By Alison Heyerdahl

During pregnancy, our bodies do a lot of incredible things to accommodate our growing baby.  Our abdomen muscles expand and separate as the linea alba (or connective tissue between the abdominis recti muscle) stretches.  After giving birth, you may notice an indentation in the middle of your belly, in the region of your “six-pack” area.  For some moms, this separation is excessive and is known as diastasis recti. 

A recent study found that around one in three women experiences diastasis recti postpartum.  Fortunately for most women, the gap usually closes on its own.  There are a few exercises can help heal the condition, but a few that should be avoided.  Read on to find out more. 

How do I know if I have diastasis recti?

After birth, you may notice a bulge in your belly area.  This is because your internal organs are bulging out between the muscles of your abdominal wall.  It may be particularly prominent when you lift a heavy object or move from lying to sitting.  The following self-check will help you determine whether you do indeed have diastasis recti:

1. Lie on your back with your knees bent and your feet resting flat on the floor.

2. Place your hand just above your belly button in the center of your abdominal muscles.

3. Raise your upper body a few inches off the floor and look down at your belly.

4. Observe if you can fit your fingers between the gap in the muscles. 

5. A gap of one to two finger-widths is normal; three or more could be a sign of diastasis recti.

Note that even in women who have not given birth, a 1 cm (or one finger) separation at the level of the belly button and 0.5 cm above and below is normal.

Should I be concerned about diastasis recti?

Recovery from diastasis recti occurs naturally between the first day and eight weeks after birth.  Following birth, it is normal for the separation to be as large as 1.5 to 2 cm at the belly button level.  A space of more than 2.7 cm between the abdominal muscles of the bellybutton is considered pathological. 

The main problem caused by the separation of your abdominal muscles is that it decreases functional abdominal strength.  This can result in problems such as lower back pain, pelvic girdle pain, and pelvic instability.  Furthermore, because the pelvic floor muscles work in concert with the abdominal muscles to maintain pelvic floor tone, it may lead to prolapse or incontinence. 

The presence of diastasis recti may also indicate that you are not yet ready to safely return to postpartum exercise.

What causes diastasis recti?

Excessive inner-abdominal pressure often causes diastasis recti.  During pregnancy, your body releases a hormone known as relaxin, which allows the abdominal muscles and related connective tissue to stretch to accommodate your growing uterus.  Directly after birth, your muscles may still be weak, and the connective tissue won’t have regained its former elasticity, resulting in diastasis recti. Excessive pushing during birth may also lead to diastasis recti. 

Does diastasis recti heal on its own?

For most women, diastasis recti heals on its own within three to six weeks after birth.  Sometimes it persists long after delivery.  Further intervention is required if you notice that the gap is not closing or are experiencing severe pain.  In some cases, a hernia may develop. 

How do you fix diastasis recti?

Diastasis recti is usually treated with targeted exercise therapy.  Exercise therapy has been found to be effective in cases where a hernia has not developed. 

Certain muscle contractions can act to bring the abdominal muscles closer together.  Exercises involving pelvic floor strengthening and deep horizontal abdominal contractions are usually recommended.  Any exercise regime should ensure effective control of the intra-abdominal pressure (i.e., no 'coning' or 'doming' of the abdominal muscles) and create good tension across the whole abdomen. 

For women with separations, less than four finger widths between the muscles, corrective exercises (such as those described below) will be prescribed.  These exercises can be performed for 2 – 6 weeks until the separation has closed or is less than two finger widths.

In the case of larger separations (four finger-widths or more), a corset or binder is recommended in conjunction with exercise.  The corset is worn 24 hours a day and only taken off for bathing or during exercise.  For those in which exercise is ineffective, surgery (known as an abdominoplasty) may be considered.  Surgery helps relieve lower back and pelvic pain. 

What exercises help treat diastasis recti?

Before beginning any exercise regime, seek the advice of a healthcare practitioner, such as a physical therapist trained in treating conditions of the pelvic floor.  They will advise you on which exercises you should perform to improve diastasis recti.  Most exercises will strengthen the deep core muscles, such as the transversus abdominis and pelvic floor muscles.  Knowing which abdominal muscles to strengthen is important for preventing an increase in intra-abdominal pressure, thereby furthering the recti separation and causing a hernia. 

The following exercises can help to strengthen the transversus abdominis and pelvic floor muscles:

Before starting with a strengthening program, it is important to ensure that you are breathing correctly.  Incorrect breathing can increase your intra-abdominal pressure and worsen diastasis recti. 

To ensure that you are breathing correctly:    

1. Lie flat on your back with your knees bent, and your arms stretched out at your sides. 

2. Take a deep breath in through your nose and allow your belly button to rise with the in-breath. 

3. Hold the breath for 2 seconds and proceed to breathe out through your mouth. 

4. Repeat for 5 minutes. 

Holding your breath or only breathing into your chest puts excessive pressure on your pelvic floor and can widen the gap between your abdominal muscles.

Deep transversus abdominis strengthening:

1. Lie on your back with your knees bent and feet flat on the floor.

2. Breathe into your tummy (as outlined above), and as you breathe out, draw the sides of your abdominal muscles together, pulling your belly button towards your spine. 

3. Hold the contraction for 5s, and repeat 10 times.  You can gradually increase the time you hold the contraction to 10s. 

4. Perform these exercises every day.

Pelvic floor tilts:

This exercise engages your transversus abdominus as well as the muscles of your pelvic floor.

1. Lie on your back with your knees bent and your feet flat on the floor.

2. Press your lower back into the ground, and draw your belly button towards your spine. 

3. Contract your pelvic floor by taking in a breath and as you breathe out, tighten the muscles surrounding your vagina and anus, as if you were preventing a wind. 

4. Keeping your lower back pressed into the ground and the pelvic floor contracted, gently lift your pelvis an inch off the floor.  Hold the contraction for 5s and then release your pelvis slowly back down to the floor.

5. Repeat the exercise 10 times and do three sets of contractions.

Things to avoid if you have diastasis recti

• If you suspect you may have diastasis recti, avoid unsuitable abdominal exercises such as sit-ups, straight leg raises, trunk rotations, and criss-cross sit-ups.

• Avoid yoga stretch exercises such as the upward-facing dog or full wheel, where your back is arched, and your abdominals are in a stretched position. 

• Do not lift or carry heavy objects.

• Avoid carrying your baby on one hip.

• Try not to cough or sneeze without supporting your abdominal muscles.

Conclusion

In conclusion, diastasis recti is a fairly common occurrence following childbirth.  It is usually nothing to worry about, but if it has not resolved or at least improved within 8 weeks after childbirth, you should consult your healthcare professional for advice.  Certain exercises, if performed correctly, will improve diastasis recti, while others should be avoided to prevent its worsening.