Why Aren’t We Telling Pregnant Women About Diastasis Recti?
By: Laurie Mega
Tags: Postpartum Fitness, Postpartum Care, Womens Health, Postpartum, Pregnancy

“I was like, seriously? Why is this not being checked more often? Why does it take me a year and a half after having a baby?”

I was at my doctor’s office for my post-partum wellness checkup after the birth of my third son. I’d been through this twice before, so I knew the routine, or so I thought.

My nurse practitioner looked at my C-section scar to see how it was healing, and poked around at my belly to check that my uterus was shrinking the way it’s supposed to.

Then, she stopped at my midsection and placed her fingers right below my ribs.

“It looks like you have some diastasis recti. It’s not too bad — I’d say about two fingers.”

Huh? What on earth was she talking about?

She saw my puzzled expression and explained what diastasis recti is: a separation of the abdominal muscles that sometimes happens after having a baby.

The whole conversation was nonchalant. Alright, I thought. This must be no big deal.

“Here are some websites you can subscribe to. They provide exercises you can do to make it go away,” she said.

Sweet! I thought. I’ll have this fixed in no time!

I left the office unphased by my new diagnosis. After all, it was just going to take exercise and time, right?

But I had no idea how serious diastasis recti can be, and how misunderstood it is. In the months following, I would talk to women who’s diastasis caused them serious pain and disrupted their lives.

It would take almost a year for me to fully understand my own condition and finally find my way to a physical therapist who began to help me heal.

What Is Diastasis Recti?

I went home and googled diastasis recti and the first thing that popped up was a summary from the Mayo Clinic. It explained that it’s a separation of the abdominal muscles, which leaves a gap down the center of the abdomen.

“In layman’s terms, diastasis recti is where the connective tissues between the abdominal muscles widen. This occurs when the right and left sides of the rectus abdominis muscle separate,” says Wendy Powell, a personal trainer and creator of the MUTU system, an exercise program designed to improve women’s physical fitness postpartum.

Powell explains that when the two parts of the muscle separate or come apart, the connective mid-line is stretched and weakened as it takes all other muscular and fascial support structures along with it.

Women with diastisis will look like they’re still pregnant. When lying flat on their backs or attempting a stomach crunch, the abdominal muscles will push up into a dome or a cone shape.

“If I lie flat on my bed, it looks like an alien is coming through the middle of my stomach.” Says Jennifer Soares, a hairdresser from Woburn, MA, who developed diastisis recti after having her first baby.

To measure the amount of separation, a doctor or physical therapist will have you lie down on your back. They will then align their fingers vertically down the middle of your abdomen, so their fingertips are pointed to your belly button. They then, press gently down and determine how wide the gap is by how many fingers they can fit between the two separated muscles.

A mild separation is two fingers wide or less. Moderate is between three and four fingers wide, and a severe case is greater than four fingers wide.

What Causes Diastasis Recti?

Photo by Mateus Campos Felipe on Unsplash

While a lot of the literature on diastasis recti points to high birth weights, age, multiples, or many subsequent births as reasons why some women develop this condition, not all medical professionals agree.

“It is likely related much more to genetics and hormonal balance than anything that can be controlled,” says Dr. Adam R. Kolker, a double-board-certified plastic surgeon. “I have seen women after a twin pregnancy, large birth-weight babies, and having gained more than 50 pounds with negligible diastasis, and women who have had single pregnancy, small baby, and less than a 20-pound weight gain with very large diastasis.”

How Do Women Know If They Have Diastasis Recti?

“She told me I had it and when I asked what it was, she, exasperated, said, ‘You know what it is. Just do some planks and don’t do any sit-ups.’”

I was lucky to have my diastasis diagnosed at my six-week appointment. Not all medical providers check for it, and women go months or years without being diagnosed.

Soares first noticed something was wrong about six weeks after she gave birth. She noticed her belly button sticking out, but didn’t think much of it. Then, she started feeling the pain.

I was home. I had severe stomach pains, really bad pains.” She decided to lie down and take a nap.

“I woke up and, legit, looked seven months pregnant.”

She said her abdomen was rock-hard from her belly button to her diaphragm.

She made an appointment with her OB-GYN and found out she had diastasis recti.

For Bev Feldman, a freelance content marketer and jewelry designer in Somerville, MA, it took over a year after her second child was born to get her diagnosis. She didn’t even know anything was wrong until she started having pelvic floor issues.

She bounced between two doctors and a physical therapist until she got her diagnosis.

She was shocked. “It was, like, several fingers’ worth.”

She had started going to a personal trainer five months after she gave birth, and felt she had the best core strength she’d ever had. To hear she had this serious issue made her angry.

“I was like, seriously? Why is this not being checked more often? Why does it take me a year and a half after having a baby?”

To make matters worse, some of the exercises she had been doing with her personal trainer may have even exacerbated the problem.

Every woman who has had a pregnancy presents with some degree of muscle separation (diastasis recti),” says Dr. Kolker. “It can range from very mild to severe. I see cases of diastasis virtually every day.”

How Common Is Diastasis Recti?

According to the Mayo Clinic, there are more than 3 million cases of diastasis recti every year.

“One in two women will more than likely experience some degree of diastasis recti,” says Rachel Nicks, a doula, lactation counselor, and fitness instructor specializing in pre- and post-natal care.

And yet, as I began speaking to other women who suffer from the condition, they all told me the same thing: they had never heard of diastasis recti before they actually got it.

Jennifer Soares, a hairdresser from Woburn, MA, had her son six years ago. “I’d never heard of such a thing between all my friends and cousins. Nobody has this. I mean, I know people have four or five, six kids.”

How Serious Can Diastasis Recti Be?

Photo by H Shaw on Unsplash

While many experts (including my own doctor) will tell you that isn’t a debilitating condition, many women who have experienced it will tell you otherwise.

Jen says it feels like there is a beach ball inside of her. “When it first happened to me, people at work thought I was pregnant again.”

She says she has problems bending and getting clothes to fit around her abdomen.

Ashley Nease, an associate producer at a theater in NYC, suffers from back pain. “I’m still breastfeeding and bed sharing after 14 months, which surprisingly (to me, at least) requires a lot of core and back strength. Diastasis has taken away most of my core strength, which has left me with intense back pain because my back is unsupported.”

The condition can also cause pelvic pain, incontinence, and poor joint mechanics. According to the National Center for Biotechnology Information (NCBI), 66 percent of women with DRA also experience urinary leakage or pelvic organ prolapse, where the uterus, bladder or rectum drop into or press against the vagina. According to the Office of Women’s Health one in five women in the U.S. develop this condition.

In my case, I have near-constant lower back pain as my back muscles compensate for my weakened core muscles.

Why Don’t Women Know More About Diastasis Recti?

Both Nicks and Powell point to a lack of support and education for postpartum women in both the U.S., where Nicks is based, and in the UK, where Powell lives.

“Postnatal care is arguably one of the most underdiscussed issues amongst medical experts,” says Powell, “Often doctors themselves are not told about pelvic floor issues such as incontinence, prolapse, or painful intercourse, and they’re certainly not told how to remedy it. It and it is common for doctors, gynecologists, and urologists to concentrate on other areas of postpartum health.”

Nicks fells postpartum women are neglected in the health and fitness space, as well.

Powell also points to a stigma attached to postpartum health. “One of the main concerns is that women are either too embarrassed to talk about, or are not aware that their symptoms can be addressed, which means they do not get the treatment they may desperately need.”

In a recent study by MUTU, they found that women reported feeling uncomfortable sharing their postnatal health issues with partners and people around them. That included sharing information with a boss or colleague

How Are Women With Diastasis Treated by the Medical Community?

After several months trying to repair the damage on my own, I realized I wasn’t making any progress. I decided to see my primary care physician, the first step to getting physical therapy.

When I did, the appointment was very rushed. Again, another medical professional tried to dismiss it as not a big deal, ultimately concluding with “the only way to repair it totally is with surgery, but most women give up before that, because it doesn’t affect them. I mean, you’re not a movie star or a model, right?”

Ashley encountered the same dismissive treatment when she was diagnosed at her six-week postpartum appointment.

The midwife she saw was not her usual one. “She told me I had it and when I asked what it was, she, exasperated, said, ‘You know what it is. Just do some planks and don’t do any sit-ups.’”

“Of course, I’ve learned now that planks aren’t helpful and can be harmful. I was rushed through the postpartum exam because my baby was there and not very happy, so I had to look up what diastasis recti was when I got home.”

Meanwhile, Jen was told there was nothing she could do. Her doctor simply said, “Look at it as your battle scars from having a baby.”

She was livid, “I refused to believe there was nothing I could do.”

Can Diastasis Recti Heal on Its Own?

The short answer is no. “It doesn’t heal on its own,” says Dr. Kolker. He explains that, while you can strengthen the muscles, you cannot repair the fascia, or firm connective tissue between the muscles, which is also stretched during pregnancy. “Surgically, it is usually a component of a 2.5-hour abdominoplasty (tummy tuck) procedure.”

However, the muscles can close up to some degree, either on their own or with the proper exercise.

“Every woman’s body heals at varying rates, but I would say within the year after giving birth, with consistent physical therapy and/or proper exercises, women will see a notable difference,” says Nicks.

She says the key is making sure the abdominal muscles are properly engaged, not only when working out but also during day-to-day activities.

“Postpartum, the abdominals are weak and vulnerable and the body tends to recruit other muscles to compensate, which delays the healing and the rebuilding of strength of the core.”

She says that’s the main reason women have a lot of hip and back pain postpartum, as well as pelvic floor and core weakness.

How Can Women Treat Diastasis Recti?

Both Nicks and Dr. Kolker recommend core-strengthening exercises to women with diastasis, and Nicks urges women to reach out to a pelvic floor physical therapist.

“The health and strength of the pelvic floor is also connected to our core strength,” she says. A physical therapist can identify strengths and weaknesses and treat them appropriately.”

Powell and Nicks also recommend the following exercises:

Find and connect with your pelvic floor and transverse abdominal muscles. Without moving your chest or shoulders, draw your belly button inward as you slowly exhale. You’re not ‘sucking in’ or making any forceful or exaggerated movement. Your pelvis shouldn’t tuck under. In fact, nothing should be happening in your shoulders, chest, or pelvis. It is just a subtle drawing in at the lower abs.

If it helps, do this while lying on the floor or standing against a wall to stabilize your back and upper body. Engage the pelvic floor and transverse abdominal muscles. Now that you’ve found them try this exercise: Exhale and engage the pelvic floor muscles and transverse abs, just as you did before and count to five. Then inhale and relax. Repeat this 5 to 10 times while using the fingers to bring the muscles toward the midline of the body. Repeat 10 times. Practice engaging these muscles throughout the day. This is particularly important when you lift your baby or other heavy objects. You have to consciously engage the pelvic floor and abdominals and get out of the habit of locking your knees and pulling from your back to lift things.

Finally, if your case is severe, or if physical therapy doesn’t help, there is plastic surgery, what’s generally known as a tummy tuck. Unfortunately, many insurance plans consider the procedure cosmetic and don’t cover it.

Are There Exercises Women With Diastasis Should to Avoid?

When I finally saw my physical therapist, one of the first things she asked was how I was exercising. I showed her the leg lifts I been doing, based on a YouTube video that claimed to repair diastasis.

It turns out this exercise was completely wrong.

In fact, any exercise that makes you contract those abdominal muscles and pushes them up into that cone shape should be completely avoided. That includes planking, crunching, boat pose in yoga, bicycles, jackknifes, and burpees.

Powell explains why these can do more harm than good. “If the deep core is not engaging optimally to bear the load of the exercise and strengthen the muscles and connective tissue, then a crunch or sit-up movement can have the opposite effect — increasing intra-abdominal pressure and not giving you the result you’re after.”

Is There Anything Women Can Do While Pregnant to Prevent Diastasis Recti?

My physical therapist was very honest with me about the lack of real studies on the condition and that no one can say with certainty why some women suffer from it and some don’t.

She explained that the abdominal muscles do stretch with every pregnancy, so it stands to reason that I would get it after three babies, but that there is no definitive evidence pointing to age, number of pregnancies, or even birth weight.

Both my physical therapist and Nicks agree that there is no way to prevent diastasis recti. But there are ways, says Nicks, to lessen the severity of the muscle widening.

First of all, says Nicks, make sure you get checked for diastasis recti. Not all providers check for it, so please ask at your six-week postpartum appointment.

“When you are pregnant, avoid forward flexion, crunches or sit ups, and twisting. When you get up out of bed roll to your side and use your other hand to support you as you sit up. When you’re picking things up, squat, engage your kegels, glutes, and abs, and then stand.”

She recommends practicing kegel exercises and abdominal toning throughout pregnancy.

“You want the transverse abdominals to continue to support you throughout your pregnancy.”

How Can Women With Diastasis Recti Get the Support They Need?

“It takes commitment and awareness, but you can heal.”

For me, finding the support and care I needed for my diastasis recti meant being proactive. I had to do the research, talk to the experts, and find my way to physical therapy, and option I didn’t even know existed when I began this journey.

Both Nicks and Powell agree. The best way women can find the help they need is by educating themselves.

“Learning more about what their bodies go through and how they can help stay healthy and feel comfortable, both during and after pregnancy, is key,” says Powell.

“They should know that DR and other pelvic floor issues are common and by and large treatable It’s not something we have to ‘put up with’..Learning about how it can be treated and what support is available is important and MUTU really pushes this through MUTU Connect to give women a platform to connect and share experiences.”

Nicks agrees:

“I cannot emphasize enough how important it is to educate yourself on the pelvic floor and abdominals and diastasis recti during your prenatal and postpartum journey. Pelvic floor therapists many times are not covered by insurance, unfortunately, but you are worth the investment.”

“It takes commitment and awareness, but you can heal.”