Diastasis recti

Diastasis recti is a condition characterized by the separation of the rectus abdominis muscles, commonly referred to as the “six-pack” muscles, along the midline of the abdomen (1). This gap occurs due to the stretching and thinning of the connective tissue known as the linea alba, which normally holds the two sides of the abdominal wall together. While most people associate diastasis recti with pregnancy, it can also occur in men, infants, and women who have never been pregnant.

Though not life-threatening, diastasis recti can lead to functional and aesthetic concerns, including abdominal weakness, lower back pain, and a persistent bulge in the stomach area. Understanding the symptoms, causes, and treatment options of the condition can help individuals manage it effectively and prevent potential complications (1).

Symptoms

The symptoms of diastasis recti can vary depending on the severity of the separation. Some people may experience mild cosmetic concerns, while others may face functional limitations (2). Common signs and symptoms include:

• Abdominal Bulge: A visible or palpable ridge that runs down the midline of the stomach, especially noticeable when performing activities like sitting up or coughing.
• Core Weakness: Difficulty engaging the abdominal muscles, making it harder to lift objects, perform exercises, or maintain proper posture.
• Lower Back Pain: Due to weakened core stability, the lower back may compensate, resulting in discomfort or chronic pain.
• Poor Posture: Core weakness often leads to slouching or difficulty maintaining an upright position.
• Digestive Issues: Some individuals report bloating, constipation, or a feeling of abdominal instability.
• Urinary Incontinence: In severe cases, weakened pelvic floor muscles associated with diastasis recti can contribute to leakage of urine.

Causes

Diastasis recti develops when the linea alba stretches excessively, reducing its ability to hold the abdominal muscles together (3). Several factors can contribute to this

• Pregnancy: The growing uterus puts pressure on the abdominal wall, leading to separation. Hormones like relaxin and estrogen also soften connective tissues, making them more prone to stretching.
• Rapid Weight Changes: Significant weight gain, obesity, or sudden weight loss can strain the abdominal wall.
• Improper Exercise: Performing core-intensive exercises (like crunches or sit-ups) incorrectly or excessively, especially with poor form, may exacerbate the condition.
• Heavy Lifting: Straining the abdomen while lifting weights or objects without proper core engagement can lead to muscle separation.
• Genetic Factors: Some individuals have inherently weaker connective tissues, making them more susceptible.
• Infancy: In newborns, diastasis recti may occur due to incomplete development of abdominal muscles. It usually resolves on its own as the child grows.

Risk Factors

Certain groups are at a higher risk of developing diastasis recti. These include:

• Pregnant and Postpartum Women: Especially during multiple pregnancies, pregnancies with large babies, or closely spaced pregnancies (4).
• Older Adults: Connective tissues naturally lose elasticity with age.
• Men with Central Obesity: Excess abdominal fat increases pressure on the abdominal wall.
• Individuals with High-Intensity Training Routines: Improper core training or heavy lifting without technique awareness.
• Premature Infants: Their abdominal wall may not be fully developed, leading to temporary diastasis recti.

Diagnosis

Diagnosing diastasis recti typically involves a physical examination performed by a healthcare provider (2). During the exam:

• Palpation Test: The patient lies on their back and slightly lifts their head while the examiner feels along the midline of the abdomen. A gap of more than two finger widths is often considered significant.
• Imaging Tests: Ultrasound or CT scans may be recommended in severe cases to measure the extent of muscle separation and rule out hernias.
• Self-Assessment: Many individuals can notice the bulge themselves while performing simple movements like sit-ups or coughing.

Early diagnosis is essential, as untreated diastasis recti can worsen over time and contribute to functional limitations.

Treatment Options

Treatment for diastasis recti depends on the severity of the condition, symptoms, and individual goals. Options include:

Physical Therapy 

Targeted exercises are the cornerstone of managing diastasis recti (3). These focus on strengthening the deep core muscles, such as the transverse abdominis, while avoiding movements that worsen separation. Common techniques include:

• Pelvic Tilts
• Abdominal Bracing
• Modified Planks
• Heel Slides
  Working with a physical therapist ensures exercises are performed correctly and safely.
• Lifestyle Modifications
• Maintaining a healthy weight to reduce abdominal pressure (3).
• Practicing proper lifting techniques.
• Avoiding straining during bowel movements by ensuring adequate fiber and hydration.
• Supportive Devices

Abdominal binders or wraps may provide temporary support, especially in the postpartum phase. However, they should not replace long-term muscle strengthening.

Surgical Intervention

In severe cases or when conservative treatment fails, surgery may be recommended. Abdominoplasty (commonly known as a tummy tuck) can repair the separated muscles and restore core strength. This option is generally considered for individuals with significant functional impairment or cosmetic concerns.

Living With or Prevention

For many, diastasis recti can be managed effectively with lifestyle changes and targeted rehabilitation. Preventive and long-term strategies include (4):

• During Pregnancy
  • Engaging in safe, pregnancy-friendly core exercises.
  • Avoiding heavy lifting or intense abdominal workouts.
  • Using supportive garments as recommended by a healthcare provider.
• Postpartum
  • Beginning gentle core rehabilitation exercises under professional guidance.
  • Avoid high-impact exercises until cleared by a physician.
  • Gradually rebuilding strength rather than rushing into pre-pregnancy workout routines.
• General Prevention
  • Maintaining a stable, healthy weight.
  • Practicing good posture to reduce unnecessary pressure on the abdominal wall.
  • Using proper breathing techniques during exercise and heavy lifting.

Living with diastasis recti requires patience and consistency. With appropriate care, many individuals see significant improvement in symptoms and function. In cases where surgery is needed, outcomes are typically favorable when combined with ongoing exercise and lifestyle management.

References

1. Skoura A, Billis E, Papanikolaou DT, Xergia S, Tsarbou C, Tsekoura M, Kortianou E, Maroulis I. Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J. 2024 Mar;35(3):491-520. doi: 10.1007/s00192-024-05727-1. Epub 2024 Feb 10. PMID: 38340172; PMCID: PMC11023973.
2. Beamish NF, Davenport MH, Ali MU, Gervais MJ, Sjwed TN, Bains G, Sivak A, Deering RE, Ruchat SM. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. Br J Sports Med. 2025 Mar 31;59(8):562-575. doi: 10.1136/bjsports-2024-108619. PMID: 39694630; PMCID: PMC12013572.
3. de Oliveira LC, de Almeida LIM, Lucio MCF, Campos Júnior JF, de Oliveira RG. Effects of conservative approaches for treating diastasis recti abdominis in postpartum women: A systematic review and meta-analysis. Medicine (Baltimore). 2025 Jun 6;104(23):e42723. doi: 10.1097/MD.0000000000042723. PMID: 40489856; PMCID: PMC12151038.
4. Nahabedian MY. Management Strategies for Diastasis Recti. Semin Plast Surg. 2018 Aug;32(3):147-154. doi: 10.1055/s-0038-1661380. Epub 2018 Jul 24. PMID: 30046291; PMCID: PMC6057788.