Diastasis Recti

Diastasis recti is a common condition in women who are pregnant or who have had a baby. It is the separation of the muscles in the abdomen (abs) which run vertically along the front of the stomach, called the rectus abdominis muscles.

The muscles are separated by a thin band of connective tissue called the linea alba, which runs down the front of the stomach. During pregnancy, as the uterus expands, the rectus abdominis muscles separate as they are stretched and the linea alba becomes thinner, causing the belly to stick out.

Once the baby is delivered, the elastic linea alba usually heals and retracts to its normal position. However, in women with diastasis recti, the tissue loses this elasticity and the gap in the muscles does not close as it should. The bulge can remain for a long time after the pregnancy ends.

It can be repaired with special exercises that help to close the separation.

Who is affected by diastasis recti?

Pregnant and postpartum women are affected by diastasis recti, but it can also affect babies and men. It usually develops in the third trimester of pregnancy as the baby grows quickly and pressure on the abdominal wall increases. Most women only notice the condition once the baby has been delivered.

It is a very common condition affecting more than half of all women who have had a baby. It many women, it resolves itself within a couple of months of delivery, but some remain affected at 6 months post-delivery.

What are the symptoms of diastasis recti?

Most women notice signs of diastasis recti after their baby has been born – it can occur during pregnancy, but it is hard to diagnose as the stomach is stretched.

Signs of diastasis recti after delivery include:

• Bulge above or below the belly button
• Constipation
• Difficulty lifting or performing everyday tasks
• Doming as ab muscles contract
• Lower back pain
• Painful sex
• Pelvic/hip pain
• Poor posture
• Softness around the belly button
• Urinary incontinence
• Weak feeling in the abdominals.

What are the risk factors?

You are at an increased risk of developing diastasis recti if you:

• Are having a large or heavy baby
• Are very petite
• Have a baby over the age of 35
• Have a vaginal delivery
• Have multiple pregnancies
• Have pregnancies close together
• Have multiples (twins or triplets).

How is diastasis recti diagnosed?

Your doctor will perform a physical examination to diagnose diastasis recti and how severe it is. It can occur, below or at the belly button. They will feel for gaps in the abdominal area and assess the muscle tone. An ultrasound or Ct scan may be used.

Any gap wider than 2cm is diagnosed as diastasis recti. Diagnosis usually occurs at the appointment women have 6 weeks after delivery.

It is possible to feel diastasis recti yourself. If you lie on your back with your knees bent and feet flat on the floor, use one hand to support your head and gently lift your shoulders (a bit like a sit up). Place your free hand on your stomach and feel for a gap between the abdominal muscles. If two or more fingers can fit into the gap, talk to your doctor about diastasis recti.

How is diastasis recti treated?

In most cases, diastasis recti can be managed without surgery. Your doctor will recommend gentle movements which engage the ab muscles. They will provide a plan to follow and ensure you are doing the movements properly and safely. Only ever engage in exercise that is approved by your doctor if you have diastasis recti – some movements can make the condition worse.

If diastasis recti is severe or has caused a hernia (an organ has pushed through the linea alba) then surgery may be performed.

Diastasis recti surgery aims to repair the separation of the rectus abdominis. It involves stitching the muscles back together, reducing the appearance of the bulge in the abdomen. The surgery also improves core strength and posture. Sometimes, the surgery is combined with an abdominoplasty to remove excess loose abdominal skin.

The Hernia Surgery Program at Cleveland Clinic Abu Dhabi perform diastasis recti laparoscopically. Surgeons make a few small incisions, and a laparoscope (a long, thin tube with a light and camera) is inserted which allows the surgeon to see the abdominal wall and repair the separation. Following surgery, an abdominal support is worn for six to eight weeks. Strenuous exercise or lifting must be avoided during this time.

Can diastasis recti be prevented?

You can do certain things to reduce the risk for developing diastasis recti:

• Avoid sit-ups and crunches for 3 months after delivery.
• Breathe deeply to allow your ribs to expand and not just your belly.
• Don't strain your abdominal with heavy lifting.
• Exercise and eat healthily during pregnancy to keep weight gain within a healthy range.
• Stand up straight to maintain a proper posture.
• Try to roll out of bed while pregnant and post-delivery.

Our Hernia Surgery Program is comprised of experienced surgeons specialized in advanced laparoscopic and robotic procedures, as well as traditional open surgery and complex reconstructive surgery, for the treatment of abdominal wall and hernia conditions.

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