• Emily Reul, PT, DPT

Diastasis Recti

Hello friends! Did you have a gap in your stomach during the postpartum period? You may have had a diastasis rectus abdominus. It goes by many different names: DRA, diastasis, diastasis recti, or diastasis rectus abdominus. All of these terms are talking about the same thing and we’re going to talk all about what it is, why it matters, and what we can do about it!

What exactly is this dreaded diastasis rectus? It’s simply a widening and thinning of the linea alba tissue which creates a separation between the rectus muscle bellies—your six pack muscles. (Dufour, 2019). The linea alba is the connective tissue that holds all the abdominal muscles together.


When you’re pregnant, the baby (and your belly) grows bigger and bigger which puts some stress on the linea alba and can “stretch” it out. At 21 weeks gestation, 1 in 3 individuals has this separation and the prevalence increases as time goes on. In fact, some studies have shown that up to 100% have this separation at 35 weeks gestation (Chiarello, 2017). About 1 in every 4 individuals has a persistent diastasis rectus 1 year after delivery (Dufour, 2019).


It’s important to note that pregnant individuals are not the only ones who can have a diastasis rectus. While it is more common in pregnancy and postpartum, it can also occur in men and individuals who have never been pregnant (Barbosa, 2013; Sperstad, 2016; Spitznagle, 2007).


Here are some factors that increase your risk of diastasis rectus (Chiarello, 2017)

  • Multiparity (having more than one pregnancy)

  • Multiple gestation (e.g., twins)

  • Older age of the mother

  • Large pregnancy weight gain

  • Large babies

  • Large abdominal circumference

  • Heavy lifting more than 20 times per week during pregnancy (Dufour, 2019)


You may hear your provider or other health professionals talking about or measuring the inter-recti distance (IRD). This is the distance between the two bellies of the rectus muscles. Your provider can measure this distance in many different ways including: a tape measure, their fingers, calipers, or ultrasound. The finger method is the most commonly used method due to ease of use. Being able to fit more than two fingers between the rectus muscles is considered to be a diastasis rectus. While the IRD can play a part in looking at a diastasis rectus, it is not the only factor your provider will consider when determining the severity. Your provider will want to feel your linea alba with their fingers to look at its integrity and how strong it is (Dufour, 2019).


Aside from the gap between the muscle bellies, you may see bulging or coning along the linea alba especially with activities. When activities increase the pressure in your abdomen—think about crunches—the linea alba should be able to support you and withstand the extra force. When the linea alba is weak and stretched, the contents of your abdominal cavity can start to bulge/cone up. The bulging may happen along the entire linea alba (from your breastbone to your pubic bone) or it may only happen in a small section. A diastasis rectus may or may not be painful.


Let’s take a minute to talk about why a diastasis rectus is important. The abdominal muscles work as part of the core to help you move and to provide stability. A diastasis rectus can make these muscles function less optimally. It can cause a decrease in muscle strength and endurance, make it difficult to stabilize the pelvis with movement, cause poor posture, and can cause pelvic floor issues like pain and incontinence (Chiarello, 2017). One study found the 3 out of 4 individuals that had postpartum back or pelvic pain had a diastasis rectus (Parker, 2009).


If you have a diastasis rectus, don’t dread. Conservative (non-surgical options) can be very helpful for most individuals. What does this include? Seeing a pelvic floor physical therapist! The will help you with exercises to strengthen and coordinate the core muscles and can teach you about changing habits and your body mechanics with activities to avoid repeated increased intra-abdominal pressure (Dufour, 2019).


An exercise program should emphasize transverse abdominus activation. Exercises for other muscles like the rectus abdominus, obliques, and multifidus are also helpful. When performing exercises, make sure to get clearance from your provider, especially if you are pregnant or postpartum. Note: Exercises DURING pregnancy can be beneficial—you don’t have to wait until the postpartum period to begin (Chiarello, 2017).


Proper breathing techniques and breathing exercises (like diaphragmatic breathing) can help to manage a diastasis rectus. This allows the abdmonial piston/core (diaphragm, pelvic floor muscles, multifidus, and transverse abdominus) to work with one another. A skilled physical therapist can help teach you these techniques.


Taping is another option for a diastasis rectus, but research shows that taping is better when used in addition to exercises versus just taping by itself (Tuttle, 2018). Other things that can be used are abdominal binders and braces which help to make the inter-recti distance shorter, which puts the muscles in a better position so that they can work more efficiently until the linea alba rebuilds its strength.


Working with a trained professional can be extremely helpful to make sure you are training the right muscles and doing it properly. A skilled physical therapist can make sure your muscles are strong and make sure that they are doing the right thing at the right time. (Bonus: if you see a pelvic floor physical therapist, they can help with any other pelvic floor issues you may be having if you are postpartum!)


Typically, it can take anywhere from 3 months to 2 years to resolve a diastasis rectus. If the diastasis rectus does not improve, there are surgical options for some individuals to “close the gap.” However, surgery often does not improve function and is mainly done for cosmetic purposes (Chairello, 2005).


If you have, or even think you may have a diastasis rectus, take a deep breath. Help is out there!


Here are some great resources to learn more about all things pregnancy, postpartum, and your pelvic health:

  • Ask your healthcare provider for a referral to a pelvic therapist.

  • Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

  • Watch our two-part YouTube interview with Munira Hudani, PT on Diastasis Rectus. Part 1 and Part 2


For Healthcare providers, check out all our continuing education courses here to help you better serve your clients. You can purchase courses individually or join our Ambassador Program and most of our courses are included with your membership!


Written by Emily Reul, PT, DPT


References

1. Barbosa S, de Sa RM, Velarde LC. Diastasis of rectus abdominis in the immediate puerperium: correlatin between imaging diagnosis and clinical examination. Arch Gynecol Obstet. 2013;288(2):299-303.

2. Sperstad JB, Tennfjord MK, Hilde G, Ellstrom-Engh M, Bo K. Diastasis rectui abodominis during pregnancy and 12 months after childbirth: prevalence, risk factors, and report of lumbopelvic pain. Br J Sports Med, 2016;50:1092-1096.

3. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18(3):321-328.

4. Chiarello CM, McAuley JA. Concurrent validity of calipers and ultrasound imaging to measure interrecti distance. J Orthop Sports Phys Ther. 2013;43(7):495-503.

5. Chiarello CM. Pregnancy-related pelvic girdle pain and diastasis rectus abdominis. J Womens Health Phys Therap. 2017;41(1):3-9.

6. Parker MA, Miller LA, Dugan SA. Diastasis rectus abdominis and lumbo- pelvic pain and dysfunction: are they related? J Womens Health Phys Ther. 2009;33(2):15–22.

7. Tuttle LJ et al. Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study. J Womens Health Phys Therap. 2018;42(2):65-75.

8. Chiarello CM et al. The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Therap. 2005;29(1)11-16.

9. Dufour S, Bernard S, Murray-Davis B, Graham N. Establishing expert-based recommendations for the conservative management of pregnancy-related diastasis rectus abdominis: a Delphi Consensus study. J Womens Health Phys Therap. 2019;43(2):73-81.

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