Your body has many ways of surprising you — and pregnancy can give you the most surprises of all! Weight gain, a sore lower back, billowing breasts, and skin color changes are all par for the nine-month course. So is a fairly harmless but undesired condition called diastasis recti.
Diastasis recti is a separation of the rectus abdominal muscles in the midline, more commonly known as your “abs.” Your abs are made up of two parallel bands of muscles on the left and right sides of your torso. They run in the center of your abdomen from the bottom of your ribcage down to your pubic bone. These muscles are joined to each other by a strip of tissue called the linea alba.
The pressure of a growing baby — helped along by the pregnancy hormone relaxin, which softens body tissue — can make your abs separate along the linea alba. This causes a bulge to appear at the center of your tummy. Some diastasis recti look like a ridge, but most cases are a classic pregnancy “pooch.”
The good news is that you can heal diastasis recti with some gentle but effective exercises. Getting your abs back into pre-baby shape might take a little more work, however.
Ilene Chazan, MS, PT, OCS, FAAOMPT, has nearly a quarter of a century’s experience as a trainer and physical therapist. In her Jacksonville studio, Ergo Body, she’s seen many cases of diastasis recti.
“My first exercise for people with diastasis recti is to learn proper breathing techniques,” says Chazan. “That means learning to guide the breath into the full 360-degree circumference of the diaphragm.”
The diaphragm is a wide, domed muscle that crests at the bottom of the rib cage. It separates your thorax, or the lungs and heart, from your abdominal space. Optimally, it and its neighbor — the traverse abdominis muscle — keep your core stable. A stable core protects your back and allows for a full range of movement of the limbs and torso.
The deceptively simple exercise of diaphragmatic breathing begins by lying on your back. Place your hands on top of your lower ribcage and inhale.
“Feel the diaphragm make the lower ribs expand into your hands, especially out to the sides,” Chazan advises. As you exhale, concentrate on contracting your diaphragm, creating what Chazan calls a “corset effect.”
Once you’re confident that you’re breathing into your diaphragm, go on to the next two exercises.
Imagine how much better high school gym class would have been if you’d known about standing pushups. These exercises can help heal diastasis recti and give you the upper body toning and lower body stretch of regular push-ups.
Stand facing a wall at arms’ length with your feet hip-width apart. Placing your palms flat against the wall, inhale. “Encourage the breath to flow deeply into lungs,” says Chazan. “Allow the ribs to expand circumferentially rather than letting air create a puffed belly.”
On the exhale, draw your belly tightly in toward your spine. Allowing your arms to bend, lean into the wall on your next inhalation. Push away from the wall on the exhale and resume your straight-up position.
A more advanced healing exercise is a common yoga position, the Bridge pose (or Setu Bandha Sarvangasana, if you prefer your poses in Sanskrit).
To start the Bridge pose, lie on your back with your spine gently pressed into the floor. Your feet should be flat and your knees bent. Lay your arms at your sides with your palms facing down. Inhale slowly, using your diaphragmatic breathing.
On the exhale, tilt your pelvic area toward the ceiling until your body forms a straight incline with your knees as the highest point and your shoulders as the lowest. Inhale gently as you hold the pose, and on the exhale, slowly roll your spine back onto the floor.
“The cool thing about this sequence,” says Chazan, “is that it helps you transition into your daily functions as you heal. Awareness of your breathing and how you’re using your deep abs throughout the day — as you pick up your baby, or bend over to change [them] — is as important to healing diastasis recti as the more physical exercises.”
Your chance of developing diastasis recti increases if you have twins (or more) on the way, or if you have had many pregnancies. If you’re over 35 years old and deliver a baby with a high birth weight, you may also have a higher likelihood of developing diastasis recti.
The likelihood of diastasis recti goes up when you strain by bending or twisting your torso. Be sure to lift with your legs, not your back, and to turn on your side and push up with your arms when you want to get out of bed.
You might see diastasis recti in your newborn’s tummy, but don’t worry too much. Treatment in infants with diastasis recti is only needed if a hernia develops between the separated muscles and requires surgery. It’s very likely that your baby’s abdominal muscles will continue to grow and the diastasis recti will disappear with time. Of course, you should contact a doctor immediately if your baby has redness, abdominal pain, or continuous vomiting.
The most common complication of diastasis recti in adults is also hernia. These usually require a simple surgery for correction.
A little light activity a few days a week can go a long way toward healing your diastasis recti. However, remember to check in with your doctor before trying more strenuous exercises.
Q: How often should I perform these exercises? How soon will I see results?
A: Assuming you have had a vaginal delivery, you can begin these gentle exercises soon after birth, and perform them daily. A cesarean delivery will likely prevent you from doing any core/abdominal muscle exercises for at least two or three months after your delivery. As every patient is different, you should check with your doctor as to when you are cleared for abdominal exercise.
While diastasis recti often resolve on their own as patients lose pregnancy weight postpartum, these exercises may help the muscles reposition themselves more quickly. If after 3-6 months of regularly performing these exercises you fail to see improvement, check with your physician to rule out a hernia.
Lastly, wearing an abdominal binder or corset in the postpartum period may assist your rectus muscles in returning to their midline position. — Catherine Hannan, MD
Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.