Diastasis Recti (Abdominal Wall Separation): Causes, Symptoms, and Treatment

What is Diastasis Recti?

Diastasis recti, also known as abdominal wall separation, is a condition that occurs when the rectus abdominis muscles (commonly referred to as the "six-pack" muscles) separate along the midline of the body. This creates a noticeable gap between the left and right sides of the muscles, caused by the stretching and thinning of the linea alba — the connective tissue that holds the muscles together. While diastasis recti is most commonly associated with pregnancy, it can occur in individuals of all genders and ages when increased abdominal pressure causes the muscles to separate.

Research shows that nearly all pregnant women experience some degree of diastasis recti by their 35th week, with approximately 39% continuing to deal with it up to six months postpartum. However, this condition is not exclusive to those who have been pregnant. It can affect anyone with increased abdominal pressure, such as men who lift heavy weights, individuals who have had abdominal surgery, or those with chronic breathing pattern disorders that place stress on the core muscles.

At Mendwell Pelvic Health, we specialize in treating diastasis recti using evidence-based pelvic floor physical therapy. Our holistic approach focuses on restoring core strength, function, and stability. Whether you're recovering from pregnancy-related diastasis recti or experiencing abdominal separation due to other causes, our personalized care plan is designed to support your unique needs and help you regain a healthy, strong core.

Diastasis Recti Symptoms

Recognizing the symptoms of diastasis recti is essential for early diagnosis and effective treatment. This condition manifests through a range of noticeable signs that can significantly affect daily activities:

1. Abdominal Bulging or "Doming"
One of the most visible indicators of diastasis recti is a bulging or "doming" along the midline of the abdomen, especially when engaging core muscles in activities like lifting or crunching. This bulge may feel soft or jelly-like to the touch, indicating the separation of the abdominal muscles, making it difficult to engage the core effectively.

2. Back Pain and Core Instability
Individuals with diastasis recti often experience persistent lower back pain due to core instability. The weakened muscles fail to provide the necessary support to the spine, making everyday tasks—such as lifting children, performing exercises, or even bending—more challenging and painful.

3. Postural Changes and Alignment Issues
The condition can lead to changes in posture, as weakened core muscles affect the body’s alignment. This misalignment can cause discomfort in various areas, including the hips, lower back, and pelvic region, as the body tries to compensate for the lack of support from the abdominal muscles.

4. Functional Limitations
People with diastasis recti may also face difficulty performing routine tasks that require core strength, such as lifting objects, getting up from a lying position, or engaging in physical exercise. This lack of functional strength can interfere with daily life and physical activity.

5. Pelvic Floor Dysfunction
In addition to core instability, diastasis recti may lead to pelvic floor dysfunction, manifesting as issues like bladder control problems or a sensation of pelvic pressure. These symptoms can further affect the individual's comfort and quality of life.

Causes of Diastasis Recti

The development of diastasis recti often stems from sustained pressure on the abdominal wall, though the specific causes can vary significantly among individuals. Understanding these causes helps both in prevention and creating effective treatment strategies.

Common causes of diastasis recti includes:

• ‍Pregnancy and Childbirth: The most common cause of diastasis recti is pregnancy, where the growing uterus naturally stretches the abdominal muscles. During pregnancy, hormones like relaxin increase tissue elasticity, while the expanding uterus creates progressive pressure on the abdominal wall. This combination of hormonal changes and physical pressure can lead to separation of the rectus abdominis muscles (Diastasis Rectus Abdominis), particularly during the third trimester.
• Improper Exercise Technique: Performing high-intensity core exercises without proper form or excessive abdominal pressure can strain the linea alba, leading to muscle separation. This is particularly common in weightlifting or intense fitness programs.
• Chronic Core Pressure: Conditions that create sustained internal pressure on the abdomen can gradually weaken the connective tissue, including:
  • Chronic constipation requiring repeated straining
  • Chronic coughing or breathing pattern disorders
  • Regular heavy lifting with poor body mechanics
• Physical Factors: Several physical conditions can increase the risk of developing diastasis recti:
  • Rapid weight gain or loss
  • Multiple pregnancies, especially close together
  • Large babies or multiple births
  • Genetic factors affecting connective tissue strength

How Pelvic Floor Physical Therapy Can Help With Diastasis Recti

At Mendwell Pelvic Health, we take a comprehensive, evidence-based approach to treating diastasis recti through specialized pelvic floor physical therapy. Our treatment program addresses not just the abdominal separation, but the entire core system, recognizing that optimal recovery requires attention to how your body works as a whole.

Your recovery journey begins with a thorough evaluation of your abdominal separation, breathing patterns, and overall core function. This detailed assessment allows us to create a personalized treatment plan that evolves through three key phases:

Phase 1: Foundation Building
In your initial sessions, we focus on establishing proper core function through:

• Teaching optimal breathing mechanics to manage intra-abdominal pressure
• Training proper engagement of deep core muscles
• Addressing postural patterns that may be contributing to your symptoms
• Beginning gentle exercises that support tissue healing
• Learning modifications for daily activities to prevent further strain

Phase 2: Progressive Strengthening
As your core control improves, we advance your treatment to include:

• Graduated exercise progression focusing on functional movement patterns
• Integration of core strengthening with daily activities
• Manual therapy techniques to improve tissue mobility and muscle function
• Advanced breathing strategies for more challenging activities
• Education about optimal movement patterns for your specific needs

Phase 3: Functional Integration
The final phase of treatment prepares you for long-term success through:

• Advanced core strengthening exercises tailored to your goals
• Activity-specific training for work, sports, or hobbies
• Strategies for maintaining core stability during challenging movements
• Development of a sustainable home exercise program
• Tools for monitoring and maintaining your progress

Our Diastasis Recti Treatment Approach

At Mendwell, we take a comprehensive, evidence-based approach to support your recovery from diastasis recti. Our methods are designed to target the core muscles and promote healing, restoring stability and strength to your abdominal region.

1. Manual Therapy
We offer hands-on treatments aimed at improving tissue mobility and muscle function, helping to reduce tension, improve flexibility, and address any tightness or weakness in the abdominal and pelvic floor muscles.

2. Real-time Movement Analysis
Through real-time assessment of your movement patterns, we can identify compensations and improper movements that may be contributing to your diastasis recti. This allows us to correct these patterns and prevent further strain on healing tissues.

3. Neuromuscular Re-education
We focus on neuromuscular re-education, which trains the coordination between your core and pelvic floor muscles. This helps re-establish proper muscle engagement, contributing to more effective core function and supporting your overall recovery.

4. Progressive Exercise Programming
Our progressive exercise programs are carefully sequenced to build strength gradually while protecting your healing tissues. These exercises are designed to restore functional core strength and stability, taking your unique recovery needs into account.

Our Treatment Philosophy

We believe in a holistic and personalized approach that emphasizes:

• Individual Attention: Each client receives a customized care plan tailored to their specific recovery needs, ensuring that all aspects of your condition are addressed.
• Integration of Latest Research: We incorporate the most up-to-date, evidence-based research in core rehabilitation to ensure that your treatment is as effective as possible.
• Functional Outcomes: Our treatment focuses on achieving outcomes that directly impact your daily life, such as reducing pain during activities like lifting, exercising, or caring for children.
• Comprehensive Education: We provide thorough education to empower you with the knowledge you need for long-term success, so you can maintain a healthy core beyond treatment.
• Ongoing Assessment and Adaptation: Your progress is regularly assessed, and your treatment plan is adjusted as needed to ensure optimal recovery.

We are committed to working alongside you every step of the way to help you reach your goals—whether it’s returning to exercise, caring for your children without pain, or simply regaining confidence in your core strength.

Our evidence-based treatment methods, combined with personalized attention, provide the support needed for a successful recovery from diastasis recti.

Frequently Asked Questions About Diastasis Recti

Can diastasis recti occur in people who haven't been pregnant?
Yes, while diastasis recti is common during and after pregnancy, it can affect anyone who experiences increased intra-abdominal pressure, including men and children.

How can I tell if I have diastasis recti?
‍While a qualified healthcare provider should make an official diagnosis, you might notice a visible bulge or "doming" along your abdomen's midline during activities that engage your core. Our physical therapists can perform a proper assessment to determine the extent of separation and develop an appropriate treatment plan.

Will I need surgery to fix my diastasis recti?
‍Most cases of diastasis recti respond well to conservative treatment through physical therapy. Surgery is typically only considered when significant functional impairment persists after completing a comprehensive physical therapy program. Our team can help determine the most appropriate treatment path for your specific situation.

How long does recovery take?
‍Recovery timelines vary depending on factors such as the severity of separation, consistency with exercises, and individual healing rates. Many patients begin noticing improvements in core function within 6-8 weeks of starting treatment, though complete recovery may take several months of consistent work.

Can I exercise while receiving treatment for diastasis recti?
‍Yes, but it's crucial to work with a qualified professional to ensure exercises are appropriate and performed correctly. Our physical therapists will guide you through safe, effective exercises that support your recovery rather than potentially worsening the condition. We'll help modify your existing exercise routine and gradually progress activities as your core function improves.

Is it ever too late to treat abdominal wall separation?
‍No, it's never too late to begin treatment. Whether your diastasis recti developed recently or years ago, physical therapy can help improve core function and reduce symptoms. The key is working with qualified professionals who understand how to properly assess and treat this condition.