Diastasis Recti Is The Post-Pregnancy Condition Nobody Talks About

If your back hurts and your belly feels different after giving birth, there could be a medical reason.

img HealthyWay

Danna Lorch had never heard of diastasis recti when she was pregnant, but even if she had, the new mom didn’t have time to think about her stomach muscles after she gave birth. Back and forth she went from her hospital room—where she was recovering from an emergency c-section—to the neonatal intensive care unit, where her newborn son needed her to hold him and feed him.

No one told her then that the muscles at the core of her body might have been stretched apart during her pregnancy. In fact, it wasn’t Lorch’s physician who diagnosed her with diastasis recti. And it wasn’t the first physical therapist she saw about the agonizing pain in her hip—or the second. It took three physical therapists before the problem with Lorch’s abdominal muscles finally had a name and she could get some help.

The number of people who experience diastasis recti after pregnancy is hard for researchers to quantify. Diastasis recti—a separation of the rectus abdominis muscles in your abdomen that leaves a gap that allows your belly to pooch out—isn’t always diagnosed.

Some people with diastasis recti simply assume they’re having a hard time losing weight after giving birth or having back pain because they’ve been hunched over a baby while breastfeeding or feeling the strain of carting a bulky infant carrier. They may not be wrong, but then again, there may be another underlying condition that’s exacerbating that sore back and unrecognizable tummy.

In one study of 300 first-time pregnant women who were followed from pregnancy till 12 months postpartum, the prevalence of diastasis recti was 33.1 percent, 60 percent, 45.4 percent, and 32.6 percent at gestation week 21, 6 weeks, 6 months, and 12 months postpartum, respectively. In other words, a whole lot of pregnant people. In the study, which was published in the British Journal of Sports Medicine, the researchers found no difference in risk factors between those who had diastasis recti and those who didn’t. No one did anything “wrong” to create this painful condition. It simply happened.

So how can you tell if you might end up with diastasis recti after giving birth? And what exactly is it?

Deciphering Diastasis Recti

Diastasis recti is the separation of the rectus abdominal muscles. But does that mean the muscles in the abdomen suddenly decide to go walkabout? And if yes, why?

According to Mary Fleming, MD, an OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania, pregnancy is often to blame. As the uterus expands to accommodate a growing fetus, it puts pressure on the abdominal wall and stretches these muscles. In part, that’s a necessity of pregnancy. Our hormones ebb and flow, softening and stretching the muscles of the abdomen to accommodate the baby as it develops.

For most, that stretching is simply a way for the abdomen to round out as the uterus grows. But for others, that stretching will push the muscles apart, and the muscles won’t quite spring back into place. That’s diastasis recti.

This can happen to anyone who is pregnant, but if you have a c-section, the risk increases because the muscles have to be surgically separated during the procedure to allow doctors access to the uterus to deliver the baby.

“For most women, these muscles will return to the normal place after delivery (of either type),” Fleming says, “However, for some women they do not, leaving a separation or gap, which can be seen as a midline bulge below the umbilicus (belly button). Diastasis recti is the clinical term for this condition.”

Do I have diastasis recti?

Let’s face it: The state of the abdominal area after giving birth can really vary. Some women seem to have magical powers that pop everything back from whence they came just minutes after birth. (Or so it feels anyway…we’re looking at you, Duchess Catherine!) For others, nothing in the abdominal region will ever look quite the same as it did before they earned their tiger stripes.

According to one study, diastasis was present among all women at 36 weeks of pregnancy and decreased to 39 percent at 6 months postpartum.

How it looks doesn’t (or shouldn’t) matter. But how it feels does, and the pain and discomfort that can come with diastasis recti shouldn’t be ignored.

Of course, it’s hard to say just how many women find that their abdominal region is affected by diastasis recti. There is limited research on the condition. But according to one study, diastasis was present among all women at 36 weeks of pregnancy and decreased to 39 percent at 6 months postpartum, says Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix in Arizona.

What makes it hard to judge just how often the condition crops up is that for some people, diastasis recti will resolve on its own without medical intervention. This can happen in as little as six months, Fleming says, leaving a new mother largely unaware that her abdominal muscles decided to start wandering away from one another.

What’s more, the stigma of dealing with post-pregnancy weight can keep some parents from talking to their doctors and finding out they have diastasis recti. Even reporting on the topic of diastasis recti has been met with debate over society’s health and beauty standards and the damaging effect they can have on a new parent’s psyche. But again, it’s important to note that diastasis recti treatment isn’t about creating a “perfect mom bod.” It’s about healing the muscles of the abdomen and helping you regain core strength, which connects to overall body health.  

As Lorch says, “[Diastasis recti] kept me from feeling strong for a long time and also made me wonder why I wasn’t conforming to the pervasive ‘bounce back baby body’ nonsense that celebrity gossip magazines pump out at us.”

When someone is grappling with angst over why their body just isn’t “bouncing back” the way the tabloids tell us it should, an actual medical condition that’s split their abdominal muscles is often the last thing that comes to mind.

Diagnosis: Recti

While some folks never get help (or put it off), for others, diastasis recti can be debilitating enough to send them running to their doctor, begging for help.

That’s what happened to Grace Everett. The mom of two sons, ages 5 years and 20 months, felt what she calls “pretty acute back pain” after her second child was born, and it became untenable somewhere around the six- to eight-week mark.

“At that point, the rest of my body had recovered from the c-section, but I realized my back was not doing well at all; in fact, it seemed to be getting worse,” Everett recalls. “I wasn’t able to do normal things, like pick up my preschooler or clean (without pain) and had trouble sleeping.”

When she mentioned the pain to her doctor, they referred her to a physical therapist, where she was officially diagnosed with diastasis recti.

“[It] was essentially making my back work way too hard, because my core was totally out of commission,” Everett says. “‘My physical therapist was amazing from the start. She used an ultrasound machine so we could actually see what my muscles were doing. And then we started off small, with very specific exercises that were invisible to watch, where I was laying down prone just trying to get my abs to wake up. I had to retrain my core to engage and convince my back it wasn’t needed.”

Aside from back pain, another sign that you might have diastasis recti is a bulge right in the center of your abdominal area. This bulge will be vertical and is most apparent when sitting up from a lying-flat position, Mahnert says.

This can happen just days after giving birth, and it’s typically not an emergency situation. But it’s not normal for significant or severe pain to be associated with the separation, so that would warrant an immediate call to your doctor, Mahnert cautions.

Whether it’s pain, a bulge, or things just don’t feel right, it’s worth mentioning to your OB-GYN how your abdomen is feeling after birth. After all, this is why follow-up obstetrical care is recommended post birth—so the OB-GYN can catch conditions that relate to pregnancy or birth.

A diagnosis of diastasis recti will usually be made by measuring the length between the two muscles at rest and again when the muscles are contracted. From there, treatment will begin.

Rectifying the Recti: Healing Diastasis Recti

The good news? Surgery is very rarely needed to heal diastasis recti. Although an abdominoplasty can bring the walls of the abdomen together, this operation is considered elective, Mahnert says, meaning it’s often not covered by insurance. What’s more, it’s not recommended until after someone is finished with childbearing.

Instead, physical therapy—like the course that helped Everett get back on track—is the most common path for treatment because it’s both less invasive and more likely to be covered by insurance.

A physical therapist will examine you and begin developing an exercise routine that will target the abdominal muscles without exacerbating your symptoms.

For example, Megan Eggleton, a physical therapist at Grover M. Hermann Hospital in Callicoon, New York, says you’ll want to avoid exercises that increase that bulge, like full sit-ups.

“So very gentle abdominal activation to start, like pelvic tilts, very small crunches, pulling in your stomach like you’re sucking it in and holding for 10 seconds 10 times, and also on hands in knees doing alternating arms and legs,” she says.

Another popular diastasis recti treatment is sitting on an exercise ball and marching in place, Eggleton says, as it will help tighten the core abdominal muscles without worsening the diastasis recti.

Slow and steady can feel frustrating when you just want to feel better, but Lorch found that her physical therapist helped her feel strong and in control of her body again.

“My teacher, Hened, tailored exercises just for my diastasis and even taught me how to check my own stomach as I exercised to make sure I wasn’t straining the gap but strengthening it,” she says. “I saw results in about three months, and in about six the gap had nearly closed. It’s still not perfect by any means, but it’s no longer something that makes me feel weak or self-conscious. I used to love running before the baby and that’s something that I’m finally slowly getting back into.”

“Life won’t get less crazy. So take care of yourself now, so you can keep up once they’re zooming all over the house!”

The process was similar for Everett, who advises other parents in her situation make the call to their doctor as soon as possible, so treatment can begin right away.

“Don’t wait until life gets less crazy,” she says. “We moms have a way of putting off self-care, but honestly, taking an infant to my appointments, where he would just snooze in his car seat, was a heck of a lot easier than when he became mobile and I had to line up a sitter every time. Life won’t get less crazy. So take care of yourself now, so you can keep up once they’re zooming all over the house!”

Why Diastasis Recti Happens

Everett and Lorch both underwent c-sections, which can increase a risk of diastasis recti because of the work a doctor has to do to pull apart the abdominal wall to access the uterus.

But it isn’t only c-section deliveries that can result in the condition, Eggleton says. In fact, pregnancy isn’t the only cause, and it can happen to anyone—women, men, non-binary folks … whoever.

“The most common cause of diastasis recti is pregnancy in women. However, less commonly, it can also be caused by obesity (carrying a lot of weight in the abdominal area), lifting heavy weights incorrectly, and performing excessive and often incorrect abdominal exercises,” Eggleton says.

Few other risk factors for the condition have been identified, which makes it harder for a parent-to-be to prevent diastasis recti. Instead, doctors suggest patients simply follow the same healthy measures they’re recommended to follow anyway: Eat a healthy diet and exercise regularly.

And if diastasis recti does happen, find someone who is qualified to help get you on the path to treatment. The better acquainted they are with diastasis recti, the better chances they have of helping you!

ABOUT THE AUTHOR