Ultimate Guide to Diastasis Recti (aka Mama Pooch!)
As I’m writing this, I’m sitting at the YMCA. My kids are having fun in the childcare (woo-hoo!), so I have some uninterrupted time to talk to you about Diastasis Recti, a subject that I’ve become very passionate about over the past few years.
(Not to be confused with Diastisis Recti, which is spelled wrong, but is how I always WANT to type it!)
Every time I hear a frustrated and discouraged mama complaining about her belly pooch, my heart hurts for her. I know that her innocent little belly pooch is most likely also accompanied by things like back pain and stress incontinence (aka peeing a little when you cough or sneeze). And that while she’s quickly losing hope for her mummy tummy, she probably long ago accepted (or was told to accept…) that those other problems were just a normal part of having babies and growing older.
Newsflash: they’re not.
In fact, there’s a good chance that her belly pooch is caused by a condition called diastasis recti. And that the diastasis recti has led to those other symptoms, too. Sadly, not one professional has ever told her about it. Not her OB or midwife, not her family doctor, not even her personal trainer.
In fact, it’s MORE likely that she’s been given advice about her postpartum tummy pooch that is flat out wrong! And if she follows any of this commonly given bad advice, which most mamas unknowingly do, then she could make her problem worse.
(*Note: This post contains affiliate links, which means I receive a commission, at no extra cost to you, if you make a purchase using those links*)
My Experience with Diastasis Recti
I discovered that I had Diastasis Recti during my fourth pregnancy. The experience frightened me. I felt more easily off-balance, and my belly felt very weak and insecure. I started wondering how I would manage to take care of my other kids, much less get through the pregnancy. Would I be able to push effectively during labor? What would happen postpartum? Would my body remain strong and healthy enough to carry a future pregnancy? There were so many unknowns.
I was one of the lucky ones, though, because I already knew a little bit about Diastasis Recti. In fact, that was how I was able to identify my problem so quickly when I started having symptoms of my own!
And I knew where to start looking to get help.
What IS Diastasis Recti, Anyway?
Diastasis Recti occurs when the top layer of your abdominal muscles start to separate.
In fact, the word “diastasis” simply means “separation”. And the word “Recti” refers to your Rectus Abdominis muscle, which is the same muscle that you’re thinking about when you want six-pack abs.
Hang with me a second while I explain some basic anatomy. (I love anatomy!! I think it must be the RN in me…)
The two halves of your Rectus Abdominis muscle are normally held close together by a line of connective tissue called the linea alba. It begins at the bottom of your sternum, which is the spot on your chest where your rib cage makes an upside down “V”. The linea alba goes straight down, past your belly button, and ends at your pubic bone.
Normally, the linea alba is only about 1 cm wide, which is close enough to hold your Rectus Abdominis muscles in the correct position to do their job properly. In addition, the connective tissue should feel very shallow and relatively tight between the two muscle halves.
However, if you have a diastasis, then the linea alba can be stretched out as far as 2cm-10cm, or even further.
The further apart your separation, the more likely you are to have severe symptoms, although this is not always a direct correlation. You can still have significant symptoms even if your separation is only 2cm wide, or you can get your symptoms under control even when you’re at 4+cm!
Is Diastasis Recti ONLY caused by pregnancy, or are there other causes?
Diastasis recti can be caused by anything that increases the pressure inside your abdomen.
So obviously, pregnancy is going to be a BIG risk factor for that ?? But pregnancy is definitely not the only risk factor. In fact, even men can get Diastasis Recti!!
Here are some other common causes of Diastasis Recti:
That growing baby takes up space, and eventually there’s no where else to go but forward! That puts a lot of pressure on your linea alba. How you push during labor and delivery can also put you at risk for diastasis.
Carrying around extra weight can increase your intra-abdominal pressure, especially if your body has the tendency to accumulate fat around your mid-section.
Chronically Poor Posture
Constant sitting, slumping, not enough walking, using the computer, hunching over, arching our backs, chest thrusting…all of these things contribute to poor body alignment. And poor alignment means it’s going to be much more difficult, if not impossible, to engage our core abdominal muscles properly. This leads to weakened core muscles and an increase in (you guessed it!) intra-abdominal pressure.
Certain Workouts (for Abs and otherwise)
Oftentimes, moms think that they can get rid of their mummy tummy by doing more sit-ups, planks, or other hardcore ab work. It’s an unfortunate that there are some personal trainers who even recommend these exercises for that reason! Many of these commonly recommended exercises can increase your abdominal pressure. So if you combine those moves with other risk factors, or if your form is a little off, then it’s a recipe for disaster.
Lack of Healthy Functional Movement
Even if you don’t regularly work out (I didn’t when I discovered my DR! ?), many functional movements we do throughout the day can contribute to high intra- abdominal pressure. Bending over to pick up toys, doing laundry, picking up toys, loading the dishwasher, picking up toys, vacuuming…did I mention picking up toys?
As you can see, although pregnancy is a HUGE risk factor, you’ve probably been had some of these other dysfunctional patterns for years before you got pregnant. In that sense, pregnancy is often blamed only because it was the “straw that breaks the camel’s back”, so to speak.
The true cause of Diastasis Recti is more likely related to our lifetime of poor movement habits and a sedentary lifestyle. These bad habits make us lose a lot of our flexibility and muscle strength, especially in the core muscles of our abdomen.
The result? We quickly get tired of sitting with “good posture” at our desks, in our cars, and on our couches. Hunching over becomes our new normal.
And then, on top of it all, we get pregnant.
Our linea alba never stood a chance.
What are the Symptoms of Diastasis Recti?
The symptoms of Diastasis Recti can vary from person to person, but often include:
Although you can have a diastasis without getting pregnant (remember, even men can get it!), it’s extremely common in postpartum women, and is often the explanation as to why moms can’t get rid of that last bit of annoying mommy pooch.
Do you ever pee a little when you sneeze, cough, or laugh? Do you avoid jumping on the trampoline with your kids because you don’t want to wet your pants?
Outie Belly Button
This could indicate an umbilical hernia (or the beginnings of one), and is a sign of weakness along your connective tissue…especially if you used to be an “innie”.
Low, Mid, or Upper Back Pain
When the abdominals aren’t able to do their job, your back muscles have to work harder to compensate. I used to have a spot on my upper back that would regularly hurt and make my skin go numb, but that rarely happens anymore since I’ve worked on strengthening my core and correcting my diastasis!
Alien Belly Bulge
It’s a freaky, football-shaped bulge that can appear at the top of your tummy when you lift your knees. This is how I discovered my own diastasis. While stepping out of the bathtub during pregnancy #4, I looked down at my belly and panicked. “What IS that thing?!?!” It was the scare factor that finally motivated me to start researching and figure out what to do about my own diastasis recti.
Feeling that your insides are “falling forward”
This can be a difficult sensation to describe, but it was a prominent symptom for me by the time I was about 7 or 8 months pregnant. One of the jobs of your Rectus Abdomins muscles is to hold your abdominal organs in place, but if your muscle can’t do it’s job, then your internal organs will be able to move around more than they should. And it can give a rather “insecure” feeing to your middle.
As already mentioned, your internal organs are supposed to be held in place by your abdominal muscles. When there’s a weak spot in the muscle or connective tissue, such as around your belly button, part of your internal organs (usually a piece of your intestines) can sneak through the weak spot and poke through. This is called a hernia.
Our intestines require some firm structure in order to effectively push our poop towards the rectum. If our abdominal muscles can’t do this job, then the intestines can’t mobilize the poop adequately. AKA…constipation ?
Pelvic Floor Prolapse
You know what I’m talking about. When things aren’t in their proper places “down there”, having intimate moments with our spouse can become (at best) less pleasurable. At worst, they can be downright uncomfortable and painful! Plus, we can be completely self-conscious about showing off our broken tummies, even though we know we shouldn’t be.
Is picking up your toddler harder than it used to be? Do you find yourself slumping over instead of sitting up straight, or leaning against the counter instead of standing up straight while washing dishes?
Strong Emotions Related to Your Middle
Having a broken core is more than just a physical problem, it can release an emotional mess in us that we didn’t even realize was there.
As you might have noticed, many of the common symptoms of Diastasis Recti are considered to be a “normal” part of aging for women in our society, especially if they’ve previously given birth. And sadly, many women are being told that they just have to deal with it.
Let’s clear up this myth right now.
Just because a symptom is common, does NOT make it normal!!!
Never let a medical professional ignore or minimize your concerns. If they do, don’t take that as the final word! After all, I’m a registered nurse, and I never learned about this condition until after I started having kids. It’s never a bad idea to get a second (or even a third) opinion.
Bottom line? If you experience any of these symptoms and feel like something isn’t right, keep searching until you get answers.
Fortunately, in the case of Diastasis Recti, it is super easy to self-check your own belly to find out if this is what you are really dealing with. Once you know, then you can take the next steps to get exactly the kind of help you need to improve it.
How To Check for Diastasis Recti (With Video!)
Checking yourself for abdominal separation at home is simple. You don’t need any experience or special equipment…just a floor and your own hands!
Sometimes it’s easier to learn by watching than by reading, so make sure to also watch the video I made to make sure you’re completely clear on how to accurately check yourself for Diastasis Recti.
You should measure in 3 different locations along your abdomen to get an accurate picture of what is going on, and at each location you want to check for: 1) how wide the connective tissue is stretched at rest, and 2) how loose/firm the connective tissue is.
- Lay flat on your back, with your knees bent and your feet flat on the ground.
- Holding the fingers of one hand together, point your finger tips downward into your belly button, as though you are pointing at your spine. Position your hand so that it makes a “cross” shape with your connective tissue (linea alba).
- Optional: If you suspect a large diastasis (greater than 4 cm wide), then use both hands, placing your fingers so that they are all in a row, crossing your connective tissue.
- Slightly lift your head, without lifting your shoulders, as if doing a mini crunch.
- As you lift your head, gently push your fingers into your belly button and feel for where the edges of your muscles are at the moment they activate. Notice how many of your fingers can fit between the edges of the gap. You will probably have to put your head up and down a few times in order to get an accurate measurement.
- NOTE: It’s important that you measure the gap at the moment you lift your head. See, the higher you lift your head and the longer you keep your muscles engaged, the closer your muscles will come together. We want to know how far apart the muscles are when they’re relaxed, because that is going to tell us what the true severity of your diastasis recti is. If you wait too long after lifting your head to measure your gap, then it might feel like your diastasis is smaller than it actually is.
- After you’ve identified how many fingers wide your gap is, we want to assess how loose/firm your connective tissue is, too. Repeat the same procedure as above while lying on your back, but this time you want to focus on gently pushing down with your fingertips. Shallow = You only feel slight give between the edges of the muscle. Medium = You have to push in a bit further before you feel the connective tissue. Deep = You might not be able to feel the connective tissue at all, or else you might feel deep enough for your pulse or even (gulp) your internal organs.
- Finally, let’s check 2 more locations on your abdomen! Move your hand up until you reach approximately halfway between your belly button and the upside down “V” of your ribcage. Measure both the width of your gap and how loose/firm your linea alba is.
- Now move your hand down below your belly button, halfway between your belly button and your pubic bone. Measure both the width of your gap and how loose/firm your linea alba is.
How many fingers could you fit in your gap? It’s not unusual to have different sized gaps at different locations on your belly. Most often, the belly button location will be the widest, but that’s not always the case. If you head on over to this article, then you can see an image showing the different patterns of abdominal separation, as well as another explanation for how to measure a diastasis.
Normal, healthy connective tissue should only be about 1 cm apart. One finger is approximately the same width as 1 cm, so we can roughly convert the number of fingers you needed to use into the number of centimeters.
If you’ve previously had a diastasis recti that has closed up, then 2 cm and shallow depth can be considered healed. Of course, that is assuming that you’re not having any other symptoms. If you are still experiencing symptoms even at 2 cm and shallow, then it’s probably a good idea to pursue professional help.
Make sure to write down your measurements and today’s date before you forget!! You will want to be able to refer back to these in a few weeks or months to assess your progress.
And if you just discovered that you have a large or deep diastasis, don’t freak out!
Diastastis Recti is definitely treatable, no matter how bad it seems right now. In the past, I’ve been as wide as 5-6 cm wide and deep at the belly button, and I’ve heard stories from other mamas who have healed even larger gaps than that.
As you could see in the video, I’m still working on my Diastasis Recti (about 4 fingers and medium/deep at the belly button at the time of the recording!), but my related symptoms have improved so much that they no longer bother me at all.
One warning about measuring your diastasis…
Don’t do it more than once, maybe twice, per month. Seriously.
You want to give that connective tissue a chance to heal, and every time you dig in there to feel around, you risk stretching it out a bit. Measuring once or twice a month is a good balance between monitoring your progress without getting obsessive about it.
Also, be aware that hormones can also play a role in the size of your diastasis. So depending on where you’re at in your menstrual cycle, your gap may feel a bit larger temporarily. (In other words, don’t go checking your diastasis right before your period!)
Okay, so that was more like two warnings. ?
How Can I Fix my Diastasis Recti?
Medical Professionals sometimes insist that surgery is the only way to truly heal a diastasis, and that if you don’t want surgery (or if you desire to get pregnant in the future) then you just have to learn to live with your symptoms.
However, there are MANY others out there who offer personal stories of healing their own diastasis through abdominal rehab and tummy safe exercises. Some of these stories come from physical therapists like Kelly Dean at The Tummy Team, or personal trainers like Beth Learn of Fit2B and Ciara Jenkins at Restore Your Core and More. And I’ve heard many other stories from regular moms like you and me.
The key to healing your Diastasis Recti is found in your Transverse Abdominis muscle. This is the deepest abdominal muscle, located below your Rectus Abdominis. Your transverse abdominis is your true core muscle, sometimes referred to as your “God given corset”. It starts in your back, attached to your spine, then wraps around both sides of your abdomen until it meets again at the linea alba.
In order to fix your Diastasis Recti, you will have to relearn how to activate, strengthen, and use your transverse abdominis muscle to support your body the way it was designed to do. You also need to relearn how to perform your normal, day-to-day activities in a healthy way that relies on your transverse abdominis muscle instead of using other muscles to compensate.
Here’s what I’ve learned so far about the options for healing Diastasis Recti.
For me, doing abdominal rehabilitation was essential, especially since my diastasis was on the larger side. Abdominal rehab helped me to better understand what was going with my middle, showed me how to strengthen my core, and provided plenty of guidance on how to correct the way I approached my daily activities like cleaning house and taking care of the kids.
Even picking up toys, as a matter of fact ?
Finding a local provider is always a great option, but sometimes it can be hard to find someone who is knowledgable about Diastasis Recti. And even if you CAN find someone, it might be on the expensive side.
For my own diastasis journey, I chose to use The Tummy Team’s online core training programs. It was less expensive than seeing a physical therapist one-on-one (although Kelly also offers live eSessions!), but it still gave me the consistency and accountability that I needed to make good progress.
They offer a variety of courses online depending on your specific needs. I completed their Core Foundations course after the birth of my fourth, and also chose to do their Prenatal Core Training during the second trimester of my fifth pregnancy.
As a result, my fifth pregnancy went waaaay better than my fourth. I was stronger, with very little back pain, more energy, and zero “alien bulges” when I stepped out of the bathtub. I credit the knowledge and skills I gained from both of these online classes for these improvements.
There’s nothing magical about abdominal rehab: you will get out of it what you put into it. But I also found it highly motivating because you can start to feel results fairly quickly, within only a few weeks. And that’s always encouraging!!
Splinting (With Video!)
I personally found abdominal splinting to be essential during my fourth pregnancy since I was having significant symptoms related to Diastasis Recti. So I also purchased one during my fifth pregnancy to be prepared, but ended up using it only on rare occasions when I was doing activities that were a lot more strenuous than usual.
When you have a large diastasis, or if your symptoms are particularly bad, then you would probably benefit from wearing a splint to support your abdominal muscles while you simultaneously work on strengthening them. As a bonus, I found that my splint doubled as an effective belly binder immediately postpartum…those afterbirth contractions can be killer by baby number five ?
There are several different brands of splints available for Diastasis Recti. I used (and love) splints from The Tummy Team, since I was already taking their online rehab courses. In fact, I still keep them around just in case I feel like I need to wear one…but I haven’t needed to for months and months. But since I’ve still got them around, here’s a video showing some of the different splint sizing options and how to wear them:
Maternity support belts are not recommended because they don’t support the abdominal muscles well and require you to rest into the belt to get any support. Instead, an abdominal rehab splint will reinforce what your muscles are meant to do and will promote optimal alignment. (1)
In other words, wearing a maternity support belt has the potential to make your core muscles even weaker than they already are, while an abdominal splint supports your core muscles in doing their job.
Remember the causes of Diastasis Recti? One of them was a lack of healthy, functional movement. So even if you have the best abdominal rehab in the world, it won’t work in the long-term unless it includes info on how to improve the way you move in everyday life.
Functional movement covers all the things you do in your life, including:
- Bending over to pick things up (…toys)
- Carrying babies and children
- Washing dishes
- Working on the computer
- Running and other workouts
If you’ve been regularly moving in ways that increase your intra-abdominal pressure, then you’ll find it easier to heal a diastasis (and prevent it from recurring) if you reduce your risk factors by changing the way you move.
I consider Katy Bowman to be the queen of functional movement, and she has literally written a book on Diastasis Recti. Her website, Nutritious Movement, is a wealth of resources for learning how to move your body in a healthy way.
Stretching (With Video!)
Learning to activate and strengthen your transverse abdominis muscle is not enough. Your body has most likely been functioning with a weak core for such a long time that other muscle groups have compensated and to help out.
The exact muscles groups that are compensating for your weak core will vary slightly from person to person, but generally will involve your glutes (aka your butt), hips, hamstrings, back, and/or shoulders. Since these muscles were not designed to function in this way (they DO have their own jobs, after all!), then over time they can become very tight and sore.
It will be extremely difficult for your newly activated transverse abdominis muscle to keep your body in good posture if it has to also fight against these tight muscles. It’s much better to work on stretching and relaxing your compensatory muscles, while simultaneously relearning how to rely on the transverse abdominis to do it’s proper job.
One quick, easy stretch that you can do as many times as you want throughout the day is a simple hamstring stretch. Stand up straight, engage your core, then bend forward at the hips (this is sometimes called “hingeing” at your hips). Perform this stretch next to something sturdy and about waist high, like a couch, so that you can support your weight on it as you lean forward.
Make sure to keep your back in a neutral position. You should feel the stretch in your hamstrings, NOT your back. If you start to feel the stretch in your back, then you’re probably hingeing forward too far. Watch my video for more details on how it’s done!
Take it from a former Operating Room Nurse…there is no such thing as a minor surgery! And a diastasis recti repair is definitely not minor. In my opinion, it’s always a good idea to investigate your options and choose the least invasive option available to get the results you want.
That being said, sometimes surgery becomes the best option, especially if you have severe symptoms or if your connective tissue has actually torn. Deciding whether to get surgery to correct diastasis recti is a very personal decision, and should be made in conjunction with a knowledgable healthcare provider.
If you choose to go the surgery route, then you’ll usually be scheduled for a procedure that involves inserting a mesh screen into your abdominal muscles. It will connect to both sides of your rectus abdominis in order to hold the muscle closer together.
One VERY important thing to note…diastasis recti surgery is only available if you are finished having kids. Because of the way the mesh works, it doesn’t allow for the “give and stretch” that is required to grow a baby human in your belly.
If you want to read about the personal experience of someone who chose Diastasis Recti surgery (they removed her belly button!!), here’s a very thorough, personal story from It’s A Love/Love Thing. She journals her entire Diastasis Recti surgery journey and recovery (summary: she had a much rougher recovery than most people will have, but it didn’t make her regret her decision!).
If you don’t mind watching REAL surgery (and have a strong stomach for this sort of thing), then you can check out this YouTube video showing an example of an actual Diastasis Recti surgery. They insert the mesh into the abdomen, so you get to see under her skin, watch the surgeons cut muscle and fascia, apply the mesh, and suture everything back together. Here’s the link if you still want to watch, but remember: IT IS GRAPHIC (in a medical sort of way, of course).
I find the video fascinating…but then again, I’m a former operating room nurse 😉
Can Diastasis Recti Come Back?
Just like any potential muscle injury, there is always a risk of redeveloping Diastasis Recti if we’re continuously putting too much outward pressure on our rectus abdominis muscles. The good news is that our body is resilient, so we can always work towards healing it multiple times, if needed!
But nobody wants to do that unless they have to, so the best defense is always a good offense. Here’s some recommendations for how to prevent your diastasis from returning:
- Educate yourself on what kind of movement is good/bad for your Diastasis Recti
- Avoid or modify exercises that would exacerbate diastasis (here is a < 4-minute video overview of moves to avoid)
- Be proactive! If you get pregnant, enroll in a Prenatal Diastasis Recti Course, keep a splint handy just in case, or simply be more diligent about making sure you move your body in a diastasis-friendly way
- Work with an expert who is knowledgeable about Diastasis Recti
Additional Diastasis Recti Resources
- The Tummy Team: Offers in-person, online, and on-demand Abdominal Rehab courses, plus splints.
- Fit2B: Tummy-safe workouts that you can access online.
- Tuppler Technique: I haven’t personally used this one, but it has a great reputation for resources to heal Diastasis Recti.
- Mutu System: Another popular program for strengthening your core and healing Diastasis Recti.
- Katy Bowman has a great article series that provides even more detail about the complexities of Diastasis Recti