Diastasis Recti – Solutions for Abdominal Separation After Pregnancy

Pregnancy can result in significant changes to a woman’s body, including a persistent bulge around the tummy area, which may be associated with excess fullness in the lower abdomen, also known as a post-pregnancy pouch. Abdominal muscles may become permanently separated after childbirth, known as diastasis recti or abdominal separation. Abdominal separation can be effectively treated with a tummy tuck to achieve a toned and flat abdomen.

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What is abdominal separation?

Abdominal separation is also known as diastasis recti. The abdominal muscles are primarily composed of the rectus abdominis which are the muscles located near the midline of the stomach. During pregnancy, the enlarging uterus expands outwards and results in the separation of the two parallel abdominal muscles, which lie on either side of the midline. As the baby begins to enlarge during the later stages of pregnancy, the increased intra-abdominal pressure causes the overlying abdominal muscles to undergo abdominal separation. It is exacerbated by the hormonal surges which occur during the second half of pregnancy.

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The vast majority of women who undergo childbirth develop diastasis recti in the postpartum period. Certain women are more likely to develop abdominal separation, including:

• Those with weak abdominal muscles.
• Women who had more than one baby at delivery – twins or more.
• Women who have undergone multiple pregnancies in the past
• Older women, typically over the age of 35

What is Diastasis Recti?

Diastasis recti is a condition where the two large parallel bands of muscles that make up the rectus abdominis (commonly known as the “six-pack” muscles) separate along the midline of the abdomen. This separation is caused by the thinning and stretching of the linea alba, a connective tissue that runs vertically between the left and right sides of the abdominal muscles.

Diastasis recti is most commonly associated with pregnancy, as the growing uterus can cause the abdominal muscles to stretch and separate to accommodate the growing baby. However, it can also occur in men and women due to obesity, improper exercise techniques, or other factors that put excessive strain on the abdominal muscles.

Symptoms of diastasis recti may include a bulging or protruding abdomen, lower back pain, poor posture, and difficulty with certain movements that engage the core muscles. In some cases, diastasis recti can resolve on its own, but physical therapy, targeted exercises, or in more severe cases, surgery may be recommended to correct the issue.

What causes a bulging tummy after childbirth?

A bulging tummy after childbirth is a common concern for many women. Several factors contribute to this issue, and understanding these causes can help in addressing and managing the problem effectively. Here are the primary causes of a bulging tummy after childbirth:

1. Pregnancy weight gain: During pregnancy, women gain weight as their body adapts to the growing fetus, with the weight distributed in various areas, including the abdomen. After childbirth, it takes time for the body to shed the extra weight, which can cause the tummy to appear bulging or protruding.
2. Stretching of abdominal muscles: Pregnancy causes the abdominal muscles to stretch significantly to accommodate the growing uterus. This stretching can lead to a condition called diastasis recti, where the two sides of the rectus abdominis muscle (the “six-pack” muscle) separate, causing a bulge in the midline of the abdomen. Diastasis recti can persist even after childbirth, resulting in a protruding tummy.
3. Hormonal changes: Hormones play a significant role during pregnancy and postpartum. Hormones such as progesterone and relaxin cause the connective tissues in the body to loosen, which can affect the abdominal muscles and fascia, leading to a bulging tummy. Additionally, fluctuations in hormone levels can also influence weight retention and distribution after childbirth.
4. Slower metabolism: Metabolism tends to slow down during pregnancy and after childbirth. This decrease in metabolic rate makes it more challenging for the body to burn calories and lose weight, contributing to a bulging tummy.
5. Weak pelvic floor muscles: Pregnancy and childbirth can weaken the pelvic floor muscles, which provide support to the abdominal organs. A weakened pelvic floor can cause the abdominal organs to sag, leading to a protruding tummy.
6. Genetics: Some women may be genetically predisposed to retaining abdominal fat or experiencing muscle separation after childbirth. This genetic predisposition can make it more challenging for them to achieve a flat tummy after giving birth.
7. C-section scarring: Women who undergo a caesarean section may experience a bulging tummy due to scar tissue and adhesions that form around the incision site. This scarring can cause the lower abdomen to appear pouch-like or protruding.

To address a bulging tummy after childbirth, a combination of lifestyle changes, such as a healthy diet, regular exercise, and targeted strengthening exercises for the abdominal and pelvic floor muscles, may be helpful. In some cases, medical intervention, such as physiotherapy or surgery, may be necessary to correct issues like diastasis recti or excess skin. It is essential to consult a plastic surgeon for personalised advice and guidance on managing a bulging tummy after childbirth.

What are the clinical features of diastasis recti?

Abdominal separation is most commonly characterised by an obvious bulge which is located in the middle part of the abdomen which has not gone away after childbirth. Some women may be able to visualise a clear gap between the two parts of the rectus abdominous muscles. This gap between the two muscles can be accentuated when women lie on their backs and with their heads raised. Bulging of the abdominal muscles may also lead to women developing back pain. Weakened abdominal muscles are less able to stabilise the lower back. Many women may also develop urinary incontinence or pelvic floor dysfunction due to damage to the pelvic floor during childbirth.

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How can I tell if I have abdominal separation?

Diastasis recti can be easily identified by lying on your back with your knees bent and feet placed firmly on the floor. Your head should be gently raised whilst you place a hand along the middle part of your abdomen both above and below the umbilicus. With abdominal separation, a distinct gap can be felt in between your abdominal muscles, which may be more than 2 to 3 fingerbreadths in width.

We would recommend having an in-person consultation with a consultant plastic surgeon to determine whether you have diastasis recti.

What does diastasis recti feel like?

Diastasis recti can feel different for each person, and some may not experience any noticeable symptoms. However, common sensations and symptoms associated with diastasis recti include:

1. A bulging or protruding abdomen: You may notice that your stomach appears to be pushing outward, creating a dome-like shape when you engage your abdominal muscles or perform certain movements, such as sitting up from a lying position.
2. Palpable gap between the abdominal muscles: When lying down or engaging the core muscles, you may feel a gap or separation along the midline of your abdomen where the rectus abdominis muscles have separated. The width of this gap can vary among individuals.
3. Lower back pain: Weakness in the abdominal muscles due to diastasis recti can lead to poor posture and increased strain on the lower back, resulting in discomfort or pain.
4. Core instability: You may experience difficulty with core-engaging movements, such as maintaining balance, sitting up, or lifting objects.
5. Gastrointestinal issues: In some cases, diastasis recti can contribute to digestive problems, such as constipation or bloating, due to weakened abdominal muscles.

Does diastasis recti go away on its own?

Whilst regular exercise and healthy eating can help to tone your body following pregnancy. Persistent abdominal bulging caused by abdominal separation can be affected by several factors, including:

• Your skin quality or elasticity
• How many times have you undergone childbirth
• The number of babies delivered and their birth weight
•   How much weight you gained during pregnancy and then lost after childbirth

More than one-third of women who have undergone childbirth experience symptoms of diastasis recti. Diastasis recti does not go away on its own and cannot be improved in most cases by eating healthily and exercising regularly. The only way to repair weakened abdominal muscles after childbirth is to have an abdominoplasty with muscle repair.

What exercises should be avoided if I have abdominal separation?

Certain exercises and activities should be avoided to prevent diastases recti getting worse, including:

• Lifting heavy weights
• Abdominal crunches or planks
• Traditional push-ups

How common is diastasis recti in the UK?

There is limited data on the exact prevalence of diastasis recti in the UK. However, studies from various countries have shown that diastasis recti is a common condition, especially among pregnant women and postpartum mothers. Estimates suggest that about 33% to 60% of women may experience diastasis recti during pregnancy or after giving birth.

Can diastasis recti be corrected?

Abdominal separation can be effectively corrected with a tummy tuck or an abdominoplasty combined with muscle repair when regular physical exercise or physiotherapy has failed to achieve improvement.

RELATED: What is Diastasis Repair?

Can you fix diastasis recti without surgery?

In some cases, diastasis recti can be improved or resolved without surgery through conservative treatments such as physical therapy, targeted exercises, and lifestyle modifications. The goal of non-surgical treatment is to strengthen the abdominal muscles, improve core stability, and promote the healing of the connective tissue (linea alba). Some non-surgical treatment options include:

1. Physiotherapy: A physiotherapist can create a personalised exercise program that targets the transverse abdominis and pelvic floor muscles, which are essential for core stability and support. They can also provide guidance on proper posture and body mechanics to reduce strain on the abdominal muscles.
2. Targeted exercises: Focusing on exercises that strengthen the deep core muscles, such as the transverse abdominis, can help improve diastasis recti. Examples include pelvic tilts, deep abdominal breathing, and modified planks. It’s crucial to avoid exercises that may worsen the condition, such as traditional sit-ups, crunches, or any movement that causes the abdominal muscles to bulge outward.
3. Lifestyle modifications: Maintaining a healthy body weight, practicing good posture, and avoiding activities that strain the abdominal muscles can help prevent diastasis recti from worsening and promote healing.

Wearing an abdominal binder or support garment: In some cases, wearing a support garment or binder may provide temporary relief and support for the abdominal muscles. It’s essential to consult a healthcare professional or physical therapist for recommendations and proper usage.