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Diastasis Recti

Understanding Diastasis Recti: Causes, Symptoms, and Treatment

Diastasis recti, or diastasis rectus abdominis (DRA), is a common condition that affects many individuals, particularly pregnant and postpartum people. This condition occurs when the rectus abdominis muscles—commonly known as the “six-pack” muscles—separate along the midline of the abdomen. While the separation is a natural part of pregnancy for many, it can persist postpartum, leading to functional and aesthetic concerns.

What Is Diastasis Recti?

Diastasis recti refers to the separation of the rectus abdominis muscles due to the stretching of the connective tissue, known as the linea alba, that holds these muscles together. During pregnancy, the growing uterus exerts significant pressure on the abdominal wall, causing the linea alba to thin and pull apart. This natural adaptation creates room for the baby but may not always resolve after childbirth.

The condition can result in a visible bulge or “pooch” in the abdomen, giving the appearance of a persistent postpartum belly. In severe cases, the gap in the abdominal muscles may not close naturally due to weakened connective tissue and insufficient muscle strength.

Why Does Diastasis Recti Happen?

Pregnancy hormones like relaxin contribute to the condition by softening connective tissues, allowing the abdominal wall to stretch. This relaxation often leads to the external and internal oblique muscles contracting to stabilize the trunk. Once the baby is born and relaxin levels drop, the rectus abdominis muscles may remain weak, leaving the connective tissue unable to regain its pre-pregnancy tension. The condition is further exacerbated if the thoracic spine remains immobile or if the abdominal muscles are not properly retrained.

Who Gets Diastasis Recti?

While diastasis recti is most common in pregnant and postpartum women, it can also occur in:

  • Men: Often due to incorrect weightlifting techniques, rapid weight changes, or chronic straining.
  • Infants: Caused by underdeveloped abdominal muscles, which usually resolve naturally over time.

The risk of diastasis recti increases with factors such as:

  • Multiple pregnancies, especially in close succession.
  • Pregnancy at an advanced maternal age (over 35).
  • Carrying a large baby or multiples (twins, triplets, etc.).
  • A petite frame.

Symptoms of Diastasis Recti

Common signs and symptoms of diastasis recti include:

  • A visible bulge or “pooch” in the abdomen, especially when straining or contracting the muscles.
  • A jelly-like softness around the belly button.
  • Coning or doming of the abdomen during activities like sitting up.
  • Weakness in the abdominal muscles, making everyday tasks challenging.
  • Lower back pain or poor posture.
  • Pelvic or hip pain.
  • Urine leakage during sneezing, coughing, or laughing.
  • Digestive issues like constipation.

Diagnosing Diastasis Recti

You can perform a self-check for diastasis recti:

  1. Lie on your back with your knees bent and feet flat on the floor.
  2. Place one hand behind your head for support and lift your shoulders slightly off the ground.
  3. Use your other hand to feel along the midline of your abdomen, starting at your belly button.
  4. If you can fit two or more fingers into the gap, you may have diastasis recti.

A healthcare provider can confirm the diagnosis using manual exams, ultrasound, or other imaging techniques. They can also assess the severity and location of the separation.

Complications of Diastasis Recti

If left untreated, diastasis recti can lead to:

  • Chronic lower back pain.
  • Postural issues due to weakened core support.
  • Hernias, where internal organs push through the abdominal wall.
  • Pelvic floor dysfunction, leading to urinary incontinence and painful intercourse.

Treatment for Diastasis Recti

Treatment typically begins with non-invasive options:

Physical Therapy and Exercises

  1. Strengthening Transverse Abdominis: Focus on exercises that engage the deep core muscles, like diaphragmatic breathing and pelvic tilts.
  2. Myofascial Release: Techniques to release tension in the thoracolumbar fascia and oblique muscles.
  3. Thoracic Spine Mobilization: Improving mobility in the upper spine to reduce tension on the abdominal wall.
  4. Posture Correction: Addressing lumbar lordosis (swayback) to distribute weight more evenly across the spine.

Movements to Avoid

Certain activities can worsen the condition by increasing intra-abdominal pressure:

  • Crunches or sit-ups.
  • Planks and push-ups without modification.
  • Heavy lifting without proper technique.
  • Yoga poses like downward dog that cause abdominal bulging.

Abdominal Binders

While not a cure, binders can provide temporary support and promote awareness of posture.

Surgery

For severe cases or when other treatments fail, a tummy tuck (abdominoplasty) may be recommended. This procedure involves suturing the separated muscles and removing excess skin. However, surgery is usually considered a last resort due to risks and recovery time.

Prevention of Diastasis Recti

While not entirely preventable, you can reduce your risk by:

  • Gaining a healthy amount of weight during pregnancy.
  • Practicing safe core exercises during and after pregnancy.
  • Using proper lifting techniques.
  • Rolling onto your side when getting out of bed.

Outlook for Diastasis Recti

With consistent treatment, most cases of diastasis recti improve significantly. While complete resolution may not always be possible, strengthening your core and adopting good posture can minimize symptoms and restore function. It’s never too late to seek treatment, even years postpartum.

If you suspect diastasis recti, consult a healthcare provider or physical therapist to develop a personalized treatment plan that fits your needs.

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