Can You Prevent Diastasis Recti During Pregnancy?

The short answer to this question…

No.

You cannot completely prevent or avoid diastasis recti (DR) during pregnancy. That’s because some degree of DR is a normal and necessary pregnancy adaptation to allow space for your baby to grow. Therefore, virtually everyone experiences some degree of DR during pregnancy. In fact, some studies show that 100% of pregnant people experience DR during the 3^rd trimester (Sptiznagle et. al., 2007).

What you can do is reduce its severity and set yourself up for a faster postpartum recovery. Much of what exacerbates DR comes down to behaviors that are well within your control.

Read on to learn:

• What diastasis recti is
• What causes DR during pregnancy
• Factors that can increase the severity of DR
• Practical tips to minimize the severity of DR during pregnancy

Quick Answer: You cannot completely prevent diastasis recti (DR) during pregnancy. That’s because some degree of DR is a natural pregnancy adaptation that is necessary to create space for your growing baby. Research suggests that 100% of pregnant people experience DR by the third trimester. What you can control is its severity. Factors like alignment shifts, breath-holding upon exertion, weak deep core muscles, and performing traditional core exercises with a larger belly can all worsen DR. By mastering 360° Breathing, maintaining neutral alignment, exhaling on the effort, and regressing core exercises as your pregnancy progresses, you can minimize the severity of DR and set yourself up for a stronger postpartum recovery.

What Diastasis Recti Is

DR is a “wider than usual” separation between 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 al., 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 images below. What you are seeing is the abdominal contents protruding through the separation.

What Causes Diastasis Recti During Pregnancy

DR is your body’s natural way of creating space for your growing baby. To illustrate how it occurs, look at the diagram below. The left side shows a non-pregnant individual. Here, you can see there is a tissue that runs down the midline of the body – from the sternum to the pubic bone – connecting the left and right sides of the rectus abdominis (“6-pack”) muscle. This tissue is called the linea alba.

As the belly grows during pregnancy, it increases the pressure within the core, known as intra-abdominal pressure (IAP). This increased pressure pushes outward on the abdominal wall — stretching 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 abdominis muscle begin to widen.

This shifting and stretching is not a “bad” thing by any means. It is a normal and natural part of pregnancy so that your little one will have space to grow and be able to head out when the time is right.

That said, certain activities and behaviors can increase the severity of DR beyond what the growing belly causes on its own, and those are factors within your control.

Additional Factors that Exacerbate DR

While pregnancy is one (normal and natural) cause factor that can cause a thinning and stretching of the linea alba, the following activities or behaviors place even more pressure on that tissue, which can exacerbate DR.

• Pregnancy Alignment Shifts: Neutral Alignment is key to reducing stress on your soft tissues (including the linea alba). Unfortunately, the physical changes of pregnancy tend to pull the body out of neutral alignment. You can see how the common anterior pelvic tilt (forward-tipped pelvis) creates an excessive arch in the low back, which places greater pressure on the linea alba (and the low back muscles).

• Breath-holding upon exertion: also known as the Valsalva maneuver, it is often used by weightlifters when lifting very heavy loads. Holding your breath during the concentric phase of a movement elevates IAP (intra-abdominal pressure), which does lead to greater force production. However, it has the side effect of placing excessive pressure on your abdominal wall. This is also why DR can affect powerlifters and athletes as well. Bearing down on the toilet during a difficult bowel movement is another example of breath-holding upon exertion. While this can be an effective strategy if constipated, if used consistently over time, it can lead to issues with DR.
  
• Weak or “overwhelmed” deep core muscles: One of the many functions of the deep core muscles is to regulate the pressure within the core (IAP). If these muscles are weak or overwhelmed from the stresses of pregnancy, they can’t regulate pressure as well. They are also less effective at resisting the alignment shifts discussed above.
• Engaging in “traditional” core work with a larger belly: As the belly grows and IAP increases, performing traditional core exercises —such as the movements shown below—can further elevate IAP beyond what the growing belly already creates, potentially increasing the severity of DR.

Tips to Minimize the Severity of DR During Pregnancy

Now that you know what factors contribute to worsening DR, let’s focus on ways to minimize these behaviors and expedite your postpartum recovery.

• Get in neutral alignment: Sitting, standing, and moving your body in neutral alignment helps alleviate pressure on the linea alba. This is one of the simplest and most impactful things you can do throughout pregnancy.

• Master 360° Breathing: Your deep core muscles are responsible for regulating IAP, and the best way to activate and strengthen them is through optimal breathing mechanics. 360° Breathing is one of the most effective core exercises you can do during pregnancy. It helps manage IAP while delivering a host of systemic benefits throughout the entire 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.” This means that you 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). Exhaling on the effort allows you to generate the necessary force for a movement without the excessive IAP buildup that comes with breath-holding.

• Try to limit “bearing down” on the toilet. This is another example of breath-holding upon exertion, which elevates IAP. We appreciate that this can be easier said than done since constipation is a common side effect during pregnancy. For help with this, see these 10 Tips to Reduce Pregnancy Constipation. If possible, seeing a pelvic floor physical therapist is another great option to help with constipation, which can be a consequence of an overactive pelvic floor.

• Regress traditional core work as pregnancy progresses: As the belly grows and IAP increases, traditional core exercises need to be modified accordingly. For a detailed breakdown of which exercises to modify and when, see Core Exercises to Avoid During Pregnancy.

• 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. It means the current movement challenge exceeds what your core can manage at that time. If you see it, simply stop the movement and reduce the challenge until the coning resolves. It does not mean you will never be able to do the movement again.

Want to Learn More?

Diastasis recti is one of the most misunderstood aspects of pregnancy and postpartum fitness. However, with a clear understanding of what drives it and how to manage it, you can approach this topic with confidence. To dive deeper into DR, including learning a detailed core recovery protocol to heal DR and build a strong, functional core, explore the ProNatal Fitness Pre & Postnatal Fitness Specialist Certification.

Sources:

• 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.

• 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.