Diastasis Recti: What You Need to Know

Diastasis Recti

The word “diastasis recti” (DR) often strikes fear and panic among women who have heard of it, or sheer confusion among those who haven’t (even trying to pronounce its name is difficult enough).  And it’s no surprise.  There is a great deal of mis-information and myths surrounding DR (a separation of the rectus abdominis muscle) — from how it’s caused, to who it affects, how to detect it, and even how to heal it.  We break everything down for you here in a clear and simple fashion — dispelling common myths, and setting the facts straight to hopefully give you some peace of mind and simple guidance to help you manage or prevent DR from becoming an issue.

What diastasis recti is

In short, diastasis recti (DR) is a separation of the right and left sides of the rectus abdominis muscle (your “6-pack” muscle) due to a thinning and weakening of the connective tissue — called the linea alba — that holds the two sides together.  A small separation is normal, but a separation greater than 2.7 cm (or about 2 finger-widths) is considered DR. The word “diastasis” means separation, and “recti” refers to the rectus abdominis muscle.  It can manifest as a “torpedo-like” protrusion in the belly during any movement that engages the abdominal muscles, as you see in the image below.

Beyond the annoying “pooch-like” appearance, DR may indicate a weak and ineffective core. This can lead to a host of problems including low back pain, pelvic or hip pain, incontinence, constipation, or prolapse. It can also increases the risk of developing a hernia (when internal contents actually protrudes through a weak point in the abdominal cavity).  Hernias require surgery to address, whereas DR can typically be healed without surgery.

What causes diastasis recti

Simplistically speaking, it all comes down to one thing: excess intra-abdominal pressure (IAP). To explain further, let’s take a look at the image below.  As you can see in the image on the left, all the abdominal muscle layers (transverse abdominis, internal and external obliques, and rectus abdominis) – are connected at the front of the body by a tissue called the linea alba.  The linea alba has a consistency similar to “silly puddy.”  It’s strong, but flexible. If consistent and excessive outward pressure is placed on that tissue (like from a growing belly during pregnancy), then it eventually thins and stretches so much that its consistency becomes more like cellophane, and it loses its ability to hold anything together.  When this happens, the outermost muscle layer – rectus abdominis – begins to drift apart, as in the image on the right below.

The important thing to note here is that some degree of Diastasis Recti is actually a normal and natural part of pregnancy.  Yes, that’s right.  Some abdominal separation is necessary to allow baby room to grow.  In fact, some studies show that 100% of women will experience diastasis recti during their 3rd trimesters.  If managed appropriately, the DR will heal within a few months after delivery.  So please, do not panic if you feel some separation, especially during your third trimester, and do not attempt to “close the gap.”  Your body is doing what it is designed to do.  However, other factors (which we will discuss next) can further exacerbate the pressure in your abdominal cavity beyond the level already caused by the belly.  This is when DR can become an issue — and remain one in the postpartum period.

What factors increase risk of (or worsen) DR

The following activities or behaviors create excess intra-abdominal pressure beyond that caused by the growing belly, and could therefore worsen DR:

  • Weak “Core Canister” muscles: These muscles help regulate IAP.  If they are weak, you are much likely to get a “pressure buildup.” Learn the #1 most important core exercise to master to activate your Core Canister muscles and ensure they are functioning properly.
  • Excessive lower back arch: The growing belly during pregnancy tends to tip your pelvic forward and pull your back into an excessive arch (like in the image below). Learn the importance of neutral alignment. The more you can train your body to resist this alignment shift, the less pressure you will put on your external abdominal wall.

  • Improper “core” exercises performed with a belly:  Read this post on Core Exercises to Avoid.  All these moves like spinal flexion (like crunching), extension (like back-bends), side bends, full planks, twisting, and more create far too much pressure when performed with a belly, and will almost certainly exacerbate DR.
  • Slouching or poor bending over technique: Slouching and bending over with a rounded spine (hunching) are both crunching, which increases pressure on your external abdominal wall.  Train yourself to sit up tall, especially when at work, and learn to bend over properly by mastering this Ground Pickup.
  • Sucking in: While you may be tempted to do this to hide your belly, ironically it could have the opposite effect. This is because “sucking in” (drawing your navel in as you inhale) increases intra-abdominal pressure.  Be sure you master the #1 most important core exercise, which trains you how to properly engage your core.
  • Chronically engaging your core: You may often hear fitness instructors cueing you to “engage your core” or “draw your navel to your spine.”  A certain amount of this — if done correctly by drawing in on the EXHALE — is necessary during the more difficult portions of movements.  However, it is NOT good to keep your core chronically engaged.  This has the opposite essentially “shuts off” your core canister “pump”, which increases IAP.
  • Breath holding during exertion: Breath-holding during exertion (or Valsalva as it’s referred to) dramatically increases the pressure in your abdominal cavity.  This increased pressure actually creates greater force production, which is why powerlifters, or individuals doing heavy lifting, often use the Valsalva technique.  It helps them lift heavier loads.  The downside of this is that it can lead to DR, like you see in the image below.  So, be sure you always “exhale on the effort” and never hold your breath.

  • “Bearing down” on the toilet: This is Valsalva as well (breath-holding during exertion).  We often do this when constipated because it can provide more power to expel the bowel movement. Again, the downside is that it can lead to, or worsen, DR.  Unfortunately, hormonal changes during pregnancy actually increase the likelihood of being constipated. To help, place an 8-12″ stool beneath your feet, or read these tips to help reduce constipation during pregnancy.

How to tell if you have diastasis recti

You may notice that torpedo-like protrusion in your belly (as in the image below) during any movement that engages your abs. It’s often easiest to see after pregnancy, when the muscles are lax, but you may be able to see it during pregnancy as well.  Remember that virtually 100% of women will get a bit of DR in their third trimesters of pregnancy.  If you do notice this coning in any movement you do, simply stop that movement.

You can also perform a self-check for Diastasis Recti.  We’ve created a separate post on this, as this can be a bit of a tricky test to perform with many variables that can influence your results.  Read this post on How to Check Yourself for Diastasis Recti, which includes information on how to take action on your results to begin your healing process.

Want More Information?

Do you already know you have DR and want to work with an expert?  Our PROnatal personal trainers specialize in Diastasis Recti recovery.  You can also search for a pelvic floor (or women’s health) physical therapist near you.

Are you a fitness professional interested in learning how to help women heal their DR? Consider taking our education to become a Pre/Postnatal Performance Training Specialist.