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What is a diastasis recti?
That's what they call it when the rectus abdominis muscles in your abdomen separate during pregnancy, leaving a gap that allows your belly to pooch out. If you still look pregnant months after giving birth, you may have a diastasis recti. Here's how it happens.
Your rectus abdominis (the "six-pack muscles") is 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 gets stretched out, allowing the rectus abdominis to pull apart and separate vertically down the middle. (Pregnancy hormones also play a role by relaxing the connective tissue to accommodate your growing baby.)
Sometimes the tissue heals, and the muscles come back together after delivery when your hormone levels return to pre-pregnancy levels. But if this doesn't happen in three to six months, you can end up with a gap that won't close without treatment. Studies show that about 40 percent of women have a diastasis at six months postpartum.
After pregnancy, a diastasis recti looks 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.
How can I tell if I have a diastasis recti?
To check for a diastasis recti, lie on your back, with your knees bent and your feet on the floor. Place your hand 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.
What can I do about a diastastis recti?
If it doesn't worry you, you don't have to do anything. But if it does bother you, know that the condition can almost always be repaired, though it may take some work.
Once the connective tissue gets stretched out, it can be difficult to rebuild your core strength and bring your muscles back together. Doing traditional crunches can make your condition worse. They tend to make those muscles tighter, pushing them further apart and stretching the connective tissue even more so that it grows thinner and weaker.
You can often correct a diastasis with specific exercises, but you'll need guidance from a physical therapist. See our article on postpartum abdominal rehab for more information on how to find one and how the physical therapy works. (It can also help women who still look pregnant and have trouble strengthening their core, even if they don't have a diastasis recti.)
If your diastasis 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 a 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 diastases require open abdominal surgery through a larger incision. Unfortunately, this is considered a cosmetic procedure, so it's generally not covered by insurance.
By the way, if you do plan to have more children, it's worth the effort to repair a diastasis with physical therapy (not surgery) to strengthen your core before your next pregnancy. It may recur, but it's likely to be less severe.
Can a diastasis recti lead to other health complications?
A diastasis can lead to other problems including chronic low back pain, urinary incontinence, constipation, pain during sex, and pelvic or hip pain.
How can I avoid a diastasis?
If you can, it's a good idea to begin doing exercises to strengthen your core before you become pregnant. Once you're pregnant, you can continue some of them through the first trimester. But even gentle core strengthening is largely ineffective once your belly gets big.
In any case, it's likely that staying active can help. Some studies show that women who exercised regularly during pregnancy were less likely to end up with a diastasis recti.
Is it ever too late to correct a diastasis?
No. With proper care, you can close a diastasis even years after you delivered your last baby. How long it takes to heal depends on the severity of your diastasis (the distance between the separated abdominal muscles and the damage to the stretched connective tissue) as well as your commitment to fixing the problem.
Note: This article was also reviewed by Melinda Fontaine, DPT, pelvic physical therapist at the Pelvic Health and Rehabilitation Center in Berkeley, California and Alison Ankiewicz, DPT, pelvic health physical therapist at Inner Dynamics Physical Therapy in Ocean, New Jersey.