If you’re pregnant and reading up on how to take care of your body, you've probably run across info about the risks of developing “mommy tummy” or "separated abs." These terms are commonly used to describe diastasis rectus abdominis (DRA) or diastasis recti, a medical condition that's normal in pregnancy, but can cause problems after childbirth.
Depending on where you look, information about diastasis recti can be scary. There's a lot of outdated information — and just plain misinformation — claiming that your abs are doomed to be weak and misshapen after having a baby. Or that doing a single crunch or plank when you're pregnant or postpartum might cause your abdominals to split apart.
We're happy to let you know that the truth is far less alarming. As pelvic floor physical therapists who specialize in supporting pregnant and postpartum individuals, we are experts in not just treating diastasis recti without surgery, but also in what you can do during pregnancy to prevent it from becoming a problem later on.
Rest assured that no matter what happens to your abs during pregnancy and delivery, your postpartum body can recover with the help of a postpartum PT.
What is Diastasis Recti?
As shown in the diagram below, diastasis recti occurs when the distance between the left and right rectus abdominis or "six-pack" muscles becomes larger than 2 centimeters due to prolonged strain and pressure.
While this condition is sometimes referred to as "separated abs," the rectus abdominis muscles don't actually separate — they remain connected by the linea alba, a strip of layered tissue that runs down the midline of the torso. With diastasis recti, the linea alba has become stretched thin.
Diastasis Recti in Pregnancy
The most common cause of diastasis recti is pregnancy. In fact, it's estimated that 100% of people who are pregnant will experience DRA by their third trimester — it’s just one of the many normal ways that your body adjusts to make room for a growing baby.
Can Diastasis Recti Happen Outside of Pregnancy?
Yes! Any excessive, repetitive straining that puts chronic pressure on the linea alba can lead to diastasis recti. Examples of non-pregnancy causes of DRA include frequent, heavy weightlifting and chronic, severe coughing. DRA can affect people of any sex, at any age.
Negative Side Effects of DRA
Although normal in pregnancy, prolonged postpartum diastasis recti can become problematic. If the linea alba remains overly stretched after childbirth, it can lead to any or all of the following:
- Abdominal muscle dysfunction
- Low back pain and/or pelvic pain
- Pelvic floor muscle dysfunction (i.e. incontinence)
- Postural dysfunction
- Cosmetic disfigurement (i.e. abs that look like they're bulging or "doming")
Preventing Postpartum Diastasis Recti
The first step to preventing postpartum diastasis recti is to understand the connection between your abdominal muscles, the linea alba, and intra-abdominal pressure. Allow us to break it down for you.
There are 4 main muscles that make up your abdominal wall: the rectus abdominis or aforementioned "six-pack" muscle, the external obliques, the internal obliques, and the transversus abdominis. Check each of them out in the diagram below.
In coordination with the pelvic floor muscles, these abdominal muscles help to:
- Support and protect your abdominal organs
- Help you breathe by allowing for and assisting in diaphragmatic movement
- Assist with coughing and vomiting
- Stabilize your spine by maintaining intra-abdominal pressure
Each abdominal muscle is surrounded by connective tissue, which helps support and strengthen its function. These layers of connective tissue come together to form a sheath, or protective covering, around the rectus abdominis muscles before eventually forming the linea alba right at the center of the abdomen. The stability and function of the linea alba comes from all of the abdominal muscle layers.
When you contract your abdominal muscles, they pull on the linea alba and other connective tissues to create stability and stiffness throughout your core. They also help to distribute force between the sides of the abdominals, transforming the right and left sides of your abdomen into one strong, cohesive unit.
However, if the linea alba is overly strained, it can stretch so thin that the abdominal organs can bulge through, giving a dome-like appearance to the abs — particularly during activities that increase intra-abdominal pressure (think straining to poop, lifting something heavy, doing a crunch, or even leaning back in the shower to rinse your hair).
Don't worry — your organs will be fine! But because diastasis recti compromises the integrity of the core muscles, you're more likely to experience pain and muscular dysfunction.
Take Action to Prevent Postpartum DRA
After pregnancy, diastasis recti should heal gradually during the first 8 weeks postpartum. But this doesn't always happen.
Some contributing factors to prolonged postpartum diastasis recti are beyond your control, including:
- Your genetics
- Hormones that cause connective tissues to soften
- Your age
- Having a cesarean section
- Multiparity (having more than one pregnancy)
But there are other contributing factors that you do have control over — namely, any activities that can cause the linea alba to become chronically overloaded. By avoiding or minimizing these activities during pregnancy, you can significantly reduce your chances of having prolonged postpartum DRA.
Below are 5 ways you can do exactly that.
1. Pay attention to your posture
During pregnancy, your belly grows forward, the curve in your low back deepens, and your pelvis tilts forward. This natural shift in posture increases strain on your abdominals and contributes to diastasis recti.
The good news is that you can adjust your standing posture to help minimize abdominal strain.
When you stand, think about:
- Bringing your ears back over your shoulders
- Stacking your ribs over your hips
- Balancing your hips over the arches of your feet
To help prevent postpartum diastasis recti, check in on your posture throughout the day, and return to this balanced stance as often as possible.
2. Improve your body mechanics
As your delivery date approaches, moving around is sure to become more of a challenge. Suddenly, getting up from the sofa, or putting on your shoes can feel comically difficult.
When this happens, it's normal to hold your breath and twist and turn your body in awkward ways. If you're not careful, you can end up increasing intra-abdominal pressure and putting more strain on the linea alba, which — you guessed it — can worsen DRA.
Instead, keep breathing and use good body mechanics.
For example, use this technique to support your weight as you lift yourself off the sofa:
- Using your arms to help you, scoot yourself forward to the front edge of the couch cushion by rocking your hips from side to side.
- Place your feet flat on the floor in front of you, a bit wider than hip-width apart (you want to have enough space for your abdomen to drop slightly between your legs as you move to stand). Make sure that your feet are slightly behind your knees.
- Now, tighten your abdominals, and lean your trunk forward so that your nose is over your toes (you’ll feel your weight shift into the balls of your feet).
- Use your hands to push into the sofa as you exhale and engage the muscles in your hips and legs to stand.
There are many, many other ways to adjust your body mechanics to reduce abdominal strain in pregnancy. Working one-on-one with a physical therapist who can evaluate how you move is the best way to avoid habits that can lead to prolonged postpartum DRA.
3. Exercise safely
Exercise can do wonders for you and your baby during pregnancy. But certain precautions should be taken to keep exercise safe. This includes modifying the way you strengthen your abdominals and avoiding movements that increase strain on your linea alba.
Again, working with a physical therapist who specializes in pregnancy and postpartum is the best way to go.
A PT can help you improve the strength and endurance of your abdominal obliques, as well as the deep stabilizing muscles of the spine and pelvis (which include the transversus abdominis, pelvic floor muscles, low back stabilizers, and the diaphragm). They'll also guide you in coordinating these muscles with everyday movements to avoid excess pressure in your abdomen.
4. Strengthen your pelvic floor
Your pelvic floor muscles and abdominals work together to create strength and stability in your body. If your pelvic floor muscles are weak, your abdominals may have to work harder to compensate (and vice versa). So a great way to protect your abs is to condition your pelvic floor.
5. Don't strain to poop
Chronic constipation is another common pregnancy symptom to look out for when it comes to DRA. If you're constipated, you're likely to strain as you push out poop, which increases intra-abdominal pressure, raising your risk of prolonged postpartum DRA. Making efforts to maintain healthy bowel function will help reduce straining and constipation.
One simple step anyone can take is to start using a toilet stool. When you prop your feet up on a small stool, it helps poop to exit your body more easily, which means you don't have to push as hard.
If you develop diastasis recti, PT can help
Learning about diastasis recti, focusing on good body mechanics, reducing pressure in your abdomen, optimizing pelvic floor health, and exercising safely are all helpful ways to reduce your risk of postpartum diastasis recti.
Unfortunately, prolonged diastasis recti can still happen, and is seen in up to 33% of people at 12 months postpartum.
If you're currently pregnant or postpartum, don't hesitate to schedule an in-person or virtual evaluation with one of our expert pelvic physical therapists. They'll check you for diastasis recti and create a personalized exercise program that will help you protect your core.