Diastasis recti is the separation of the abdominal muscles and connective tissue in the region of the linea nigra or alba. It is caused by weakness of the abdominal muscles, and can lead to symptoms such as a protrusion above or below the navel or sagging belly.

Diastasis recti generally occurs during or after pregnancy and is the main cause of abdominal flaccidity and lower back pain in the postpartum period. This condition can also be diagnosed in babies or in those who are obese.

Treatment of diastasis recti can be done with exercises and physiotherapy. Surgery may be indicated when the distance between the abdominal muscles is greater than 5 cm and/or when conservative treatment with exercises has not been effective.

Main symptoms

The main symptoms of diastasis recti are:

Protuberance in the abdomen, above or below the navel, especially when lifting weights, squatting or coughing
Excessive sagging in the belly
Abdominal weakness
Difficulty lifting objects or carrying out daily activities, such as walking
Pain during intimate contact
Lower back, pelvic or hip pain
Urinary incontinence with exertion, coughing or sneezing
Constipation

Some patients may also report poor posture, a feeling of a swollen belly or the sensation of flabby abdominal skin.

The separation between the abdominal muscles can reach 10 cm. It is important for this condition to be evaluated by a doctor, who can indicate the most appropriate treatment.

How to know if I have diastasis recti

To assess whether you have diastasis recti at home, you can follow these steps:

Lie down on your back.
Place two fingers of one hand approximately 2 cm above your belly-button and two fingers of your other hand about 2 cm below.
Contract your abdomen, as if you were going to perform a sit-up.

When you contract your abdomen, your fingers jump up a little, however with cases of diastasis recti, the fingers will not show any movement. With this condition, it is possible to place 3 or 4 fingers side by side without noting any movement with abdominal contractions.

Confirming a diagnosis

The diagnosis of diastasis recti is confirmed by a gynecologist or general surgeon. The doctor will start by performing a physical examination, and evaluating the characteristics of the abdominal muscles as well as any other symptoms.

In some cases, the doctor may order imaging tests, such as an ultrasound or CT scan to visualize the abdominal muscles in more detail and confirm a diagnosis.

Possible causes

Diastasis recti is caused by weakness of the rectus abdominis muscles that leads to a separation of the abdominal muscles.

Some factors that can contribute to the appearance of diastasis recti include:

More than one pregnancy, in short intervals
Twin pregnancy
Pregnancy after 35 years of age
Giving birth to a baby weighing more than 4 kg, especially in small-framed women
Abdominal obesity, in men and women
Multiple abdominal surgeries

Furthermore, although it is rarer, abdominal diastasis can also be present from birth. This condition is referred to congenital abdominal diastasis and is generally caused by premature birth, as the abdominal muscles may not yet be completely developed and closed.

Treatment options

Treatment for diastasis recti should be guided by a doctor and may vary according to the degree of separation of the abdominal muscles. The greater the space between the muscles, the more difficult it will be to reunite the fibers using only exercise or physiotherapy. However, in diastases less than 5 cm, treatment that is carried out daily can be reduced and healed in approximately 2 to 3 months.

The main treatment options for diastasis recti that your doctor may recommend include:

1. Exercises

Exercises for diastasis recti are indicated to reduce the separation of the abdominal muscles and strengthen the muscles that provide stability to the abdominal region. These should be performed under the supervision of a physiotherapist or personal trainer, as if they are not performed correctly, they can cause an increase in intramuscular pressure. Complications of exercises that are not correctly performed include worsening of separation and the emergence of a hernia.

Generally, these exercises can be started around 6 to 8 weeks postpartum once approved by a doctor. The doctor may also advise starting clinical pilates or hypopressive exercises, as these involve contraction of the transversus abdominis and the lower fibers of the rectus abdominis. They strengthening these areas, without placing excessive pressure on the rectus abdominis.

It is important to highlight that exercises such as sit-ups, planks or push-ups should be avoided, as they can worsen the separation of the abdominal muscles.

2. Physiotherapy

Physiotherapy for diastasis recti can be prescribed by a doctor and should be guided by a physiotherapist, who may advise stretching and strengthening exercises of the rectus abdominis, as well as pelvic floor and lumbar muscle exercises.

A physiotherapy plan should be developed by a physiotherapist on a case-by-case basis. He or she may use equipment, such as functional electrical stimulation (FES), which promotes muscle contraction. This device can be done for 15 to 20 minutes and is very efficient in strengthening the rectus abdominis.

3. Surgery

Surgery for diastasis recti is normally recommended by the doctor when:

The separation of the rectus abdominis muscles is greater than 5 cm;
Exercise or physical therapy were not effective in reducing muscle separation;
Presence of symptoms such as low back pain or stress urinary incontinence;
Cosmetic reasons.

Diastasis recti surgery consists of approximating and sewing the rectus abdominis muscles, which can be performed conventionally or laparoscopically. In addition, the doctor may also suggest liposuction or abdominoplasty to remove excess fat or skin.

Care during treatment

When treating diastasis recti, you can also speed-up recovery by:

Maintaining good posture when standing and sitting
Maintaining the transverse abdominal muscle contracted throughout the day, by pulling the belly button into the spine when sitting and throughout the day
Avoiding bending your body forward as much as possible, as this can worsen diastasis
Whenever you need to bend down to pick up something from the floor, bend your legs, and squat your body to avoid leaning forward
Changing the baby's diaper on a high surface such as a changing table, or if you need to change it in bed, get on your knees on the floor to avoiding bending your body forward;
Wearing a postpartum belt, if approved by your doctor, for most of the day and even to sleep, but don't forget to keep your belly tucked in to strengthen the transversus abdominis during the day;

Furthermore, it is important not to avoid performing traditional abdominal exercises or oblique abdominal exercises to prevent worsening.

Possible complications

The main complication of diastasis recti is the appearance of back pain in the lumbar region. This pain can be felt as the abdominal muscles act as a natural brace that protects the spine when walking, sitting and exercising. When this muscle is very weak, the spine becomes overloaded and there is a greater risk of developing a herniated disc.

Therefore, it is important to carry out treatment for diastasis recti to promote the union and strengthening of separated abdominal muscles.