Diastasis Recti: What You REALLY Need to Know

Diastasis recti defined in simple terms

linea-alba-diastasis-recti
L: The green arrow indicates the linea alba, the white line between the left and right sides of her abdominals. R: The blue arrow indicates the linea nigra, a dark line that appears in some pregnant women on the skin over top of the linea alba.

Maybe you’ve heard about diastasis recti because someone diagnosed you with one. Or maybe you’ve heard others talk about it, but you still feel a little in the dark about what it really means.

As an example, you’re probably very comfortable with the idea that you have a left and right arm. Along the same lines, you also have a left and right side to your abdominal muscles. The soft tissue between these two sides is called the linea alba (white line). To help you find its location, the skin over top of the linea alba is what turns darker during pregnancy, forming the linea nigra (black line).

A diastasis recti occurs when the linea alba stretches. It’s generally defined as a gap between the left and right abdominal muscles of greater than 2 cm or any outward bulging at midline. (In the title picture, you can see a gap on the far left and bulging on the far right).

When does a diastasis occur?

It occurs in 100% of women who make it to their due date. Yes. 100%. Here’s the research. (This link only takes you to the abstract. If you want to access the entire article, click the link for Volume 20, Issue 1, and it will give you an option to download the PDF.)

You can think of it like this. The cervix and the vagina of a woman who isn’t pregnant could never pass a baby through them. One of the many amazing feats of a pregnant body is that it expands to meet this demand for childbirth. Opening and stretching of the vagina and cervix are necessary for a successful vaginal delivery in the same way that stretching of the linea alba is necessary for the growing of a full term baby.

Unless her baby is very tiny and is born very preterm, the mother will develop a diastasis recti as her belly expands and her abdominal muscles and linea alba stretch out to accommodate the growing baby. The time at which it occurs will vary from woman to woman.

So, why all the hype?

mom-pooch
A belly that looks like this MAY have a diastasis recti but not necessarily.

Because they don’t all go away on their own. According to this study, at one year postpartum, 32% of first time mothers still have a diastasis recti. (This study did not consider mothers of multiples or mothers with more than one child).

Why does that matter? Because the separation of the abdominals usually results in decreased strength and function. Additionally, a diastasis recti has an increased risk of umbilical hernia. These women may also have low back, pelvis or hip pain; pelvic floor dysfunction (including leaking of urine or feces); or a protruding belly (commonly referred to as mom pooch or mummy tummy).

A diastasis doesn’t necessarily cause any of these conditions, but resolving what causes the diastasis often resolves the accompanying scenario. Let’s say that again, just in case you didn’t get it. A diastasis recti does NOT cause a protruding belly. If you’d like more information on what can cause a protruding belly, this blog post should give you some ideas.

Do YOU have a separation? Here’s how to know:

So, the gold standard is to see a pelvic floor physical therapist. There are doctors and midwives who are great at checking for this, but there are also loads of women who have been told by their doctor or midwife that they don’t have a diastasis when in fact, they do. If you want to do your own test, here are the basics.

Diastasis recti test:

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1. Lie on your back with your knees bent and your feet resting flat on the floor. Raise your shirt up so that you can put your own hands on your skin.
diastasis-recti-test-step-2
2. Place your fingers in your belly button so that your fingernails are facing your feet. Lift just your head from the floor.
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3. You should be able to feel the left and right sides of your abdominals pinch in around your fingers.
— If your abs can close down to a gap of less than 2 fingers, this is not considered a diastasis. — If the gap between the left and right sides of your abdominals is between 2 and 4 fingers, it’s considered a diastasis. —If the gap is greater than 4 fingers in width, it’s considered a severe diastasis.
diastasis-recti-test-step-4
4. Then turn your fingers (still in your belly button) 90 degrees. Let your head down and pick it back up again. —If your fingers meet a firm resistance (similar to a trampoline), this is not a diastasis (left picture). —If your fingers sink down into a squishy space between your abs, this is another sign of a diastasis (right picture).
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5. You want to repeat the check for the width of the gap and the squishiness at several points between your belly button and your pubic bone.
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6. Then you need to check again for both of these at several points between your belly button and your breast bone.

Interpreting your test

bulging-diastasis
Coning or bulging above navel

In addition to the gap and the squishiness, a coning or bulging is also a sign of a diastasis. Each of these (gapping, bulging, or squishiness) means something different about the specifics of YOUR diastasis.

The bulging means you are creating too much outward pressure. The squishiness means you are creating too little. You may see one with a particular task and the opposite with a different task. This is just a reflection of your brain recuiting muscles in a different way depending on the task.

The gap seems to get the most attention, but it really isn’t as important as the squishiness. The gap seems to be narrowed by increased activity of a particular abdominal muscle called rectus abdominus. But the squishiness reflects a lack of connection between the left and right sides of the body and is a much more significant deficit. The squishiness seems to firm up with increased activity from a different ab muscle called transverse abdominus.

What to do if your test is positive for diastasis recti

The gold standard is still a pelvic floor physical therapist.

You can think of your torso like a cylinder of muscle, where your diaphragm is the top of the cylinder and your pelvic floor is the bottom. Then, wrapping around the sides of the cylinder are the muscles of your back and your abs.

If you believe everything you read on the internet, diastasis recti is a problem with your abs, but in reality, it is an issue with this entire muscular cylinder. Consequently, addressing all of the cylinder—and sometimes parts outside the cylinder—can be necessary to resolve a diastasis. In different women, the focus will need to be in different places. Along the same lines, squishiness, gapping, or bulging indicates the need for attention to different concepts.

You may have read about specific DO’s and DON’T’s for diastasis recti. Most of these can be thrown out the window. You know by now that every separation is specific to the woman. Literally, the exact right exercise for one woman can be the exact wrong exercise for the woman sitting next to her. To be clear, I’m not trying to discourage anyone from googling exercises for diastasis recti or from looking them up on YouTube. But I am trying to say that if you don’t find your answers by doing those things, it’s because diastasis recti can be far more complicated than this cookie-cutter approach.

In fact, diastasis recti can be affected by your breathing, your pelvic floor, your hips, your feet, your upper body, OR your abs. If answers like these sound like what you’re looking for, you might be interested in the Mama Made Strong program. On the other hand, posture can be a key piece of the postpartum puzzle, affecting the resolution of diastasis recti, incontinence, or pelvic organ prolapse. A Flatter Belly Without Weight Loss is a free online course about the effects of pregnancy on your posture and how to reverse them.

flatter-belly

6 thoughts on “Diastasis Recti: What You REALLY Need to Know”

  1. Another good post! Next time I go in to the see doctor, I am definitely going to ask about a pelvic floor specialist.

    1. Betsy Petry-Johnson

      Thanks, Mo! I really believe a visit to a pelvic floor PT should be a standard of care after having a baby. For. Everyone.

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