Diastasis Recti is something that I don’t recall talking about with other women prior to me seeing someone with it. And even then I didn’t really know what that meant. But it is something that many women deal with in relation to pregnancy so it needs to be discussed a bit more and with a lot less shame around it.
Now to be clear I’m not a medical professional, so the information I’m sharing here is what I’ve learned because I have Diastasis Recti and am trying my darndest to heal it. And while the information is direct from medical professionals I’m NOT providing anyone with any medical advice in any capacity ok, I’m just relaying my personal experience.
So with out further ado, here is what I’ve come to understand about Diastasis Recti.
What is Diastasis Recti?
Diastasis Recti is a separation of your abdominal 6 pack into two 3 packs is the simplest description I’ve encountered. The more scientific explanation that I’ve been given by my pregnancy care team is that the connective tissue (called the linea alba) that holds the muscles (rectus abdominis) together thins and stretches causing the muscles to separate.
This can cause a bulge in the middle of the abdomen between the muscles, which is sometimes also called “tenting”. It’s really only noticeable when the abdominal muscles are tense like when you move from laying down to sitting up, or if you are on your back and lift just your head (not shoulders) slightly off the ground.
Sometimes though, this causes us to look like we are still pregnant months after giving birth. According to BabyCenter.com it can “look like a ridge or even a loaf of bread protruding from your midline. The ridge becomes more prominent when you’re straining – from coughing or sitting up, for example. It may disappear or cave in when you lie down or relax your abdominal muscles.”
Beyond how it looks though it can also be painful, and result in pelvic problems. In fact, there is a good chance that many of us women struggle with this condition in some way without being aware of it. And it is one of the least discussed topics around pregnancy, and childbirth.
From personal experience, I’m fairly certain I had this in the last months of my first pregnancy and didn’t even know it! And then to top it off I delivered Little G while on my hands and knees, which is a position that applies MORE pressure to the affected area… ie could make it worse. And I had no clue it was even a potential issue because no one I talked to about pregnancy even brought it up.
Symptoms of Diastasis Recti
Some of these symptoms are similar to normal after-birth symptoms which can lead to some confusion over if you have a separation or not. But if you have any of these symptoms and talk to your Midwife/Doctor or better yet Physio Therapist about what could be going on.
- The belly bulge (hanging forward or sticking out when standing and a dome-like bulge when sitting up)
- Lower back pain
- intestinal discomfort
- pelvic floor issues
- incontinence (pee when you sneeze)
- core weakness
- pain during sex
Causes of Diastasis Recti
“During pregnancy, the growing uterus stretches the muscles in the abdomen. This can cause the two large parallel bands of muscles that meet in the middle of the abdomen (rectus muscles) to become separated by an abnormal distance.”The MayoClinic
I like my Physio’s description (or my understanding of it) better, which is that internal pressure in the abdomen causes the connective tissue between the parallel verticle muscles to stretch and thin which permits the muscles to separate more than normal.
This pressure can be caused by more than just pregnancy, which is why men and children can have this as well. For instance, some babies are born with it, and after surgery or injury, some men and children may also experience a separation. It is just more common to see in women of childbearing age due to the additional pressure pregnancy creates.
Some of the common reasons that cause a separation in the abdominal muscles besides pregnancy are:
- Improper weightlifting and exercise
- yo-yo dieting
- various injuries
- surgeries and recovery
For myself I’ve been working with my Physio to get the amount of pressure in my abdomen down for over 6 months, ie well before I got pregnant. And little did I know that I was doing things in a way that made the pressure worse not better.
How to check for Diastasis Recti
The easiest way to check yourself is to lay on your back, knees bent and feet on the floor. Place your hand palm down over your belly, with fingers pointing towards your toes. Press gently into your navel area then slightly lift your head pulling your chin to your chest. This will cause your stomach muscles (rectus abdominis) to contract. Repeat above and below your belly button as there are different areas that separation may occur.
If you feel a gap of at least two fingers between the muscles when they contract, you likely have a diastasis. I’ve heard that a gap of five fingers or more is thought of as severe.
What to do about Diastasis Recti
The good news is that there are options to help heal Diastasis Recti, in many cases Physio Therapy with a knowledgable physio therapis is critical to getting your core strength and stability back. So my big piece of advice is find one in your area that knows what they are talking about to work with you directly.
There are some exercises that can help and some that will make it worse, a good physio will know which ones will help you and which are a big no-no. So get the guidance of a professional, you won’t regret it.
If you are looking for an at home program that will help you get your tummy back I’m sorry but I don’t have a recomendation yet. I do know that my physio is building a program for this and I am going to use it to heal my separation, as such I don’t feel comfortable recomending any of the online programs I’ve encountered so far since I haven’t used them myself.
While I know that my Midwife is supportive of my work with my Physio Therapist for this. I’m not certain what stance my Doctor will take. I do plan to discuss it at the next appointment with him so we shall see. But either way, if you have a doctor that doesn’t support or understand the impact of Diastasis Recti on your life you should seek a provider who is knowledgeable about the condition to help you repair it.
In severe cases, and cases where no matter what you do you struggle with a weak core. Surgery may be an option, especially if you don’t plan to have any more pregnancies.
Surgery to repair a diastasis recti involves stitching the abdominal wall muscles back together along the midline. Sometimes this is done laparoscopically (tiny camera and instruments inserted via small incisions). For severe diastases often it requires open abdominal surgery through a larger incision.
Unfortunately, this is considered a cosmetic procedure, so it’s not generally covered by insurance. As a side note some times this “abdominoplasty” will be called a “tummy tuck”.
Now I want to be clear, that any and all surgery has it’s own risks, but is certianly NOT the easy way out so if you go that route don’t let anyone tell you it is OK? You are taking care of your body the best way you can, and sometimes that means being under the knife.
If you want to check out one Mamma’s story about her diastasis repair including surgery check out TheCrazyOutdoorMama.com I love how candid she is about how it affected her and the honest photos she has up from her experience.
What to avoid with a Diastasis Recti
As with most injuries (which lets face it that is what this is) sometimes what you avoid doing can be just as important as what you do.
From what I’ve read and the feedback I’ve gotten from my Physio Therapist (who specializes in Diastasis Recti and pelvic health) it seems common excercises that target the core strength can actually make it worse and should be avoided if you have a diastasis separation.
Things like crunches, sit-up, and planks actually increase the internal pressure and even if you don’t have diastasis recti recent research suggests that these types of isolation exercises are hard on the back and not as effective anyway (Harvard Health).
I’ve also been advised that in my situation I’m not to do any twisting excersizes (think wringing out your middle) or any heavy lifting. For me this means nothing, I even downsized my bag that I take to work everyday to reduce the amount of weight that I carry every day.
It can be frustrating though as I now also try to avoid picking up my active toddler, not because I can’t pick him up, but because doing so makes my middle ache and well he squirms a lot… which means I need to engage all my muscles to keep my balance and that includes the muscles that hurt when they engage.
Diastasis Recti and Pregnancy…
Usually this condition develops late in pregnancy (like month 8 or 9 I think) or after baby is delivered. I have found it a challenge to locate any reliable information on working with it when you are in the earlier stages of pregnancy. So like you’ve probably figured out from earlier comments I turned to my Physio …
I can’t speak to anyone else’s experience but in my situation, I’m only 4 months pregnant… not a time many notice a separation. And with the level of separation I have my physio is confident that I can close the separation after birth, I’m hoping it will get smaller before the birth and plan to follow all the instructions I’m given. (You can check out how I found out I had a separation here)
For me my biggest concern is that this doesn’t impact my delivery, with our first I was able to deliver on my hands and knees in a waterbirth which I loved (Full Story here), and I hope to do so again. But if my abdominal muscles are not engaging enough to push I worry that I may not be able to deliver on my own. And while I have no issue with c-sections (they save lives) I would like to avoid major surgery if I can help it.
What it means for future pregnancies
My understanding is that having a diastasis separation doesn’t prevent you from getting pregnant again or from having a healthy pregnancy. And you won’t necessarily get another separation just because you got pregnant.
The bigges thing is to do what you can to fix the separation NOW to reduce potential complications later. Follow the instructions of your physiotherapist, and continue exercises to help repair and strengthen your core now.
Then when you find out that you are pregnant begin pregnancy appropriate pelvic floor exercises to keep your core strong. And always practice good posture and limit heavy lifting.
My understanding is that it is rare for diasatis recti to be so severe as to impact a vaginal delivery in the future. However since it can make it harder to engage the core muscles needed to push there is a possibility (I still need to talk to my physio on this one regarding my situation).
There are some things that can be done to reduce your risk of a diastasis separation, but even those who actively try to prevent one may still experience one. Remember some things are out of our control, there is no need to beat yourself up.
- Work with a PhysioTherapist to maintain your core
- Maintain an active lifestyle
- practice safe abdominal and pelvic floor strengthening
- practice good posture
- Seek out and work with a PhysioTherapist that specializes in helping support diastasis recti separation
- Practice pregnancy-safe core and pelvic floor exercises and avoid heavy weight lifting/training, holding your breath and abdominal exercises.
- Maintain a neutral posture – try to not let your belly push out
- Avoid lifting heavy objects if possible and only with great care and sparingly if you need to. This includes older children. And if you are lifting do so with the correct technique (bend at the knees, exhale as you pick up. Do not strain or hold your breath)
- Wear a belly band for extra support (or use kinetic tape)
- eat plenty of protein and healthy fat to support muscle development and skin elasticity.
- ABOVE ALL LISTEN TO YOUR PHYSIO’s ADVICE and your body
- REST immediately following childbirth
- avoid heavy lifting
- do not use any excercises that build abdominal pressure (heavy lifting, crunches, planks, situps)
- if you had a c-section make sure the incision heals fully before resuming regular activity
- practice good posture
- If advised by a medical professional wear a belly binder – talk to your physical therapist/doctor/midwife about that is right for you.
How to fix a Diastasis Recti
First off I’m going to say it again here, SEEK THE HELP OF A TRAINED MEDICAL PROFESIONAL LIKE A PHYSIOTHERAPIST!!! I can’t say that enough, everyone’s body is differnt, what works for me may not work for you and vice versa.
It is important to do any exercises to correct any injury (diastasis recti included) under the care of a physical therapist to avoid further injury. And you will get much better results if you get evaluated personally since it doesn’t always present the same way.
That said I understand that sometimes the money isn’t there, and all we can do is work at home. If you want to try some at-home exercises make sure you get your doctor or midwife’s approval or at least do an assessment with a physio and choose a well-respected program then GO SLOWLY!
As I’m approved to do new exercises I’ll post them here so you can see what I’m upto, but that doesn’t mean they are the right fit for you.
- Expansive Breathing
- Opposing Dead Bug
Do binders or splints really help?
Some of what I’ve read online is conflicting information about binders and if they help or not. Based on my current situation of being pregnant I’m not likely to consider binding anything since that would also squish the baby.
However, I personally think that a bit of support around an injury can be a benefit. After all, there is a reason why we cast broken bones, why wouldn’t we also support injured muscles? This is another one of those things you should ask your Doctor/Midwife/PhysioTherapist.
The big concern I would have with this is if it became something I was reliant on for daily life. Thats like using crutches to help you get around with a broken leg only to heal the leg and keep using the crutches…what would be the point?
If my physiotherapist says I’m a good candidate for using a splint you bet your bottom I’m going to do so with the one she has in development. But in all likelyhood, I’ll try and avoid it if I can, and if I do use one I will follow the instructions to the letter!
Will I get my belly back?
This is probably one of my biggest questions and I’m sure if you have read this far you may be wondering that too. The truth is everyone’s body is different, and it may take weeks or even months of targeted exercises to get your abdominal and pelvic floor muscles back in shape. And even then some of us may need surgery too!
Plus it can take time and effort to lose the weight gained during pregnancy, and if you are (like me) carrying extra weight prior to pregnancy more time and effort to reduce that.
Some women will regain something close to their pre-pregnancy shape, and others won’t. And it’s not all due to the diastasis separation either, pregnancy often results in permanent chnges to the body, like softer belly, looser skin, wider hips, and a thicker waist. And if you breastfeed or just have the weight changes your boobs may not be the same either.
What I hope for is that you can be gentle with yourself and show yourself some love and compasion. No matter the shape of your body (before, during, or after) you grew a whole human, birthed it and are a Mamma. In order to take better care of our littles we need to first take care of ourselves, and that means loving the body we are in. Scars, stretchmarks, and “mommy pouch” included.