Diastasis Recti: How to Fix Ab Separation After Pregnancy
May 13, 2021
Pregnancy is never easy. But after baby number 4, Jenny had a literal falling out with her abdominal wall. In other words, she had diastasis recti, a condition in which the belly becomes so overstretched that its muscles separate. There was “just an overall feeling of collapse,” says Rachel Welch, Jenny’s postnatal fitness instructor and founder of Revolution Motherhood in Brooklyn, New York.
Diastasis recti is a legitimate concern during and after pregnancy—after all, your uterus stretches to accommodate baby as they grow from the size of an avocado to an entire watermelon. That can take a toll on your body, but fortunately, you can minimize the damage and jump-start the recovery. Here’s how.
Think of diastasis recti (pronounced dai-uh-stei-suhs rek-tai) as what happens when you try to force an overstuffed duffel closed and end up with a broken zipper, one that gapes open, the teeth off-track and undone. Diastasis recti is kind of like that—a condition that occurs as a result of the tremendous pressure baby exerts on your abdominals, including the rectus abdominis (the “six-pack” muscle) and the linea alba, a strip of connective tissue that runs along the center of your abdominal wall. As baby grows and as you push during labor, this strip gets stretched—and sometimes overstretched—widening the distance between the muscles on the left and right.
“Diastasis recti is a mechanical thing,” says Michael Tahery, MD, a Los Angeles-based ob-gyn with subspecialty training in urogynecology. “The abdominal wall has a certain ability to stretch to accommodate the baby.” But as the uterus stretches things out, it also pushes everything from the center out to the sides. The result can be a separation of the abs, sometimes wider than two fingers apart—you can feel it about two inches above and below your belly button. The situation can potentially resolve itself, though studies show that about one-third of women still have ab separation after 12 weeks post-delivery.
Women often think negligence during their prenatal fitness routines caused their diastasis recti—either they worked too hard (holding full planks!) or not nearly enough (because, life). But muscle stress is not the sole culprit. Diastasis recti can affect women differently, because every body is so different.
Diastasis recti does tend to be more common if you’re a petite woman with a bigger-than-average baby than a tall woman with a smaller-than-average baby. Twins and multiples may exacerbate diastasis recti as well. “The bigger the uterus, the more pressure, and the more separation,” says Tahery.
It’s also possible to go through the entire pregnancy intact—only to get diastasis recti during labor and vaginal delivery. “The force of pushing further increases that abdominal pressure,” Tahery adds. Genetics may play a role too, though more evidence is needed.
Women who have had more than one baby, especially without much time to recover and strengthen between pregnancies, are also susceptible because their abdominal wall is “weakened tissue on top of weakened tissue,” says Welch.
You know you have diastasis recti when that divot in the center of your stomach feels like a soft crevasse about 1-inch wide (or more). Severe diastasis recti may feel like a pool of Jell-O. That’s because the rectus abdominis muscles are pushed further apart, offering no resistance in the middle, even when you tighten your abs. Alternatively, you may notice a “pooch” around your belly button that looks like a ball of pizza dough.
In contrast, some diastasis recti symptoms are less obvious. Your stomach may look flat, but the waistline is wider, necessitating a bigger pants size.
Back pain is a common side effect because a weakened core can put added strain on your posterior. This is what happened to Jenny, the mother of 4, says Welch. By working together to improve her abdominals, they also treated her aches and pains.
With a big belly, you may not realize you have diastasis recti during pregnancy. Essentially, the condition might reveal itself only when a woman is trying to bear weight in her abs, says Welch—only to then find that her ab muscles don’t compress as they normally would. If you have a suspicion that you have ab separation, do a self-examination about six weeks postpartum, which will help keep you from mistaking fatty tissue with diastasis recti. Here’s how to perform a diastasis recti test:
- Lie flat, knees bent, like you’re preparing for a crunch.
- Place your fingers on the center of your belly—either at the belly button on just below the ribs.
- Gently lift your head, in a modified crunch.
- Note how your belly feels.
If you feel a “pool of softness,” says Welch, it’s likely that the muscles aren’t zipped tight down your torso. This lack of muscle integrity is a tell-tale sign of ab separation.
If you feel a bulge, like a little hill across your stomach, it could also be diastasis recti. Typically, your abs should contract, flattening everything. But if those muscles are weak or separated, then skin and any fatty tissue can pop or “cone” up. (In rare instances, a bulge may also be a symptom of a hernia. Talk to your doctor if you think this may be the case.)
The good news about diastasis recti is it’s almost never too late to treat it. “Your body is so resilient,” says Keller, co-author of an Obstetrics & Gynecology paper on diastasis recti and exercise. In terms of diastasis recti treatment, you have options, including some at-home solutions.
Diastasis recti exercises
Contrary to popular belief, it’s okay if you weren’t exactly diligent about your core exercises during your pregnancy. As Keller discovered in her research, all subjects achieved similar improvements, whether they took part in an exercise program to prevent diastasis recti during their pregnancy or only after it. What’s more, you don’t even have to do diastasis recti exercises immediately postpartum. You can actually still make a difference years after giving birth.
The key is to build strength in the transverse abs to help stabilize the waist, which in turn helps activate the rectus abdominis. Consistency counts too. Jenny focused on the exercises 20 to 30 minutes at a time, four to five times a week, along with a weekly hour-long session with Welch. By three months, her diastasis recti was closing, and she was able to achieve planks with her knees on the ground and supported sit-ups. Results of course vary, but experts say, generally speaking, daily exercises between 10 and 30 minutes can bring noticeable improvements between six and 12 weeks. Best of all, you don’t need a lot of equipment. Here are two easy moves from Welch:
• Heart-opening yoga poses. A gentle one to start with is a modified cobra pose. It keeps your hips on the floor, anchoring the body to prevent the lower ribs from expanding more than necessary. As you continue your postpartum routine, consider how your abs are engaged and whether the exercises cause additional strain before you move on to more challenging poses.
• Toe taps. Welch recommends using a soft foam roller to “wake up” your body—“it allows your back muscles to relax and let the front turn on,” she says. Place the roller under the pelvis, like a bolster, and then do toe taps to isolate the transverse abdominals. “It’s like lifting weights with your abs, and the weight is your legs,” Welch explains.
Body wraps or bands
While these corset-like belly wraps can’t correct diastasis recti on their own, they can help support the lower back and abdomen as well as hold the abdominal muscles closer together to facilitate the healing process, Keller says. Body wraps can also help with posture, naturally supporting the connective tissue in the front. However, they may also exacerbate uterine prolapse. If you feel downward pressure, as if you need to pee, it’s best to skip them.
Diastasis recti surgery
This option—involving mesh reinforcements and sutures to bring the midline together—is controversial, and there are four different types. You should try an exercise and diet program for at least 12 weeks before considering this route, experts say, and hold off altogether if you’re planning to have another baby. A new pregnancy can essentially undo the procedure.
Diastasis recti is not inevitable. “You can prevent it,” Keller says, “or you can at least make it as minimal as possible so there is less trauma to the tissue.” Start by building up the strength in your abdominal wall even before your pregnancy, and certainly in its early stages. Tahery, who compares labor to a marathon, emphasizes that you have to prepare for it to help avoid potential damage. Even if there are labor-related injuries, a healthier body will recover much faster. “When you exercise, it increases blood flow,” he says. “Healing is a lot easier.”
While exercise is encouraged, be smart about it—particularly when you’re bearing weight against gravity and especially around the midline. Trying to hold a full plank with a balloon belly is asking for trouble. “It’s too difficult to do it safely, especially in the second and third trimester,” Keller says. “The chance of injury is too high to justify the benefit.” Mountain climbers can also destabilize your core. “Your body is already stretched to its limit,” Welch adds.
Instead, modify core-intensive activities by adding support. For instance, leaning on your knees or a sturdy sofa can distribute body weight better. Alternatively, focus your core work on seated and side-lying prenatal exercises that engage the transverse abdominal line. With proper exercise and awareness, you can worry less and focus your attention on what’s inside that baby bump.
About the experts:
Rachel Welch is a Brooklyn, New York-based postnatal fitness instructor and founder of Revolution Motherhood a doctor-recommended fitness method that integrates breath-based core activation, soft foam fascial rolling, yoga, pilates, barre and pelvic functional exercises. She earned a Master Certificate at Motherhand Shiatsu and received her 200-hour yoga teaching certificate in 2005. Welch is also a certified health and wellness coach from Wellcoaches International.
Michael Tahery, MD, is a Los Angeles-based ob-gyn with subspecialty training in urogynecology. He graduated from The Mayo Clinic in advanced pelvic surgery and urogynecology with specialty training in obstetrics and gynecology from the University of New York, and has been in private practice for more than 20 years. Tahery also serves as an assistant professor of obstetrics and gynecology at UCLA’s David Geffen School of Medicine.
Leah Keller is a certified personal trainer and the founder of Every Mother in New York. The pre- and postnatal fitness exercise program (previously known as The Dia Method) is designed to prevent and resolve diastasis recti and improve core strength and function while building total body fitness through safe, effective workouts.
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