The term “diastasis recti” (DR) often strikes fear among those 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 misinformation and myths surrounding what is largely a normal and necessary pregnancy adaptation. In this article, we’ll break everything down for you in a clear, simple way — dispelling common myths and setting the facts straight to give you some peace of mind and confidence about how to move forward.
Read on to learn:
- What diastasis recti (DR) is and how to spot it
- What causes DR during pregnancy
- Factors that can increase the severity of DR
- How to minimize the severity of DR during pregnancy
- How to check for DR
- Whether you can heal DR
Quick Answer: Diastasis recti (DR) is a wider-than-usual separation of the left and right sides of the rectus abdominis (“6-pack”) muscle. It occurs when consistent and excessive intra-abdominal pressure (IAP) pushes outward onto the abdominal wall, thinning and weakening the linea alba (the tissue that connects the two sides of the rectus muscle). There are many causes of DR, which is why it can occur in anyone (male or female), but one completely normal and necessary cause is pregnancy. DR is a natural way the pregnant body adapts to allow space for a growing baby. That said, certain activities and behaviors can increase the severity of DR during pregnancy and slow postpartum recovery. The good news is that with the right approach, you can minimize the severity during pregnancy and develop a strong, functional core postpartum.
What Diastasis Recti Is and How to Spot It
DR is a “wider than usual” separation of the left and right sides of the rectus abdominis (or “6 pack” muscle). One commonly used definition is a separation of 2.7 cm (about 2 finger-widths) or greater at the umbilicus (Rath et a., 1996). The word “diastasis” means separation, and “recti” refers to the rectus abdominis muscle. You can see a visual of how this might look below.
DR can often present as a “torpedo-like” protrusion in the belly. It is often easiest to see it during any movement that engages the abdominal muscles, such as in the image below. What you are seeing is the abdominal contents protruding through the separation.
What Causes Diastasis Recti During Pregnancy
The primary cause of DR is consistent and excessive intra-abdominal pressure (IAP). While it can happen to anyone — male and female alike — it is very common during pregnancy because a growing belly increases pressure in the core. To illustrate this, look at the images below.
The left side shows a non-pregnant individual. Here, you can see a tissue running down the midline of the body, connecting the left and right sides of the rectus abdominis muscle. This tissue is called the linea alba. During pregnancy, consistent and excessive outward pressure from the growing belly stretches the linea alba (as you see in the image on the right), which thins and weakens it. When this happens, the left and right sides of the rectus muscle begin to widen (as you see in the image on the right).
What’s important to understand is that some degree of DR is a normal and necessary part of pregnancy. It’s the natural way the pregnant body adapts to allow space for a growing baby. In fact, some studies show that 100% of pregnant people experience diastasis recti during the 3rd trimester (Spitznagle et. al., 2007). However, engaging in certain activities or behaviors that further increase IAP – beyond that caused by the growing belly – can exacerbate DR and potentially make it more of an issue in the postpartum period.
Factors that Can Increase the Severity of Diastasis Recti During Pregnancy
While pregnancy is one (normal and natural) cause of elevated IAP, there are other factors that can also increase the pressure in the core. The following activities further elevate IAP. So, when combined with a growing belly, they could increase the severity of DR during pregnancy.
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- Breath-holding upon exertion: This technique, known as the Valsalva maneuver, is often used when lifting heavy loads. Holding your breath during the concentric phase of a movement elevates the pressure within the core. This results in greater force production. However, it has the side effect of placing excessive pressure on the abdominal wall (potentially increasing the severity of DR). This is why DR is an issue that affects some powerlifters or individuals doing heavy lifting. Another example of breath-holding upon exertion is “bearing down” on the toilet during a difficult bowel movement. While this can be an effective strategy if constipated, using it consistently over time may contribute to issues with DR.
- Alignment shifts: Neutral alignment is key to reducing stress on the linea alba. However, the physical changes of pregnancy tend to pull the body out of neutral alignment. For example, the growing belly often tips the pelvis forward into an anterior pelvic tilt, as you can see in the image below. This places additional stress on the linea alba connective tissue.
- Insufficient deep core strength: Your deep core muscles (diaphragm, transverse abdominis, and pelvic floor) help to regulate intra-abdominal pressure. If these muscles are weak, or fatigued, they cannot regulate pressure as well, which can lead to elevated pressure pushing outward onto the abdominal wall.
- Engaging in “traditional” core work in later stages of pregnancy, or too early postpartum: Pregnancy and early postpartum are periods when the deep core is being taxed from the chronically elevated IAP due to months of increasing weight gain and the stress from labor. During the later stages of pregnancy (when there is an obvious belly), and in the initial postpartum stages (in which the core needs a gentle recovery focus), engaging in many traditional core exercises – such as sit-ups, weighted side bends, full planks, bicycles, V-sits, and leg lifts – could exacerbate DR because they further elevate IAP beyond that caused by the growing belly.
How to Minimize the Severity of Diastasis Recti During Pregnancy
While some degree of DR is inevitable during pregnancy, there is plenty you can do to minimize its severity and set yourself up for a stronger postpartum recovery.
- Get in neutral alignment: Sitting, standing, and moving your body in neutral alignment helps to alleviate pressure on the linea alba.
- Master 360° Breathing: As mentioned above, your deep core muscles are responsible for regulating IAP. The best way to activate and strengthen your deep core muscles is through optimal breathing mechanics. You can accomplish this by mastering 360° Breathing. We refer to 360° Breathing as the most effective core exercise because it not only helps manage IAP but also provides systemic benefits throughout the body. For more details, see how the way you breathe impacts your health.
- Exhale on the Effort: After mastering 360° Breathing, incorporate it into your movements by “exhaling on the effort.” In other words, inhale on the easier portion of the movement (like lowering down into a squat or extending your arms for a bicep curl) and exhale to perform the more challenging portion of the movement (like standing up from the squat or curling). This generates the force you need without the IAP spike that comes with breath-holding.
- Watch for “coning” in the belly: This is an incredibly helpful tool. As we discussed above, coning in the belly is a telltale sign of Diastasis Recti. If you see this during a movement, it tells you that the current challenge exceeds what your core can manage at this time. Simply stop the movement and reduce the challenge until you no longer see the coning.
- Regress traditional core work as pregnancy progresses: As the belly grows and IAP increases, traditional core exercises need to be regressed accordingly. For a detailed breakdown of which exercises to modify and when, see Core Exercises to Avoid During Pregnancy
How to Check for Diastasis Recti
Since everyone will have at least some degree of DR by the third trimester, checking for it during pregnancy isn’t necessary. Furthermore, everyone will also have some degree of DR in the immediate aftermath of labor. This will resolve a bit over the following weeks, so it is best to wait at least 6 weeks postpartum before checking. This gives the tissue time to begin healing on its own and provides a more accurate picture of the recovery work needed.
When you are ready to check, follow the step-by-step instructions in the articles below to learn how to perform the DR assessment in a manner that gives you the most accurate results.
Can You Heal Diastasis Recti?
The short answer is yes. The linea alba is made up of collagen, and, like other soft tissues in the body, it can remodel. With the right approach to recovery, many people can develop a strong and functional core (perhaps even stronger than pre-pregnancy). Of course, there is much more nuance to answering this question, especially regarding what “healed” means. For a detailed explanation and the various factors that impact healing, see Can you fix diastasis recti (even years later)?
Want to Learn More About DR?
Diastasis recti is one of the most misunderstood aspects of pregnancy and postpartum fitness, but it doesn’t have to be. With a solid understanding of what it is, what drives it, and how to manage it, you can approach this topic with confidence. To learn more about DR, including a detailed core recovery protocol to help your clients heal DR and rebuild their core from the inside out, explore the Pre & Postnatal Fitness Specialist Certification.
Sources:
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Rath, A.M., Attali, P., Dumas, J.L., Goldlust, D., Zhang, J., Chevrel, J.P. (1996). The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical and Radiology Anatomy. 18, 281-288.
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Spitznagle, T. M., Leong, F. C., & Van Dillen, L. R. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International urogynecology journal, 18(3), 321-328.