Do you feel like you still look pregnant? It could be diastasis recti, a separation in the rectus abdominis muscles (aka your “six pack”) that occurs in 60% of postpartum women. It can create a pregnancy-like bulge in your midsection that sticks out just above or below your belly button.
Diastasis recti usually develops in the third trimester due to increased pressure on the abdominal wall but isn’t noticeable until after giving birth. For most people, this “ab gap” heals within eight weeks of delivery, but about 40% of those who develop diastasis recti still have it six months after childbirth.
Risk factors for this common postpartum condition include being over 35, having multiple pregnancies (especially back-to-back), having multiple babies (twins, triplets, or more), having a large baby, being extremely petite, and delivering your baby vaginally.
Signs and symptoms of diastasis recti
Because your abdomen is stretched during pregnancy, you may not notice the signs and symptoms of diastasis recti until the postpartum period. They can include:
- A visible bulge or “pooch” in your midsection
- A softness or jelly-like feeling around your belly button
- “Coning” or “doming” of the midsection when you contract your abs
- Difficulty lifting objects or performing everyday tasks
- Urine leakage when you sneeze, laugh, or cough
- Pain in your lower back, pelvis, or hips
- Abdominal weakness
- Pain during sex
- Poor posture
- Constipation
It’s important to note that diastasis recti isn’t painful in and of itself—meaning there is no pain at the site of your “ab gap”—but you may feel pain in other areas such as your lower back, pelvis, or hips due to the weakness in your core. It can also make intercourse painful as a side effect.
With diastasis recti, there is a gap between the muscles, but connective tissue still covers the abdominal wall. A hernia is a similar condition that sometimes happens with or without diastasis recti. In the case of a hernia, there is a gap in the connective tissue as well, but a hole also develops. When this hole forms, abdominal organs, like your bowel or intestines, can push through that hole, causing a bulge. A hernia can be painful and can sometimes cause serious complications if not treated, so it’s important to have your healthcare team evaluate any belly bulge.
Getting diagnosed and treated
To diagnose diastasis recti, your healthcare provider may start by examining your abdomen with their hands. A gap in your muscles wider than two or three fingers is considered diastasis recti. From there, they may use an ultrasound, measuring tape, or caliper to get a more accurate measurement.
Depending on the size and severity, your provider may prescribe exercises to perform at home and certain things to avoid doing to promote healing. They may also refer you to a physical therapist who can guide you in safely engaging the deep abdominal muscles with slow, controlled movements.
What activities should be avoided? They include:
- Lifting anything heavier than your baby
- Crunches, sit-ups, planks, and push-ups
- Downward dog and other yoga poses
- Scissors, double leg lifts, and other Pilates moves
- Sitting straight up to get out of bed (instead, roll onto your side and push with your arms)
- Any activities or movements that push your abs outward
The good news is that when you avoid the things that make diastasis recti worse and do the recommended exercises that make it better, your prognosis for healing may be completely positive.
Not sure what to do?
If you suspect you may have diastasis recti, make an appointment with your healthcare provider or plan to bring it up during an existing postpartum appointment. It’s one of the key factors your provider typically evaluates when deciding whether to clear you for exercise.
Reviewed by the Ovia Health Clinical Team
Sources:
- Cleveland Clinic Staff. “Diastasis Recti.” Cleveland Clinic. February 08, 2022. https://my.clevelandclinic.org/health/diseases/22346-diastasis-recti
- National Library of Medicine, NCBI, Stat Pearls. “Diastasis Recti Rehabilitation.” Last updated August 8, 2023. https://www.ncbi.nlm.nih.gov/books/NBK573063/#:~:text=Introduction-,Diastasis%20recti%20is%20an%20increased%20distance%20between%20the%20rectus%20abdominis,distance%20between%20the%20rectus%20muscles.
