What Is Diastasis Recti?

Diastasis recti is a condition where there is a midline separation of the belly muscles. It causes a visible gap of 2 cm or more between the muscles in the middle of the belly. This often leads to a bulge where the intestines and fat in the belly push against that gap in the muscles.

What are symptoms of diastasis recti?

Diastasis recti may cause several symptoms. This is because strong belly muscles play a huge role in your body and help to stabilize your core. These muscles help with your posture and give support to the organs and tissues within the belly. When these muscles weaken and separate you may experience:

• Bulging in the belly

• Leaking of urine

• Poor posture

• Back pain

While diastasis recti does not always cause belly pain, it can in severe cases. Some people may also feel self-conscious or have a negative body image because of the belly bulge.

What causes diastasis recti?

Diastasis recti is often caused by increased pressure in the belly. There are different ways that this can happen. But pregnancy is the most common cause.

In fact, more than 60% of pregnant women develop diastasis recti towards the end of pregnancy. This is because as a baby grows larger in pregnancy and takes up more space, the pressure in the belly increases. The increased pressure stretches the wall of the belly and can cause visible stretch marks on the skin. Beneath the skin, the stretching can weaken the muscles of the belly and lead to diastasis recti.

Other things that can raise the pressure in your belly and put you at risk for diastasis recti include:

• Extra belly fat

• Weightlifting

• Liver disease, which can lead to extra fluid in the belly

• Tumors in the belly

Who is at risk for diastasis recti?

Diastasis recti can happen in both men and women. Other than increased belly pressure, experts haven’t agreed on other risk factors. Some groups that may be at risk include:

• Those born prematurely, since their belly muscles may not be fully developed

• Older adults, whose muscle tone naturally decreases as they age

• Those with previous surgery on the belly, as their muscles may be weak from being cut

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How do I know if I have diastasis recti?

If you have concerns about diastasis recti, it is best to discuss them with your healthcare provider. This is because diastasis recti causes a belly bulge that can occur in other conditions. Common causes for a bulging belly that might be mistaken for diastasis recti include:

• Hernia

• Bloating from excess gas

• Excess belly fat

A physical exam or special imaging of your belly — like an ultrasound, CT scan, or an MRI — can help diagnose the condition. There are also a few differences to help you know the most likely cause of your belly bulge.

Difference between diastasis recti and hernia

Diastasis recti is commonly misdiagnosed as a hernia. Hernias differ from diastasis recti because there is an actual hole in the tissue underneath the muscle. As a result, there is a risk of bowel and other belly contents becoming stuck in the hole. This is called “incarceration.” And it is a surgical emergency in severe cases. In diastasis recti, the tissue holding the belly contents in place under the muscle is intact. Some people with the condition go on to also develop a hernia.

Difference between diastasis recti and bloating

Bloating generally causes your entire belly to swell. But with diastasis recti only a small section in the middle of your belly bulges. Because excess gas causes bloating, it tends to come and go. It will resolve after passing gas, pooping, or changing the foods that you eat. Diastasis recti, however, does not respond to the quick fixes for bloating. 

Difference between diastasis recti and belly fat

One way to tell if you just have excess weight or an actual muscle gap is by tensing your belly muscles. Try lying flat and then lifting your head like when doing a sit-up. If present, the gap or bulge of diastasis recti will be pronounced in the center of your belly.

You can have diastasis recti with extra belly weight or with a flat tummy. If you are carrying a lot of excess weight and have diastasis recti, weight loss is often suggested. But it usually doesn’t fix it. 

How do you treat diastasis recti?

If you develop diastasis recti during pregnancy, you may not need treatment at all. In most women, it goes away on its own — typically within 12 months of giving birth.

Other people may need diastasis recti treatment. And the treatment will vary based on the cause of the muscle separation and how severe it is.

Common treatments for diastasis recti include:

• Exercise therapy

• Surgery 

• Nonsurgical options

Exercise therapy

The first step in treating diastasis recti is often exercise therapy. This treatment will typically focus on strengthening your core muscles. Core-strength training exercises, often done in yoga or Pilates, may be useful. Still, it is unclear which exercises are most helpful.

But it is a common belief that you should avoid exercises that cause the belly wall to bulge more. This includes exercises like:

• Crunches

• Sit-ups

• Lower leg raises while lying flat

These exercises may unintentionally widen the gap between your belly muscles. Pelvic floor exercises, like Kegel exercises, are also sometimes recommended. But they haven't proven to be very helpful. A structured exercise plan may be more useful in treating diastasis recti. A physical therapist can help you know which exercises work best and which ones you should avoid. 

Surgery

Another common treatment is surgical repair of diastasis recti. This is a major surgery that involves sewing the separated muscles back together. It may also involve inserting a mesh into your belly to provide more support for the abdominal wall.

This surgery is sometimes confused with abdominoplasty (“tummy tuck”). A tummy tuck is a cosmetic procedure to remove excess belly skin and fat. The surgeon may also tighten the abdominal muscles in the process. It is common for some people to get a tummy tuck at the same time as a diastasis recti repair. 

Nonsurgical options

High-intensity focused electromagnetic (HIFEM) waves are also used to treat diastasis recti. The magnetic stimulation on the belly destroys fat tissue and improves muscle tone. During a treatment, a device placed on the belly for 30 minutes causes the muscles to contract.

After several sessions, muscle thickness improves and the gap starts to close. An added benefit of treatment is the destruction of fat tissue. After 3 months, more than 90% of people had an improvement in belly appearance. 

What happens if diastasis recti goes untreated?

In most cases, nothing will happen if you choose not to treat it. You may feel self-conscious exposing your midsection to others due to its tendency to bulge. If you have any symptoms, they may worsen over time. But it rarely leads to problems. There may be a higher risk of problems if you have both diastasis recti and a hernia.

A waist trainer or abdominal support band can also help the symptoms of diastasis recti. 

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Written by:

Stephanie Reese, DO, MS

Dr. Reese is board-certified in family medicine and resides in Savannah, Georgia. She received her undergraduate degree from the Florida Institute of Technology and master’s in hematology/immunology from Long Island University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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