The ANYA Fact Sheet: Diastasis Recti

“Diastasis recti is a separation of the rectus abdominis muscle,” explains Leah Keller, a personal trainer and the founder of the Every Mother (EMbody program), an exercise program designed to prevent and resolve diastasis recti.


In other words, it’s when your six-pack muscle is stretched apart. “It’s not a tear—it’s when the muscles are overstretched laterally,” says Keller. Usually harmless and very common in those who are pregnant or postpartum, diastasis recti often resolves on its own, but there are ways to help it along.


Keller has worked with Weill Cornell Medical College on research of diastasis recti. A 2014 study coauthored by Keller found that at the end of twelve weeks in the EMbody program, 100 percent of participants had resolved their diastasis recti. 


How common is diastasis recti?

A 2016 study in the British Journal of Sports Medicine found that 60 percent of women experience diastasis recti six weeks into pregnancy.


What causes diastasis recti?

“The growing uterus stretches the muscles in the abdomen, which can cause the two large parallel bands of muscles that meet in the middle of the abdomen—the rectus muscles—to become separated,” explains Dr. Shamsah Amersi, an obstetrician and gynecologist in Los Angeles. “It can cause a bulge in the middle of the abdomen where the two muscles separate and may be more noticeable when you move from lying down to sitting up.” 


The connective tissue that keeps the abdominal muscles attached at the midline (the linea alba) stretches sideways during pregnancy and can become weak. “Then you don’t have the support that you need for your organs or your back because the muscles are no longer front and center—they’ve migrated sideways,” Keller says. 


How do I know if I have it?

You can usually check by looking in the mirror: A wider waistline indicates mild separation, “but if it’s a more severe, deeper separation, you’ll present as if you’re five months pregnant and have a pooch that persists even after you lose the baby weight,” Keller says. If your belly button pops from an innie to an outie, it can be a sign of an umbilical hernia (which often accompanies diastasis recti). Set a reminder to ask your doctor to check you for diastasis recti at your six-week checkup. 


What can I do about it? 

There are programs and exercises that can resolve diastasis recti with regular practice guided by a physical therapist or a fitness or Pilates instructor. (Your ob-gyn is a great resource for a physical therapist referral.) There are also online programs to join, like  Every Mother, a subscription service that offers members exercises specifically designed to target diastasis recti


“The therapeutic intervention to resolve a separation can be done in daily ten-minute exercises,” says Keller. Often, it can be resolved with a core compression routine. (Core compressions are a combination of exhalation and activation of the transverse abdominis muscle, while engaging deep core muscles like the pelvic floor and diaphragm.) Start with five minutes a day and work up to ten to strengthen and restore the abdominal wall, decrease intra-abdominal pressure, and reinforce the strength and elasticity of both the muscles and the connective tissue.


“You can do core compressions seated, lying in a fetal position, or in a semi-bridge position on the floor,” Keller says. “For the seated position, you might just be sitting there pumping. And you might as well be productive and get your core work out in there, too. Some people can do that.” 


“For core compressions, just start gently in early postpartum,” Keller says. “Once you’re past six weeks, you want the intensity to feel moderate.”

 

Surgery

Surgery is rarely necessary, but in severe cases, where exercise and physical therapy don’t help, abdominoplasty (also known as a tummy tuck) is an option. But Keller says, “I usually recommend going to the least invasive option possible, so exercise is always a good place to begin.” Some surgeons offer minimally invasive options, but unless you also have a hernia, surgery for diastasis recti is considered cosmetic and not covered by insurance. “In my experience of working with thousands of women with this condition, I’ve had maybe three that I can think of who were candidates for surgery,” Keller says. “It just comes down to what degree of severity, how damaged the fascia is, and how many layers of fascia are damaged.” 


What not to do if you have diastasis recti

Classic crunches, bicycle crunches, ab exercises that lift both legs at once when you’re lying on your back, and any movement that bulges the abs forward or twists the abdominals could all make the condition worse. Also avoid high-impact exercises like jumping rope, trampoline exercises, and high-intensity running if you have pelvic organ prolapse or feel any bladder pressure, leaking, or urgency to pee when you perform them. It’s best to wait until the core is fully healed postpartum to resume those activities. 


When should I see a doctor?

“If you can fit eight fingers deep into that gully between the rectus abdominus and they’re sinking way in and you can feel your organs, you might want to talk to a doctor,” Keller says. Ask your obstetrician about diastasis recti at your six-week appointment to start a conversation about treatment. 


How long will it last?

A study from the British Journal of Sports Medicine found that 60 percent of women had diastasis recti at six weeks postpartum. After six months, the number dropped to 45.5 percent, and at the one-year mark, it was 32.6 percent.