you’re ready to perform Core Compressions in tabletop position:

1. Inhale, then exhale as you squeeze and lift both your pelvic floor and your abdominal muscles up toward the spine. Maintain a flat back.
2. When your abdominal muscles are at your spine, continue exhaling as you lift your pelvic floor and squeeze your abs even closer to the spine. Then soften and fully release your core and pelvic floor as you inhale. 
3. Repeat this pattern of two-tier muscle engagement, exhaling then relaxing the muscles while inhaling. Work up to two minutes of this position, resting as needed.

Wall Plank with Core Compressions + Progressions

1. Place your hands on a stable wall at about chest height, shoulder-width apart.
2. Walk your feet back and draw your hips forward, rolling your shoulders down away from your ears. Maintain this position and allow your abdominal muscles to partially relax as you inhale.
3. Next, exhale as you engage your abdominal muscles and your pelvic floor up and in toward the spine. Continue exhaling as you squeeze and lift your core and pelvic floor muscles a bit tighter toward the spine, and then inhale as you relax the muscles slightly.
4.  Continue with this pattern of exhaling as you engage and then inhaling as you gently release the muscles. Work up to a full minute, stepping out of the plank to rest as needed. 

When a full minute of this move feels easy, you might choose to progress the plank difficulty by trying any of the following:

• Incline plank with hands on a high, stable surface, such as a kitchen countertop.
• Incline plank with hands on a slightly lower, stable surface, such as the back of a sofa.
• Straight arm knee plank with hands and knees on the floor, as shown below.

In each plank variation, focus on performing core compressions throughout the pose and come out of the plank to rest as needed. Never hold your breath while planking. Stay at each level until it feels easy to complete a full minute while performing core compressions throughout the plank.

If you notice yourself getting fatigued or you’re finding it difficult to maintain good form, pause and rest before resuming. It is better to plank safely for a shorter duration than to lose control over the direction of muscle engagement (always drawing the core and pelvic floor up and in toward the spine) and coordination of breath (exhale on engagement; never hold your breath).

When finished planking, rest in child’s pose and take some full, deep breaths. With each inhalation, allow your belly and pelvic muscles to fully release, relax and expand.

For more information on exercises you can do to help with diastasis recti, visit Every MotherOpens a new window.

Can diastasis recti be fixed with surgery?

If your diastasis recti is severe and you don't plan to get pregnant again, surgery may be an option, especially if you've done all you can with physical therapy but are still struggling with a weak core.

Surgery to repair diastasis recti involves stitching the abdominal wall muscles back together along the midline. In some cases, a surgeon may be able to do the procedure laparoscopically (using a tiny camera and instruments inserted through small incisions). Severe diastasis recti requires open abdominal surgery through a larger incision.

If you do plan to have more children, surgery isn't recommended since the abdominal muscles will need to separate again for those pregnancies. But it's still a good idea to work with a physical therapist to strengthen your core, since that could help you avoid severe diastasis recti in the future.

How can I avoid diastasis recti?

First, keep in mind that diastasis recti is a normal condition that plays a role in making room for your growing baby. And there's a good chance it will improve after your pregnancy.

But there are some things you can do that may minimize diastasis recti:

Exercise before and during pregnancy

If you can, it's a good idea to strengthen your core before you get pregnant. Core work isn't just to prevent diastasis recti. Research suggests that stronger abdominal muscles throughout pregnancy can support your pelvic floor to reduce frequent urination and increase lower back support – which is hugely important as your pregnancy progresses and pulls your weight forward.

Take special care during pregnancy and postpartum

During pregnancy, avoid stressing your abdominal muscles too much. Again, it's a good idea to exercise to strengthen your abs while you're pregnant, but talk with your healthcare provider to make sure your workouts are pregnancy-safe (both in the types of exercises and the amount of exercising you're doing). You may also need to make modifications as your pregnancy progresses.

Learn tips for safe pregnancy exercise and how long it's safe to do sit-ups while pregnant.

Try to gain the recommended amount of pregnancy weight. And take care getting in and out of bed with your pregnant belly by always rolling to your side and pressing up with your arms.

After your baby arrives, continue to avoid straining your abdominal muscles. Don't lift heavy objects, and try to support your abdominal muscles (with your hands) when coughing or sneezing.

Is it ever too late to correct diastasis recti?

No. With proper care, you can close a diastasis recti gap even years after you delivered your last baby. How long it takes to heal depends on the severity of your diastasis recti and the effectiveness of physical therapy or, in some cases, surgical intervention. Also, your abdominal muscles take time to adjust post-delivery, so sometimes the best treatment is simply time.