Diastasis recti

Woman with a diastasis recti

After pregnancy most women find themselves with a gap of about two fingers' width between their abdominal muscles. This can cause a bulge in your belly. It's a little unpleasant but, in most cases, goes away fairly quickly. Sometimes, the gap refuses to narrow and you might need physiotherapy to address the problem. Here's everything you need to know about the causes, symptoms and solutions.

What is diastasis recti?

Diastasis recti (“separated stomach muscles”) occurs when the parallel bands of muscles in the middle of your abdomen (rectus abdominis) move apart during pregnancy and stay separated after you’ve given birth. This leaves a loose bulge in your stomach, depending on the width of the gap between the muscles. It can cause discomfort, make carrying and lifting difficult and leave you feeling demoralised about your appearance.

Most women will have a separation of one or two fingers' width after pregnancy. This usually clears up on its own. That said, it's fairly common for women to find themselves with a wider gap which does not go away quickly and requires some physiotherapy. Most cases can be addressed by exercise, although make sure you discuss exercise first with your doctor or physical therapist, as some exercises can be dangerous when you're suffering from a diastasis recti. You need make sure what you're doing is safe and won't make the problem worse.

Whatever you do, don't try and self-rectify with stomach crunches or usual abdominal exercises – these can often make the problem worse.

What causes diastasis recti?

As your belly grows during pregnancy, the connective tissue is stretched, so the muscles pull apart. At the same time, your pregnancy hormones help your muscles to relax, lengthen and separate down the middle.

Usually, your rectus abdominis hold your organs in and provide stability to your core. This is integral to your core strength, which is why diastasis recti makes you feel weaker. When those muscles are separated, your stomach sticks out a bit and the lack of core support can cause back pain.

While you’re pregnant, you’re unlikely to notice a diastasis recti, although you might notice a bulge developing down the front of your bump, above and below your belly button. After you’ve given birth, the tissue might heal, as the hormone levels reduce. If you still have a gap after three months, however, surgery might be required to close it.

Diastasis recti symptoms

The bulge is the surest sign. It can also take the form of a ridge, and is especially prominent when you’re sitting up. Other symptoms include:

  • Lower back pain
  • Difficulty maintaining good posture
  • Bloating
  • Constipation

If you’re concerned about a diastasis recti, and you’ve had your baby, then you can gauge how your stomach muscles are moving back together by following this safe technique from the NHS:

  • Lie on your back with your legs bent and your feet flat on the floor.
  • Raise your shoulders off the floor slightly and look down at your tummy. Using the tips of your fingers, feel between the edges of the muscles, above and below your belly button. See how many fingers you can fit into the gap between your muscles.
  • Do this regularly to check that the gap is gradually decreasing. A diastasis recti is usually a gap of about two fingers’ width. If the gap is double that size then the problem is severe. If your stomach muscles have not moved back together by the time your baby is eight weeks old, you should see your doctor.
Diastasis recti diagram

Exercises for diastasis recti

If you’re suffering from a diastasis recti then you’re probably keen to start exercising to make the muscles in your abdomen narrow and restore strength to your core. It's not as simple as working off the bulge though, so be careful and speak to your GP or a physiotherapist before proceeding.

Pilates (with a teacher experienced in this area) is your best bet. You need to strengthen the deep core muscles first. Avoid sit ups/crunches/twisting movements. You can definitely reduce the gap with the right exercises.

You need to be careful about what you do: some exercises will help, but there are others that will make the problem worse. Abdominal exercises, such as crunches or sit-ups, that put strain on the midline of the abdominals, are a no-no.

Pelvic floor exercises, which strengthen your back passage, bladder and vagina, should help. As should deep stomach exercises for which you should:

  • Lie on your back or your side with your knees bent and your feet flat
  • Keep the normal inward curve in your lower back throughout
  • Place your fingers on your lower abdominal wall just inside your pelvic bones
  • Imagine you are wearing a low-slung belt across your hips
  • Gently draw in the area between your tummy button and pubic bone towards your spine as if you were trying to do the belt up a few more notches
  • Hold this for as long as you can then relax. Then repeat. Then relax. Then…
  • Increase how long you hold for as you become stronger (up to 10 seconds)
  • Try this exercise in sitting or standing when you feel confident.

“Don't do any straight sit up movements, even when you're getting out of bed. Always roll onto your side first.”

This NHS patient information sheet has some good advice for exercising, but do speak to your doctor or a physical therapist before you begin your own course of physical therapy.

Also, bear in mind that, at the same time as exercising, there are some activities you should avoid if you’ve got a diastasis recti:

  • Strenuous exercises that cause your abdominal wall to bulge out
  • Heavy lifting or bending
  • Straining on the toilet
  • Holding your baby on one hip

When getting out of bed, roll on to your side first before pushing up, avoiding the sit up motion

Surgery for a diastasis recti

If you’ve tried all the recommended physical therapy and still have a diastasis recti, you might need surgery to correct the problem, especially if it’s interfering with daily activities, such as lifting and carrying your baby, or just making you uncomfortable generally.

Surgery for diastasis recti is similar to a tummy tuck (abdominoplasty), bringing the separated muscles back together. Unfortunately, a tummy tuck is regarded as cosmetic surgery so is not available on the NHS.

This doesn’t mean that you definitely won’t get surgery on the NHS. Their website states: “An abdominoplasty is regarded cosmetic surgery, so not normally available on the NHS.” So much depends upon that “normally” (about £4000-£6000, actually, plus the cost of pre-op consultations and follow-up care). If the gap between your abdominal muscles is particularly wide, and a serious impediment to your quality of life, then your GP might try to get you the operation, so it is definitely worth making your case.

Eights week post-birth, my GP said that, if the gap didn't close in a year, she'd refer me for surgery. If your diastasis looks bad, you should keep going back to your GP, or find a different one, because you can have problems in future with hernias.

Mumsnetters report mixed experiences, with some told by doctors that they need to go private for surgery and others saying their GPs referred them for a tummy tuck on the NHS. Several swear by the Tupler technique, although we cannot vouch for it.

If you’re prepared to pay – and bear in mind that a tummy tuck is major surgery – then see the Care Quality Commission for a list of treatment centres that offer the operation.

Complications of a diastasis recti

Diastasis recti has been known to involve the following complications:

  • Back pain
  • Hernia
  • Pelvic pain
  • Pelvic floor dysfunction
  • Bad posture

Can a diastasis recti be prevented?

Unfortunately, there is no way to completely preventing a diastasis recti. You can reduce your chances, though, by doing exercises to strengthen your core before you become pregnant, and carrying on with some of them through the first trimester of your pregnancy.