Diastasis Recti: Understanding and Managing Postpartum Abdominal Separation
Diastasis recti, or stretching and separating muscles in the abdominal area, is a common issue during and after pregnancy. Learn more about this condition.
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Lower back pain, stretch marks, a constant need to pee. These make the top of the what-to-expect-when-you’re-expecting symptom list. Further down on the list: an often overlooked — and yet super common — issue. It’s called diastasis recti (or diastasis recti abdominis), which means separation of the abdominal muscles.
What happens is just as it sounds: as your uterus expands to accommodate your growing baby, the core muscles that run vertically along the front of your abdomen can separate, creating a gap down the middle. It’s usually not painful, and it can resolve on its own after delivery. But for about two-thirds of women, the condition persists for weeks or months postpartum — leading to a visible bulge, pelvic floor issues, back pain, and other effects.
The good news: With time and the right exercises, most cases of diastasis recti will heal. Read on to learn about the symptoms of diastasis recti and how exercise and physical therapy can help treat it.
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Kandis Daroski, PT, DPT
Tamara Grisales, MD
What Is Diastasis Recti?
The rectus abdominis muscles — or six-pack ab muscles — run parallel down the front of your stomach, from your ribs to your pelvis. They are divided into left and right sides and connected by a band of tissue at your midline called the linea alba. As your uterus expands during pregnancy, your ab muscles stretch and that band of tissue thins and widens as it’s pushed outward. Hormonal changes in pregnancy that loosen connective tissue also play a role.
Once you give birth, the linea alba can bounce back into place like a rubber band. But when the tissue loses its elasticity from being overstretched, the gap in your ab muscles will not close as much as it should. That’s diastasis recti.
While this issue is most common in pregnant and postpartum women, it can also affect men, infants, and children.
Symptoms of Diastasis Recti
Most people have diastasis recti during pregnancy but don’t notice symptoms until after delivery. The most obvious sign is a visible bulge or “pooch” that protrudes just above or below your belly button.
Other symptoms may include:
Doming or coning when you contract your ab muscles
Softness and a jelly-like feeling around your belly button
Weakness in your ab muscles
Lower back pain
Difficulty lifting objects, walking, or doing everyday activities
Posture issues
Leaking urine (urinary incontinence)
Diastasis Recti Risk Factors
Pregnant women are more likely to develop diastasis recti if they:
Are pregnant with twins, triplets, or multiples
Are petite or have a small stature
Are pregnant later in life
Have had more than one pregnancy
Have had diastasis recti with a previous pregnancy
Have weakened abdominal muscles
Have other conditions like umbilical hernia or pelvic instability
Physical Therapy to Help Heal Diastasis Recti
Exercise is often the first step to treating diastasis recti. It can help lessen the separation between ab muscles and ease symptoms. “Current research shows that the most important factor in healing diastasis recti is creating tension through the gap,” says Kandis Daroski, PT, DPT, a Hinge Health pelvic floor physical therapist (PT). “That means focusing on exercises that strengthen and coordinate deep core muscles to better support the area of the ab separation.” Healing your diastasis recti after childbirth is as much about knowing what not to do as what to do. Certain exercises (like sit-ups or planks) that put pressure on your abdominal muscles before they’re fully healed can make your abdominal separation worse. Similarly, performing everyday movements— such as lifting your baby or getting in and out of bed — while holding your breath or with poor ergonomics can delay healing.
“It’s important to focus on exercises that strengthen and coordinate your abdominal muscles after delivery before moving on to more challenging core exercises like sit-ups or crunches,” Dr. Daroski says. A pelvic floor physical therapist can recommend a postnatal exercise program for your specific needs and teach you how to use proper body mechanics to engage deep core muscles when lifting and pushing to help promote healing. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Rarely, severe diastasis recti doesn’t improve with exercise and physical therapy and your healthcare provider may recommend surgery to repair your abdominal muscles.
Exercises for Diastasis Recti
Want expert care? Check if you're covered for our free program →- Diaphragmatic Breathing
- Abdominal Bracing With Heel Slide
- Child’s Pose With Side Bend
- Seated Kegel With Thigh Squeeze
- Kneeling Hip Flexor Stretch With Overhead Reach
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
PT Tip: Your PT Partner in Healing
“There’s no one-exercise-fits-all cure for diastasis recti,” says Dr. Daroski. “To most effectively engage your core to decrease symptoms, a physical therapist will need to create a customized and comprehensive program to help you feel better, faster. Improving diastasis recti is a journey — with a PT as your guide.”
Learn More About Hinge Health for Pelvic Symptom Relief
If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.
Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
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References
Diastasis Recti (Abdominal Separation): Symptoms & Treatment. (2022, February 8). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22346-diastasis-recti
Hall, H., & Sanjaghsaz, H. (2022). Diastasis Recti Rehabilitation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK573063/
Sharma, G., Lobo, T., & Keller, L. (2014). Postnatal Exercise Can Reverse Diastasis Recti. Obstetrics & Gynecology, 123, 171S. doi: 10.1097/01.aog.0000447180.36758.7a
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092–1096. doi:10.1136/bjsports-2016-096065
Thabet, A. A., & Alshehri, M. A. (2019). Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of Musculoskeletal & Neuronal Interactions, 19(1), 62–68. https://pubmed.ncbi.nlm.nih.gov/30839304/