Diastasis Recti: Causes, Symptoms and Treatment
Diastasis recti is a separation of the two parallel bands of the rectus abdominis muscle along the midline. It commonly occurs after pregnancy and may cause back pain, core weakness, and abdominal discomfort.
Things worth knowing about "Diastasis Recti"
Diastasis recti is a separation of the two parallel bands of the rectus abdominis muscle along the midline. It commonly occurs after pregnancy and may cause back pain, core weakness, and abdominal discomfort.
What is Diastasis Recti?
Diastasis recti (also called diastasis recti abdominis) is a condition in which the two parallel columns of the rectus abdominis muscle -- the main vertical muscle of the abdomen -- separate along the midline of the body. These two muscle bands are normally held together by a connective tissue structure called the linea alba. When this tissue is overstretched or weakened, the muscle bands drift apart, creating a visible gap along the center of the abdomen.
A gap of up to approximately 2 cm between the muscle edges is generally considered normal in adults. When the separation exceeds this threshold, the condition is considered clinically significant and may require treatment.
Causes
The most common cause of diastasis recti is pregnancy. As the uterus expands, it stretches the abdominal wall and the linea alba, which may result in a lasting separation. Other contributing factors include:
- Multiple pregnancies or closely spaced pregnancies
- Obesity and elevated intra-abdominal pressure
- Incorrect abdominal exercises (e.g., traditional crunches with excessive strain)
- Chronic cough or chronic constipation with repeated straining
- Connective tissue weakness, which may be hereditary
- Newborns and infants frequently show a physiological form that typically resolves on its own within the first years of life
Symptoms
Many individuals first notice diastasis recti as a visible or palpable bulge or ridge along the center of the abdomen, particularly when performing abdominal movements. Common symptoms include:
- A visible doming or ridge along the midline when tensing the abdominal muscles
- Lower back pain or lumbar discomfort
- A sense of core weakness or instability
- Digestive problems such as bloating or constipation
- Urinary incontinence or pelvic floor dysfunction
- In severe cases: ventral hernia along the linea alba
Diagnosis
Diagnosis is usually made clinically by a physician or physiotherapist. The patient is asked to perform a gentle head lift from a supine position (mini-crunch), while the examiner palpates the gap between the muscle bands.
An ultrasound examination is frequently used to precisely measure the width of the separation and to assess the quality of the connective tissue. In cases where an associated hernia is suspected, an MRI scan may be indicated.
Classification by Severity
- Grade 1: Gap width 2-3 cm
- Grade 2: Gap width 3-5 cm
- Grade 3: Gap width greater than 5 cm
Treatment
Conservative Treatment
For mild to moderate diastasis recti, targeted physiotherapy is the first-line approach. Key components include:
- Specific training of the deep abdominal muscles, especially the transversus abdominis
- Pelvic floor strengthening exercises
- Breathing techniques to regulate intra-abdominal pressure
- Avoidance of high-load exercises such as traditional sit-ups or heavy lifting
- Supportive abdominal binders during the early rehabilitation phase
Surgical Treatment
In cases of severe diastasis recti that does not respond to conservative management, or when an associated hernia is present, surgery may be necessary. The most common procedure is abdominoplasty (tummy tuck), in which the linea alba is surgically repaired and excess skin is removed. Minimally invasive (laparoscopic) techniques are also available at specialized centers.
Prevention
During and after pregnancy, targeted pelvic floor exercises and professionally guided abdominal rehabilitation can help reduce the risk of developing a significant diastasis recti. Pregnant individuals are advised to avoid exercises that place high strain on the linea alba and to participate in postpartum rehabilitation programs supervised by qualified professionals.
References
- Lee D, Hodges PW. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. Journal of Orthopaedic and Sports Physical Therapy, 2016;46(7):580-589.
- Mota P et al. Diastasis recti abdominis in adult women and its association with pregnancy, pregnancy outcomes and morphological variables. Journal of Orthopaedic and Sports Physical Therapy, 2015;45(4):200-205.
- Bø K et al. Evidence-Based Physical Therapy for the Pelvic Floor. 2nd ed. Edinburgh: Churchill Livingstone Elsevier, 2015.
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