Ultimate Guide to Diastasis Recti: What it is, What Causes it, How to Check for it, and How to Heal it
Written by Kara Swanson with contributing clinical research by Dr. Molly Lechtenberg.
I discovered I had diastasis recti with our second baby girl. As soon as I discovered it, I went to work trying to repair it. In this post I’m going to explain what diastasis recti is, what causes it, how to check for it, how to heal it, and even what you can do to prevent the adverse affects associated with it.
Below are the four main sections of this Diastasis Recti Guide. You can use them as the table of contents to take you to the specific information you’re searching for.
Under “How to Prevent Diastasis Recti” you will also find how you can check to see if you have abdominal separation.
I have to admit that I’ve allowed life to get in the way of my DR exercises the past several months. I’ve made some great progress, but I have a little ways to go before it’s gone completely.
Do you have diastasis recti (DR)? Or maybe you know someone who has been affected by it? As common as diastasis recti is, it’s more than likely you or someone you know has been impacted by it. But I am going to explain what exactly diastasis recti is, what causes it, how to prevent it, and how to heal it.
What is Diastasis Recti?
Diastasis Recti diagram courtesy of Baby Center.
The term “diastasis recti” is made of two Greek words: “diastasis” meaning separation and “recti” referring to the rectus abdominis muscle. Diastasis recti is a condition in which the right and left halves of the Rectus Abdominis muscle spread apart at the body’s mid line fascia, the linea alba. Pregnancy hormones combined with the uterus’ pressure against the abdominal wall cause a widening and thinning of the mid line tissue that softens the connective tissue.
According to Dr. Molly Lechtenberg of Breathe Physical Therapy, the tissues widen to make room for the baby. “It is totally natural process. The problem is when it doesn't close on it's own.”
The statistics of diastasis recti can be misleading. Rather than being a matter if, Dr. Lechtenberg explains it’s a matter of when. “100% of women have DR in their 3rd trimester (you have to make space for baby!) but in about 30% of women, it doesn't close naturally by 6 weeks postpartum.”
It can occur anytime in the last half of pregnancy but is most commonly seen after pregnancy when the abdominal wall is lax and the thinner mid line tissue no longer provides adequate support for the torso and internal organs. A space of more than 2 to 2.5 finger-widths, or 2 centimeters, is considered problematic, but can be repaired with the correct exercise program.
Having more than one child can make the condition associated with it more likely, especially if the children are close in age. It’s more common among women who are over 35 and pregnant, or those having a heavy baby, twins, triplets, or more. But women aren’t the only ones to experience diastasis recti. Newborn babies have been known to have diastasis recti as well, but usually goes away on its own. Men can also experience diastasis recti from yo-yo dieting, poor sit-ups technique, or improper weightlifting.
Dr. Lechtenberg points out that there hasn’t been research to directly connect DR with back pain or incontinence, but they do see a correlation clinically. Women who experience diastasis recti have reported symptoms of lower back pain, constipation, and urine leaking. Some have even said they experience difficulty with breathing in extreme cases. In very rare, extreme cases, the tissue may tear, and organs may come through the opening resulting in a hernia.
But the good news is that it can be healed and I am going to help you!
What Causes Diastasis Recti?
Diastasis recti occurs when the uterus begins pushing against the abdominal wall. As previously mentioned by Dr. Lechtenberg, this is a natural part of pregnancy as your body makes room for your baby.
The pressure of the uterus along with the pregnancy hormones cause the midline tissue to widen and become thinner resulting in softened connective tissue. Diastasis recti is most commonly noticed after pregnancy when the woman’s abdominal wall is soft. As a result the midline tissue no longer provides sufficient support to the woman’s internal organs.
When not fully repaired in between pregnancies, diastasis recti can become more severe from several different issues including having more than one child, especially when the children are close in age. Women over the age of 35 also are more likely to experience symptoms possibly related to diastasis recti. Heavier babies or multiple babies born in the same pregnancy can also be a cause.
But did you know women aren’t alone in this experience? Newborns can also experience diastasis recti, but it will typically go away on its own. And men have also been found to experience diastasis recti. For men, it can be caused from yo-yo dieting, poor sit-up form, or other improper exercise techniques.
How to Prevent the Symptoms Often Associated with Diastasis Recti
How common is distasis recti? And can you prevent it? These are both common questions when talking about DR.
I have good news and I have not-so-good news. Let’s get the not-so-good news out of the way: diastasis recti is more common than you might think. According to Dr. Lechtenberg 100% of women get it during the 3rd trimester.
Now for the GOOD NEWS! The severe symptoms sometimes associated with Diastasis recti can be prevented!
[SIDE NOTE: Stay tuned – I’ll explain how to heal diastasis recti.]
Some women’s mid lines will close to less than 2 finger-widths after birth without doing anything. But this isn’t the case for many. For most women with diastasis recti, the tissue separation remains too wide and can end up causing problems. So let’s discuss what we can do to prevent this from ever becoming an issue.
Protecting your midline should be a top priority during pregnancy. Lynn of Intuitive Hands Physical Therapy in Colorado says women should be protecting their belly by contracting the belly button back toward the spine with everything they do during pregnancy. As with most prevention, the symptoms associated with diastasis recti can be avoided by following a few simple guidelines.
Exhale with any effort
As a mom with a baby, in addition to your many daily tasks, you might pick up your baby countless times throughout the day. Simply exhaling during these movements is better than any other exercise. "One of the best tools and easiest things to do is to exhale with any effort. Since we know women with more than one child are more susceptible, especially those with children close in age, being mindful of how you are picking up toddlers can be more effective than any exercise," suggests Dr. Lechtenberg.
Utilize the log roll method when getting out of bed (or couch)
Ben Butts, P.T., director of rehabilitation services and Performance Therapy at Providence Saint John’s Health Center in Santa Monica, California strongly recommends protecting your vulnerable abdomen from separation by using the log roll maneuver to help when getting out of bed, up off the couch, or off the floor (any time you are laying in a supine position). This is often a method healthcare providers recommend patients utilize in the hospital. Parents Magazine explains the log roll method as, “rolling onto one side with your torso and head aligned, then using your arms to help push yourself up to a sitting position.”
Use caution when lying down
When laying down, begin by sitting on the edge of the bed. Then pull your belly button back to your spine and lay down on your side pulling your legs up onto the bed. Following this step, place your head on the pillow while you are on your side. As you roll to your back make sure your stomach is once again contracted.
Maintain this method of lying down even after your baby is born.
Avoid certain yoga poses and abdominal exercises
There are many movements to avoid during pregnancy. Yoga poses that stretch your abs such as the cow pose, up-dog, backbends, and belly breathing exercises should all be avoided. Additionally, any pilates exercises that utilize a head float position, upper body flexion, or double leg extension should also be avoided. As a general rule, any yoga or pilates abdominal movement that stretches your abdomen should be avoided during your pregnancy.
Avoid any abdominal exercises that causes your abdomen to bulge during execution. Exercises such as crunches, sit ups, oblique curls, bicycles, and roll ups/roll downs should all be avoided. According to Intuitive Hands Physical Therapy, “Doing a crunch shortens the recti muscles and actually makes any separation worse. When the muscles shorten they bulge out in the middle. Crunches also increases pressure in the pelvic bowl area. This can weaken the pelvic floor muscles and contribute to pelvic organ prolapse.”
Motherhood has enough difficulties. In the next section I’ll explain how you can check to see if you have diastasis recti and the exercises you can do to heal it.
How to Check for Diastasis Recti
After reading all about diastasis recti, I’m sure you’re left with one question: “How do I know if I have diastasis recti?” Thankfully you can conduct an easy assessment on yourself to know if you have it and how severe it might be.
For about 30% of women, diastasis recti will not close on its own by 6 weeks postpartum. So give yourself 6 weeks postpartum before you checking to see if your DR still persists.
To perform a self-assessment, do the following 4 steps.
Diastasis recti self-assessment
1. Lie on your back with your knees bent, and the soles of your feet flat on the floor.
2. Place your palms on your belly with your fingers on your belly button.
3. Slightly lift your head and neck just off the floor while you press down with your fingers. If you feel a gap down the middle of your abdomen, that is the diastasis.
4. Do the same test right above your belly button and just below the belly button (the separation can vary in width in either location).
When conducting this simple test make sure that you’re using proper form. Simply lifting your head off the floor won’t accurately indicate whether you have diastasis recti or not. Your ribcage must move closer to your pelvis in order to contract your abdominals. Remember that everyone’s midline is lax following childbirth. You may even feel a “hole” while doing this exercise - don’t panic. With time, your midline tissue will become tighter and this hole will begin to disappear (or become more shallow).
If, while performing this exercise, you see a round, hard, bulge protruding from your belly button area, or along your mid line, inform your OBGYN. If not healed, diastasis recti has been reported to cause lower back pain, constipation, and urine leaking. It’s also been reported that it can possibly make vaginal delivery more difficult for future pregnancies.
How to Heal Diastasis Recti
And now for your second burning question: “How do I heal diastasis recti?"
As stated in the previous post, "Diastasis recti: how many women get it? And how do you prevent it?” avoid any exercises, movements, or activities that place stress on your abdominal midline. Any movements that stretch or overly expand the abdomen should be avoided.
Unfortunately, there’s a wide range of advice available online that can make it very difficult to decipher what is best. As Dr. Lechtenberg points out, you might come across advice that leads to unnecessary alarm or even worse, cause further separation if followed.
In general, your midline should be treated delicately following childbirth. As with any new exercise or therapy program, you should consult your physician and/or physical therapist before you begin. Thankfully, there are many beneficial exercises that will heal your diastasis recti.
The following are a collection of safe and highly effective exercises that will help dissipate your abdominal separation and strengthen your midline following pregnancy.
I’ve found the following five exercises to be the most effective in healing my diastasis recti. Once you have accomplished the first four weeks, maintain the repetition schedule of Week 4 in order to heal your midsection.
*If the condition persists, I have also included an exercise you can begin later on. But it should not be used until 9 months postpartum.
Exercises to heal diastasis recti
Week 1:
Exercise 1
Single leg lifts
Repetition: 3 rounds of 5 per side
Exercise 2
Single leg tucks
Repetition: 3 rounds of 5 per side
Exercise 3
Cat-cow
Repetition: 3 rounds of 5
Exercise 4
Table-top
Repetition: 3 rounds of 5
Exercise 5
Single leg lifts
Repetition: 3 rounds of 5
Week 2:
Exercise 1
Single leg lifts
Repetition: 3 rounds of 10 per side
Exercise 2
Single leg tucks
Repetition: 3 rounds of 10 per side
Exercise 3
Cat-cow
Repetition: 3 rounds of 10
Exercise 4
Table-top
Repetition: 3 rounds of 10
Exercise 5
Single leg lifts
Repetition: 3 rounds of 10
Week 3:
Exercise 1
Single leg lifts
Repetition: 3 rounds of 15 per side
Exercise 2
Single leg tucks
Repetition: 3 rounds of 15 per side
Exercise 3
Cat-cow
Repetition: 3 rounds of 15
Exercise 4
Table-top
Repetition: 3 rounds of 15
Exercise 5
Single leg lifts
Repetition: 3 rounds of 15
Week 4:
Exercise 1
Single leg lifts
Repetition: 3 rounds of 20 per side
Exercise 2
Single leg tucks
Repetition: 3 rounds of 20 per side
Exercise 3
Cat-cow
Repetition: 3 rounds of 20
Exercise 4
Table-top
Repetition: 3 rounds of 20
Exercise 5
Single leg lifts
Repetition: 3 rounds of 20
*After 9 months:
You can incorporate single left lifts:
Single leg lifts
Repetition: 3 rounds of 20 per side
Be cautious with this exercise prior to 9 months. “80% of women are not ready for this exercise for at least 9 months,” explains Dr. Lechtenberg.
Additional Frequently Asked Diastasis Recti Questions
Can a diastasis recti be fixed?
Yes, diastasis recti can be fixed. With time and implementing appropriate exercises, this condition can be healed. Sometimes an individual will require physical therapy, and very few extreme cases require corrective surgery.
How do you diagnose diastasis recti?
According to Dr. Molly Lechtenberg, “100% of women have DR in their 3rd trimester.” The tissues in a mother’s abdomen widen to make room for the baby.
Although both women and men can experience DR, it is most often associated with postpartum mothers. To check to see if you have DR, follow these four steps to perform a self-assessment:
1. Lie on your back with your knees bent, and the soles of your feet flat on the floor.
2. Place your palms on your belly with your fingers on your belly button.
3. Slightly lift your head and neck just off the floor while you press down with your fingers. If you feel a gap down the middle of your abdomen, that is the diastasis.
4. Do the same test right above your belly button and just below the belly button (the separation can vary in width in either location).
What causes diastasis recti?
For pregnant and postpartum mothers, diastasis recti is the result of the abdominal tissues separating to make room for the baby during their 3rd trimester.
For men and women who haven’t been pregnant, diastasis recti can be the result of yo-yo dieting, poor sit-ups technique, or improper weightlifting.
Can diastasis recti get worse?
For mothers who have had multiple pregnancies, the abdominal separation associated with diastasis recti can become more severe.
More Diastasis Recti Resources
Want more information about healing your diastasis recti? Go to the Life Well Lived Diastasis Recti page for more tools to help you heal your DR. While you’re there, you can also follow my journey to healing my DR with Dr. Molly Lechtenberg of Breathe.
Let me ask you:
What exercises have you used to heal your diastasis recti?
About the contributing doctor:
Dr. Molly Lechtenberg has worked with clients through all phases of life for over 10 years, but started focusing on women’s health after years of fertility struggles and the traumatic birth of her first daughter. She focuses on hands on therapy to ease pain quickly and she is certified in myofascial trigger point dry needling. She also has training in Medical Therapeutic Yoga, and uses that to restore strength & flexibility after the muscle restrictions are released. You can learn more about her practice by visiting breathedsm.com.
About the author:
Kara Swanson is a certified nutritionist and founder of Life Well Lived. She is married to her best friend and the proud mother of three. Her passion is to make nutrition simple+easy+delicious!