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Closing the Gap: Understanding Rectus Diastasis (Abdominal Separation) and how to fix it

Updated: Aug 4, 2023

The process of pregnancy can lead to notable transformations in a woman's physique, often presenting as a lingering protrusion around the abdominal region. This condition, also referred to as a post-pregnancy pouch, is characterized by increased fullness in the lower abdomen. Many women seek professional advice for improving the contour of their abdomen. The first step is to analyze the cause. Skin laxity and fat accumulation are common after pregnancy and can both contribute to the "pouch". Furthermore, childbirth may cause a permanent separation of the abdominal muscles, known as rectus diastasis (or diastasis recti), also known as abdominal separation. While skin and fat may not be aesthetically pleasing, they rarely cause functional issues. Rectus diastasis, however, is more than a cosmetic concern. Patients with rectus diastasis have weakened core function and can have a series of related functional problems.

What is Rectus Diastasis?

Rectus diastasis is a condition that occurs when the two prominent parallel bands of muscles, known as the rectus abdominis or "six-pack" muscles, separate along the midline of the abdomen. This separation is triggered by the thinning and stretching of the linea alba, a connective tissue that vertically runs between the left and right sides of the abdominal muscles.

While diastasis recti is commonly associated with pregnancy, where the growing uterus causes the abdominal muscles to stretch and separate to accommodate the developing baby, it can also affect men and women due to factors like obesity, improper exercise techniques, or excessive strain on the core muscles.

Symptoms of Rectus Diastasis:

1. Bulging or Protruding Abdomen: Diastasis recti can lead to a noticeable bulge or protrusion in the abdominal area, particularly during certain movements or when lying on the back with the head raised.

2. Lower Back Pain: Weak abdominal muscles resulting from diastasis recti can lead to poor posture and increased strain on the lower back, causing discomfort or pain.

3. Compromised Posture: The weakened core muscles can affect posture, leading to a hunched or rounded back, further contributing to back pain and discomfort.

4. Difficulty Performing Core Movements: A weakened core can make it challenging to perform movements that require core strength, leading to limited physical activities and reduced quality of life.

5. Gastrointestinal Issues: Diastasis recti can contribute to digestive problems like constipation, bloating, or acid reflux, as weakened abdominal muscles may provide less support for the abdominal organs.

How can I tell if I have Rectus Diastasis:

To determine if you have Rectus Diastasis, you can perform a simple self-check. Lie on your back with your knees bent and feet flat on the floor. Gently raise your head and place a hand along the middle of your abdomen, both above and below the belly button. If you have abdominal separation, you may feel a noticeable gap between your abdominal muscles, measuring more than 2 to 3 fingerbreadths in width.

For a more accurate assessment, we recommend scheduling an in-person consultation with a consultant plastic surgeon, who can provide professional guidance and determine the presence and severity of diastasis recti. Ultrasound assessment is often performed and any separation can be visualized and quantified.

Can Rectus Diastasis resolve naturally?

While maintaining a healthy lifestyle with regular exercise and balanced nutrition can help tone your body after pregnancy, it may not completely address persistent abdominal bulging caused by diastasis recti. Several factors can influence the severity of abdominal separation, including the quality and elasticity of your skin, the number of childbirths, the birth weight of your babies, and your pregnancy weight gain and subsequent loss.

It is important to note that more than one-third of women who have undergone childbirth may experience symptoms of diastasis recti. In most cases, diastasis recti does not resolve on its own, and it may not significantly improve solely through healthy eating and regular exercise. Physiotherapy with professional guidance can significantly improve function. However, to effectively repair weakened abdominal muscles after childbirth, surgical repair of the separated muscles, usually through the abdominoplasty route, is often the recommended approach.

The Surgical Repair

During the surgery, a horizontal incision is made in the lower abdomen, typically below the belly button. This incision allows the surgeon to access and visualize the abdominal muscles. The surgeon then carefully brings the separated abdominal muscles back together, realigning them along the midline of the abdomen. Sutures are used to close the gap and securely tighten the muscles. In some cases, the surgeon may also remove excess skin and fat to create a flatter and more toned appearance of the abdomen.

Open repair of rectus diastasis can be performed as a standalone procedure or in combination with other abdominal surgeries, such as a tummy tuck (abdominoplasty) or liposuction, to achieve more comprehensive results. Recovery from the surgery typically involves wearing a compression garment to support the healing tissues and following post-operative instructions to ensure proper healing and optimal outcomes.

The procedure aims to enhance core strength, improve posture, alleviate back pain, and restore a more aesthetically pleasing abdominal contour. However, it is essential to consult with a board-certified plastic surgeon or a qualified healthcare professional to determine if you are a suitable candidate for open repair of rectus diastasis and to discuss the potential risks and benefits of the surgery.

What if I do not want surgery?

While surgery, especially in severe cases, is the most definitive fix for rectus diastasis, for some, non-surgical management can also be considered, particularly for those seeking conservative approaches or who may not be candidates for surgery. Here are some non-surgical methods to manage rectus diastasis:

1. Physical Therapy: Engaging in targeted exercises under the guidance of a certified and experience physiotherapist can be instrumental in strengthening the abdominal muscles and promoting core stability.

2. Core Strengthening Exercises: Performing exercises that specifically target the transverse abdominis, obliques, and pelvic floor muscles can provide better support to the abdominal region.

3. Posture Correction: Practicing good posture can alleviate strain on the abdominal muscles, reducing the separation's progression. Maintaining an upright posture while sitting and standing can contribute to improved abdominal support.

4. Avoiding Straining Movements: Refrain from activities that may place excessive stress on the abdominal muscles, such as heavy lifting or crunch-type exercises, which can exacerbate rectus diastasis.

5. Use of Supportive Garments: Wearing abdominal binders or belly bands can provide external support and help reduce pressure on the abdominal muscles, especially during activities that require increased core engagement.

6. Breathing Techniques: Diaphragmatic breathing techniques can aid in core activation and abdominal muscle engagement. By breathing deeply and engaging the diaphragm, you can facilitate better stability and support for the abdomen.

7. Pelvic Floor Exercises: Strengthening the pelvic floor muscles can complement the management of rectus diastasis. Kegel exercises or pelvic floor muscle training can enhance core stability and provide additional support.

8. Progression Monitoring: Regularly assess the degree of separation by lying on your back and feeling for the gap between the rectus abdominis muscles. Keep track of your progress and consult with a healthcare professional to evaluate the effectiveness of your non-surgical management plan.

It is crucial to consult with a healthcare provider or physical therapist before embarking on any non-surgical management plan for rectus diastasis. They can tailor an appropriate exercise regimen, monitor progress, and provide personalized recommendations based on your specific condition and needs. While non-surgical management may not completely eliminate rectus diastasis for everyone, it can significantly improve symptoms and enhance core strength and function, leading to an improved quality of life. Regular monitoring, ideally by ultrasound to provide more objective assessment, should be performed to monitor the progress and ensure the intervention is not worsening the rectus diastasis.


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