Diastasis recti

Diastasis recti is the separation of the two rectus abdominis muscles (the “six-pack” muscles) along the midline, the linea alba. It is very common after pregnancy: it is present in most women at the end of pregnancy and persists in some of them months after giving birth. It can also occur in men, especially with abdominal obesity or after heavy lifting with poor technique.

What diastasis recti is

During pregnancy, the growing uterus and hormones stretch the linea alba, the tissue that joins the two rectus muscles. If this tissue does not regain its tension after birth, the muscles stay apart and the abdominal wall loses firmness. Diastasis is usually defined as a separation of more than about 2 centimetres.

How to check for diastasis recti

Diastasis recti shows as a belly that does not go away even after regaining your weight, and as a ridge-shaped bulge in the middle of the abdomen when sitting up from lying down. To check at home, lie on your back with knees bent, lift your head slightly and feel with your fingers for a gap between the muscles above and below the belly button. A professional confirms the diagnosis, sometimes with an ultrasound that measures the gap.

Symptoms of diastasis recti

Besides the appearance of the abdomen, diastasis recti can be associated with lower back pain, poorer trunk control, pelvic floor problems and, in some cases, an umbilical hernia.

Treatment of diastasis recti

• Physiotherapy: the first step. Specific exercises for the deep abdominal muscles (transversus) and the pelvic floor, guided by a physiotherapist, improve function and sometimes reduce the gap. Classic crunches and efforts that make the belly bulge are best avoided at first.
• Tummy tuck with rectus plication: when the gap is large or persists after physiotherapy, surgery stitches the muscles together in the midline and removes any excess skin. It is best done once no further pregnancies are planned, as a new pregnancy can separate the muscles again.
• Laparoscopic or endoscopic repair: in some cases, especially with a hernia and little excess skin, the muscles are repaired with minimally invasive techniques.

Abdominal binders can feel supportive after birth, but they do not correct diastasis on their own.