Weight Loss

Diastasis recti (abdominal separation): Exercises and how to fix

Diastasis recti is the pulling apart of the two long muscles called rectus abdominis.

The right and left rectus abdominis muscles run vertically along the front of the abdomen. A band of tissue called the linea alba divides them in the middle.

In diastasis recti, the linea alba widens, spreading the abdominal muscles further apart. Consequently, the abdominal contents bulge outward.

Diastasis recti can be congenital, which means that a person has it from birth. However, it usually occurs during pregnancy.

According to a 2016 study, it can also affect males and postmenopausal females.

In pregnancy, diastasis recti is usually due to hormones and the physical effects of carrying a child. The 2016 study investigated a variety of risk factors for diastasis recti during pregnancy and the postpartum period. These risk factors included age, weight gain, multiple babies, and heavy lifting. The authors conclude that heavy lifting was the only factor linked to the condition.

The primary sign of diastasis recti is a midline bulge down the abdomen.

Although this may sometimes be the only symptom, some people may experience additional symptoms, such as:

  • discomfort and pain in the abdomen
  • loss of bladder control
  • accidental bowel leakage
  • musculoskeletal problems, such as lower back pain and pelvic instability
  • pelvic organ prolapse, which means that one or more organs slip down and bulge into the vagina
  • poor self-image
  • lower quality of life

In most cases, doctors can diagnose diastasis recti by taking a thorough medical history and carrying out a physical examination. Ultrasound, CT scans, and MRI scans can help determine the severity of the condition.

A separation larger than 2 centimeters between the rectus abdominis muscles indicates an abnormality.

People can perform a basic self-test for diastasis recti at home by following these steps:

  1. Lie on the back with the knees bent and the feet on the floor.
  2. Place one hand over the midline of the abdomen, keeping the fingers flat.
  3. Place the other hand under the head and neck.
  4. Lift the head slowly and press down on the abdomen with the finger pads.
  5. Feel for a gap between the muscles.

If a person feels a space of more than two finger widths, they should contact a doctor.

In some people, diastasis recti heals on its own without treatment.

Conversely, in approximately 60% of people, the condition persists after the early postpartum period. In these cases, the treatment options include conservative treatment and surgery.

Conservative treatment

Most experts advise starting with conservative treatment methods. First-line treatments may include:

According to a 2019 review, the efficacy of physical therapy is questionable. There is insufficient evidence to determine the best exercises.

However, some research indicates that exercise may help people heal their diastasis recti.

A small 2021 study investigated the effect of a 12-week exercise program in reducing diastasis recti in eight people who had given birth in the last 6–24 months. The program consisted of diaphragmatic, or belly, breathing, along with core strengthening exercises.

It found that a postpartum exercise program can decrease the severity of diastasis recti.

Surgery

If conservative treatment does not produce results in 2–6 months, a doctor may suggest surgery. They can perform surgery open, laparoscopically, or robotically.

  • Open surgery gives a surgeon access to the abdomen via a single large incision.
  • Laparoscopy gives access to the abdomen with multiple small incisions.
  • Robotic surgery involves the use of a camera and mechanical arms that hold surgical instruments.

Open and laparoscopic surgeries are effective, and a doctor can recommend the best option for an individual. Both types have relatively few complications and low recurrence rates. They can also improve symptoms such as urinary incontinence and lower back pain.

According to a 2021 research article, doctors generally do not recommend surgery for people who expect to have future pregnancies.

For other individuals, surgical options include:

  • rectus plication to rebuild the linea alba, which involves tightening the muscles
  • modified hernia repair techniques
  • a combination of the above

Exercises that strengthen the abdominal and pelvic floor muscles may be beneficial in preventing diastasis recti. However, certain exercises can place excess pressure on the abdominal muscles, so individuals should ask a doctor or physical therapist to recommend safe ones for them. Their recommendations may change as the pregnancy progresses.

A small, older 2005 study looked at the effect of exercise during pregnancy on the likelihood of developing diastasis recti. In the study, eight pregnant people participated in an abdominal exercise program, while a group of 10 did not exercise. The authors note a higher occurrence and greater severity of diastasis recti among those who did not exercise.

Other prevention tips include managing weight gain and avoiding heavy lifting.

Diastasis recti involves a separation of the two long muscles down the front of the abdomen. It is common during pregnancy and often persists after giving birth.

The first-line treatment options consist of conservative measures such as physical therapy exercises and weight management. If the initial treatment is not effective after 2–6 months, a doctor may recommend surgery.

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