Diastasis recti! As your pregnancy progresses, the connective tissue that joins your recti muscles thins and widens to make room for your growing baby, in a process called diastasis recti. After the baby is born, this can remain, creating a vertical bulge that can vary in size and take time to heal. There are diastasis recti exercises that may help, although it can take up to a year for the abdominal wall to fully return to normal.

IN THIS ARTICLE

• What is diastasis recti? 
• Is there a diastasis recti test? 
• Diastasis recti exercises 
• How can I avoid diastasis recti? 
• Is it ever too late to correct diastasis recti? 

What is diastasis recti?

The rectus abdominis muscles in your abdomen – the ones associated with the “six pack” look – are a pair of long, flat muscles that run vertically down each side of your abdomen. These muscles hold in your internal organs and stabilize your core.

As your belly expands during pregnancy, the connective tissue that joins the two sides of the muscle thins and widens, making room for your growing baby. This change in the connective tissue and increased distance between the two sides of the recti muscles is called diastasis recti. (Pregnancy hormones also play a role by relaxing the connective tissue to accommodate your growing baby.)

After pregnancy, this separation can remain, and the middle portion can bulge upwards or sink inwards whenever you contract your tummy. In addition, there may be weakness in the muscles of the abdominal wall that can make your belly protrude.

Diastasis recti tends to become prominent when you’re straining to do something like coughing or sitting up, for example, and it may disappear or cave in when you lie down or relax your abdominal muscles. These pictures illustrate what diastasis recti looks like inside:

Most postpartum women will find that their diastasis distance will reduce over time, but if this doesn’t happen in three to six months, you may have a gap that won’t close without the help of a physical therapist that specializes in women’s health.

Is there a diastasis recti test?

Here’s how to tell if you still have diastasis recti after delivery: Lie on your back, with your knees bent and your feet on the floor. Place your hand’s palm down over your belly, with your fingers pointing toward your toes. Press your fingers gently into your navel area then slowly lift your head, drawing your chin to your chest. This causes your rectus abdominis to contract.

If you feel a gap of at least two finger widths between the muscles as they contract, you have a diastasis. A gap as wide as four or five fingers is considered severe. Repeat the procedure below and above your belly button because the separation may be wider in different places.

Diastasis recti exercises

It’s important to rebuild your core strength and improve abdominal muscle strength with a gentle, progressive exercise routine. You can often correct a diastasis with specific exercises, but you’ll need guidance from a physical therapist.

Research has shown that certain types of core exercises can help heal diastasis recti, but they’re not all equally effective. The three exercises below from Every Mother coordinate engagement of the transverse abdominis, the pelvic floor and the diaphragm while omitting moves with repetitive forward flexion that can exacerbate diastasis recti (think sit-ups, crunches and crossover crunches).

Double Arm Waist Anchor

This exercise is a great replacement for crunches. Instead of using your head and shoulders to challenge your core, this move uses a pair of light weights and two straight arms as a lever. (Don’t have dumbbells handy? Two water bottles work, too!)

1. Lie on your back with your knees bent and your feet flat on the floor.
2. As you exhale, extend your arms toward the ceiling, directly above your shoulders (as shown in the first image above). 
3. Inhale as you slowly lower your arms overhead toward the floor, keeping your ribs anchored and pelvis neutral and maintaining the natural curve in your low back (as shown in the second image above). Only lower the weights as much as you comfortably can while maintaining control.
4. When your arms are near the bottom of your range of motion, exhale as you perform a Kegel and flatten your abdominal muscles firmly toward the spine. Continue exhaling and engaging the core as you lift your arms back up until they’re straight above your hips.
5. Repeat this slow, controlled exercise for two full minutes, inhaling as you lower your straight arms overhead towards the floor, then exhaling as you engage the deep core and pelvic floor, flattening your abdomen towards the spine to stabilize as you lift the weights back up.

Core Compressions in Tabletop

Before starting this exercise, it helps to practice some diaphragmatic breaths. To do so, place your hands on the floor directly below your shoulders, with your knees directly below your hips. Keep your back flat and your head in line with your spine. With your shoulders relaxed, take a few deep, full breaths; as you inhale, allow your belly to drop and your abdominal muscles to relax. With each exhalation, gently hug your belly up toward the spine. 

After doing a few of these breaths, you’re ready to perform Core Compressions in tabletop position:

1. Inhale, then exhale as you squeeze and lift both your pelvic floor and your abdominal muscles up toward the spine. Maintain a flat back.
2. When your abdominal muscles are at your spine, continue exhaling as you lift your pelvic floor and squeeze your abs even closer to the spine. Then soften and fully release your core and pelvic floor as you inhale. 
3. Repeat this pattern of two-tier muscle engagement, exhaling then relaxing the muscles while inhaling. Work up to two minutes of this position, resting as needed.

Wall Plank with Core Compressions + Progressions

1. Place your hands on a stable wall at about chest height, shoulder-width apart.
2. Walk your feet back and draw your hips forward, rolling your shoulders down away from your ears. Maintain this position and allow your abdominal muscles to partially relax as you inhale.
3. Next, exhale as you engage your abdominal muscles and your pelvic floor up and in toward the spine. Continue exhaling as you squeeze and lift your core and pelvic floor muscles a bit tighter toward the spine, and then inhale as you relax the muscles slightly.
4.  Continue with this pattern of exhaling as you engage and then inhaling as you gently release the muscles. Work up to a full minute, stepping out of the plank to rest as needed. 

When a full minute of this move feels easy, you might choose to progress the plank difficulty by trying any of the following:

• Incline plank with hands on a high, stable surface, such as a kitchen countertop.
• Incline plank with hands on a slightly lower, stable surface, such as the back of a sofa.
• Straight arm knee plank with hands and knees on the floor, as shown below.

In each plank variation, focus on performing core compressions throughout the pose and come out of the plank to rest as needed. Never hold your breath while planking. Stay at each level until it feels easy to complete a full minute while performing core compressions throughout the plank.

If you notice yourself getting fatigued or you’re finding it difficult to maintain good form, pause and rest before resuming. It is better to plank safely for a shorter duration than to lose control over the direction of muscle engagement (always drawing the core and pelvic floor up and in toward the spine) and coordination of breath (exhale on engagement; never hold your breath).

When finished planking, rest in child’s pose and take some full, deep breaths. With each inhalation, allow your belly and pelvic muscles to fully release, relax and expand.

You can also see our article on postpartum abdominal rehab for more details on how to find one and how to do some of the most common diastasis exercises. (They can also help women who still look pregnant and have trouble strengthening their core, even if they don’t technically have diastasis recti.)

If your diastasis recti is severe, and you don’t plan to get pregnant again, surgery may be an option, especially if you’ve done all you can with physical therapy but are still struggling with a weak core.

Surgery to repair diastasis recti involves stitching the abdominal wall muscles back together along the midline. In some cases, a surgeon may be able to do the procedure laparoscopically (using a tiny camera and instruments inserted through small incisions). Severe diastasis recti requires open abdominal surgery through a larger incision.

If you do plan to have more children, surgery is not recommended since the abdominal muscles will need to separate again for those pregnancies. But it’s still a good idea to work with a physical therapist to strengthen your core, since that may cause diastasis recti to be less pronounced in the future.

How can I avoid diastasis recti?

If you can, it’s a good idea to begin doing exercises to strengthen your core before you become pregnant. Consider consulting with a physical therapist who specializes in women’s health, about how to keep your abdominal wall strong during and after pregnancy. Keep in mind that you won’t cause diastasis recti by doing ab exercises, and remember that it’s a normal condition that plays a role in making room for your growing fetus.

There’s no reason to stress about this condition, as it’s not something that will negatively affect your pregnancy or recovery. Things like genetics, number of pregnancies, weight gain and baby size all contribute to how wide your diastasis recti will be, but even if you do develop a wide diastasis, there’s a good chance it will improve after your pregnancy.

Core work isn’t just to prevent diastasis recti. Research suggests that stronger abdominal muscles throughout pregnancy can support your pelvic floor to reduce frequent urination and increase lower back support – which is hugely important as your pregnancy progresses and pulls your weight forward.

Is it ever too late to correct diastasis recti?

No. With proper care, you can close a gap even years after you delivered your last baby. How long it takes to heal depends on the severity of your diastasis recti and the effectiveness of physical therapy or, in some cases, surgical intervention.

Keep in mind that diastasis recti is a normal part of pregnancy and serves a purpose – your baby needs that room to grow, after all. In the same way that other aspects of your body take time to adjust post-delivery, your abdominal muscles do as well, so sometimes the best treatment is simply time.

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