What is Diastasis Recti?

Also known as abdominal muscle separation, Diastasis Recti is a condition which causes abdominal muscles to separate.

Diastasis Recti is most common in women following pregnancy; however, it has several other causes and can also affect men.

Depending on the severity and cause, Diastasis Recti can have several physical and emotional effects:

• A change in the shape of the abdomen, either protruding or doming
• A visible indent running vertically down the centre of the abdomen
• Reduced core strength and stability
• Pain or discomfort in the lower back, hips and pelvis
• Self-consciousness and lack of confidence when wearing tight-fitting or revealing clothing such as swimwear
• Avoiding certain activities, or feeling uncomfortable in intimate relationships

Cadogan Clinic’s team of expert Plastic and Reconstructive surgeons has extensive experience in treating Diastasis Recti, providing the highest-quality patient care and transformative results from our surgical centre of excellence, located in Chelsea, London.

Types of Diastasis Recti and Diastasis Recti Severity

Diastasis Recti is classified by location and the degree of separation. During your consultation, your surgeon will discuss your concerns and examine your abdomen to establish where your abdominal muscles have separated, and your Diastasis Recti severity.

Types of Diastasis Recti include:

• Open Diastasis Recti - A full opening of the space between the abdominal muscles
• Above the Naval – Separation of the abdominal muscles in the upper abdomen, above the naval (belly button)
• Around the Naval – Separation of the mid abdominal muscles around the naval
• Below the Naval - Separation of the abdominal muscles in the lower abdomen below the naval

To establish how severe your Diastasis Recti is, your surgeon will measure the distance of the gap that has opened between your abdominal muscles:

• Less than 3cm – Mild Diastasis Recti
• 3-5cm – Moderate Diastasis Recti
• More than 5cm – Severe Diastasis Recti

Although these measurements are an important part of diagnosis, it is essential to take into account that any separation over 2.5cm is considered clinically significant and may require treatment. Even if you feel your Diastasis Recti is not serious, discussion with a surgeon may prevent worsening of the condition or other associated concerns from developing.

What are the Symptoms of Diastasis Recti?

Depending on the cause, Diastasis Recti can develop gradually, and it may not be immediately noticeable.

Common Diastasis Recti symptoms include:

• A visible bulge affecting the whole abdomen, or part of it, which doesn’t improve with weight loss
• A coned or domed appearance to the abdomen when contracting the abdominal muscles, or leaning backwards
• Softness or a jelly-like feeling around the naval
• Core weakness, which affects balance, lifting objects, exercising, or performing daily tasks
• Lower back pain
• Poor posture

Untreated or severe Diastasis Recti can also lead to further concerns and complications, which may include:

• Hernia
• Digestive discomfort
• Bladder incontinence
• Pain during sexual intercourse
• Ongoing pelvic and hip pain

Your surgeon will discuss any symptoms you are concerned about during your consultation, in order to help establish a diagnosis and treatment plan.

What Causes Diastasis Recti?

Diastasis Recti has several causes, although it generally occurs due to excessive strain being placed on the abdominal muscles for an extended period.

The two muscles which run vertically down the abdomen are called the rectus abdominus, often referred to as the six-pack. Between the rectus abdominis muscles is a band of tissue called the linea alba.

If the linea alba thins or becomes weakened, this results in the rectus abdominus muscles separating and being unable to come back together.

Common Diastasis Recti causes include:

Pregnancy

Pregnancy is the most common cause of Diastasis Recti and affects up to 6 in 10 women post partum

It typically develops during the last three months of pregnancy but may not be apparent or visible until several months after giving birth. As the abdominal muscles are stretched outwards due to the expansion of the uterus, this can cause the muscles and connective tissue to weaken. Additionally, the hormone relaxin is produced by the body to relax the ligaments and muscles, which can further exacerbate this condition.

Factors which may increase the risk of developing Diastasis Recti during pregnancy include:

• Pregnancies which are less than 12 months apart
• Being over 35 years old
• Multiple births (twins or triplets)
• Having a large or heavy baby
• Having a very petite or slim frame
• Extreme strain from pushing during a vaginal delivery

Dramatic Weight Fluctuations

Diastasis Recti caused by dramatic changes in weight can affect men and women.

Weight fluctuations can put strain on the abdominal muscles, which can then cause weakness in the linea alba, leading to separation.

Factors which may increase the risk of Diastasis Recti due to weight changes include:

• Rapid weight loss
• Repeated weight loss and gain
• Not maintaining muscle tone while losing weight (a common side effect of weight loss medication)
• Obesity

Incorrect Exercise Technique

Performing various exercises with the incorrect form or technique can place high levels of strain on the abdominal muscles, resulting in abdominal muscle separation.

Exercises which are most likely to cause Diastasis Recti when performed incorrectly include:

• Weightlifting
• Abdominal exercises such as crunches and sit-ups
• High-impact cardio, such as running and jumping
• Certain yoga poses which involve twisting or placing excessive weight through the hands or knees without proper balance

This can affect men and women, and risk factors associated with Diastasis Recti caused by exercise include:

• Lifting overly heavy weights
• Carrying out exercises with poor form or technique
• Regular strenuous exercise with insufficient recovery time

Occupational Hazards

People who work in environments involving consistent physical tasks may be at a higher risk of developing Diastasis Recti.

Those with occupations involving heavy lifting or strain on the core muscles, such as construction workers, warehouse operatives, firefighters and other manual labourers, typically place more strain on their abdominal muscles over long periods of time, often without realising. This is also a common cause of Diastasis Recti in men, as men more often fill these types of roles.

Risk factors which may increase the chances of developing Diastasis Recti at work include:

• A lack of proper health and safety training around heavy lifting
• Suitable heavy lifting equipment not being provided
• Long term protections not being put in place to prevent future injury

Ageing

As we age, the proteins that make up our muscles naturally break down and are produced at a slower rate. This results in overall muscle weakness, and it also becomes more challenging to build up muscle mass. This may result in Diastasis Recti developing over time.

Risk factors which may increase the likelihood of Diastasis Recti developing due to age include:

• Not maintaining consistent muscle tone and strength during younger life
• Excessive strain being placed on the abdominal muscles through occupational or daily activities
• A genetic predisposition to Diastasis Recti occurring

How to Fix Diastasis Recti?

If you are concerned about Diastasis Recti, it is important to seek the correct medical advice and treatment quickly to prevent the condition from worsening.

Depending on the cause and severity of your Diastasis Recti, there are several treatment options available. Your surgeon will discuss the most suitable treatment options to address your concerns during your consultation.

Non-Surgical Diastasis Recti Treatment

Non-Surgical Diastasis Recti treatment options are typically suited to patients with mild abdominal muscle separation, which has been diagnosed at an early stage.

Exercise

Although exercise can be a cause of Diastasis Recti, the right exercises, performed carefully and correctly, can strengthen the core muscles and repair abdominal muscle separation.

The most effective Diastasis Recti exercises engage the deep abdominal muscles, and involve slow controlled movements, paired with deep breathing to prevent over straining the muscles.

This is achieved by lying on the floor with your knees bent and your feet flat on the floor. As you breathe out, draw your naval inwards towards your spine. From here, there is a series of exercises for separated abdominal muscles you can carry out:

• Transverse Abdominal Squeeze – Engage your abdominal muscles as instructed above, aim to hold for 5-10 seconds, you will need to build up gradually.
• Bent Knee Fall Outs – In the same position, gently lower your right knee outwards towards the floor while your left knee remains bent with your foot flat. Return your right leg to the starting position, and repeat on the other side
• Heel Slides – Whilst lying on the floor with your abdominal muscles engaged, slide your flat foot across the floor until you feel your back beginning to arch. Return to the starting position and repeat on the other side
• Pelvic Tilts – In the same position, round your lower back and roll your pelvis forwards until you feel like you are squashing an imaginary ball between your back and the floor. Hold this for a few seconds, and gently return to the starting position

When exercising to repair Diastasis Recti, it is important to avoid any movements which place strain on the abdominal muscles, including:

• Crunches
• Sit-ups
• Downward dog
• Double leg lifts
• Any exercise that causes your abdomen to bulge or dome

Physical Therapy

In some cases, your doctor may refer you to a specialist physical therapist to provide additional support in treating your Diastasis Recti.

A physical therapist may provide a combination of support and services while treating Diastasis Recti:

• Supervised exercise to ensure you have the correct form and technique
• Working to improve posture
• Physical support from a binder or belly band to help engage the muscles and provide a physical reminder to maintain posture
• Radiofrequency or Electromagnetic Therapy to encourage healing in the area
• Massage and diaphragmatic release
• Education and support

Surgical Diastasis Recti Treatment

For moderate to severe Diastasis Recti, surgery may be required to rejoin and strengthen the abdominal muscles.

Abdominoplasty

Abdominoplasty (also known as Tummy Tuck) is the most suitable surgical procedure to repair Diastasis Recti. During the procedure, the two sides of the rectus abdominus are secured together with sutures. Surrounding loose skin and excess fat are also removed, resulting in a toned and defined appearance to the abdomen.

Although the doming of the abdomen that is associated with Diastasis Recti can be addressed with Abdominoplasty, it is important to take into account that surgery cannot restore muscle function. Following Diastasis Recti surgery, proper core alignment and strength training are required to rebuild full stability.

Patients who are suitable for Abdominoplasty to repair Diastasis Recti typically:

• Have completed their families, to reduce future strain on the abdominal muscles
• Are maintaining their ideal, healthy weight (under a BMI of 30) for at least 6-12 months

The best way to determine if Abdominoplasty is the best way to address your abdominal muscle separation is to speak with an experienced Consultant Plastic and Reconstructive Surgeon who can examine your concerns and create a bespoke treatment plan.

How to Prevent Diastasis Recti

Although it may not always be possible to prevent Diastasis Recti, there are measures you can take to help prevent it from occurring:

• Maintain a consistent weight – Avoiding dramatic weight fluctuations prevents the abdominal muscles from weakening
• Practice good posture – Sitting and standing with a good posture helps to keep the abdominal muscles strong and engaged
• Sustain good exercise form and technique – Ensure you are using the correct form and technique, especially when performing any exercise focusing on the core
• Adjust your position when getting out of bed – Roll to one side and use your arms to push up out of bed, or any lying position

For those with a genetic predisposition to developing Diastasis Recti, prevention may limit the separation of the abdominal muscles, meaning that less invasive treatment is required.

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