We’ve all heard how important it is to “strengthen the core,” from assorted fitness pros, and for so many reasons beyond just looking taut. Not only does core strength promote stability and balance, but it can help protect you from lower back pain, future muscle injury, and a common condition called diastasis recti, aka diastasis or diastasis recti abdominis (DRA), which is most frequently caused by pregnancy. Here, we dive into all things diastasis recti, including how to know if you have it, the potential health risks associated with it, and how to repair it—both at home and in the doctor’s office.
What is diastasis recti?
“Diastasis recti is a separation of the six-pack muscles that run down the middle of the abdomen,” explains Dr. Ruth Celestin, a board-certified plastic surgeon based in Riverdale, Georgia. Those six-pack abdominal muscles, aka rectus abdominis, are divided by a tough band of connective tissue known as the linea alba, which connects the rectus abdominis from the breast bone down to the pubic bone. (You’ve seen it—it’s that vertical line that runs down the center of particularly toned abs.) “Normally, that connection is less than about two centimeters wide,” says Dr. Lisa J. Peters, a board-certified plastic surgeon in Oak Park, Illinois. This is known as the inter-recti distance. “In some people, it can stretch, resulting in the rectus abdominis muscles’ being positioned too widely apart,” she adds.
That stretching is caused by excessive, built-up pressure behind the abdomen, so it’s logical that DRA most typically occurs during pregnancy. In fact, it affects about 60% of pregnant women. “As the uterus enlarges, it pushes on the rectus muscles, which flatten and separate in the midline, to accommodate the increased size of the uterus,” explains Dr. Gerald Imber, a board-certified plastic surgeon in New York City. He points out that those carrying a larger baby or multiples are at greater risk for abdominal separation. However, DRA can also be caused by weight gain, especially if a person is prone to carrying their fat viscerally (around their muscles, like a hard beer belly) rather than subcutaneously (pinchable, squishy fat).
If you think you could have diastasis recti, try doing a sit-up while observing yourself in the mirror. “The abdomen tends to look round, as the muscles can flex and have tone, but the stretched-out connection between them doesn’t,” explains Dr. Peters. If you have DRA, you may see an obvious vertical bulge protruding from your abdomen during your sit-up, above the belly button, at the umbilicus, or below it. “It kind of looks like a large sausage,” says Dr. Peters, adding that if a relatively thin person has an especially round tummy while standing yet it flattens out completely once lying down, this is likely an indication of diastasis recti.
Is diastasis recti dangerous?
Though having a gap between your ab muscles sounds troubling, diastasis recti is not a significant medical concern. “There are no life-threatening ramifications of letting DRA go untreated, long- or short-term,” assures Dr. Celestin. Even in severe cases, that gap is still too narrow for an organ to literally force its way through it (unlike a hernia), so pain is unlikely. “If a diastasis isn’t bothersome to a patient, it does not require treatment, and an untreated diastasis will not cause other medical problems,” agrees Dr. Peters.
However, if the space caused by diastasis recti is particularly large—greater than two inches or more—Dr. Celestin notes that abdominal strength will fall by the wayside, which could cause a person to put more strain on the lower back. Though there is limited research to support the theory that DRA can cause back issues, it makes sense: “Many people don’t realize that the core muscles go way beyond your abs,” adds Brian Danielson, personal trainer at E by Equinox in New York City. “Your abdominal core is built in such a way that all the layers are supposed to work together, to stabilize you in whichever direction you move.” Once the ab muscles get separated along your linea alba, your entire core gets thrown out of whack and your body is forced to compensate. This potentially could cause injuries in other muscles, like those your back or even the pelvic floor.
Ultimately, though, diastasis recti is mostly a cosmetic issue. “By the time most women notice it—most often, years after childbirth—the changes they’ve observed are permanent,” says Dr. Celestin. “Generally, the issue is the inability to get back to pre-pregnancy shape,” adds Dr. Imber. That said, with careful attention to diet and exercise, in many cases, the abdomen can recover on its own. That’s why Dr. Celestin recommends patients wait six months to a year postpartum, to see what returns to its pre-pregnancy state and what doesn’t, before taking more significant measures.
If it doesn’t heal on its own, how can you fix diastasis recti?
If someone’s abdomen doesn’t go back to normal postpartum (or if weight loss doesn’t help DRA), you have options—from simple exercises to plastic surgery—for improving and even curing diastasis recti, depending on what kind of commitment you’re open to making.
Diastasis recti treatment option #1: physical therapy and exercise
While this is the least expensive and most DIY-friendly option, it’s important to have realistic expectations. “Keep in mind that the permanent stretch occurred in nonmuscular tissue around the rectus muscles . . . [which] cannot be worked out and strengthened in the way that one would be able to do for a muscle,” points out Dr. Celestin.
Danielson agrees, noting that fitness won’t cure DRA but can help improve it. According to a study in the Journal of Women’s Health Physical Therapy, workouts targeting the transverse abdominis, or TVA, can help reduce inter-recti distance. “The TVA is one of the deepest core muscles and forms a wall-like sheath, to protect the inner organs,” says Danielson. “It starts below the last rib, on either side of the spine, wraps around to the front of the body, and ends by inserting into the linea alba.” Basically, this muscle acts like nature’s corset, supporting your lower body and flattening the stomach from the inside.
To work on your own TVA at home, try these three abdominal exercises, getting in the supine position (lying on your back), with your knees bent and feet on the floor—though you can eventually raise your legs, for more of a challenge. “For all these moves, it’s important to have your shoulders and tailbone connected to the ground, for stability, and to pull the inner thighs together, to engage the pelvic floor,” says Danielson, who recommends doing three rounds of eight reps of these exercises, working your way up to more. (Not sure if you’re ready to try these exercises? Get clearance from your OB-GYN first.)
TVA breathing
While relaxed, inhale from deep within your body, expanding your belly, for four seconds. Then exhale for four seconds, pulling the belly button in. Imagine you’re trying to get your belly button to touch your spine to fully engage your TVA. Repeat.
Heel slides
Use TVA breathing as your foundation. Slowly slide one of your bent legs away from your body, exhaling as you do so, until it’s fully straightened out, leg and heel touching the floor. (Your stabilized leg should be responsible for 90% of your support, while your sliding leg provides 10%.) As you inhale, pull your leg back up to its original bent position, then repeat, switching legs for each rep.
Band pullovers
Secure a resistance band to a fixed position, about three feet behind you, then get into your supine position, starting with your arms overhead and behind you. Keeping your shoulder blades pinned to the floor, pull the band down toward your sternum with both arms and exhale using your TVA breathing. As you inhale, expand your stomach and return your arms to starting position, then repeat. While you could use weights for this, Danielson recommends bands because they provide constant resistance, which makes your muscles work overtime to support you.
Diastasis recti treatment option #2: Emsculpt Neo or HIFEM (high intensity focused electromagnetic) stimulation
If working out isn’t quite giving you the results you’re looking for, you can kick your abs into high gear with a treatment like Emsculpt Neo. “Emsculpt technology uses electromagnetic energy that triggers supramaximal contraction—20,000 in a 30-minute period—to build new muscle and tighten diastasis recti,” explains New York City board-certified dermatologist Dr. Bruce Katz. “Studies have shown that the treatment can help improve [diastasis recti] by about 19%.”
Obviously, even the most impressive fitness junkie couldn’t execute that many crunches in 30 minutes.
Related: My Unfiltered Emsculpt Neo Review: From Cost and Pain Level to What Results Were Really Like
Emsculpt provides the same effect on diastasis recti as abdominal workouts do—but much more quickly. However, it’s important to keep in mind that multiple treatments will be required, to achieve the best results—usually four treatments over the course of a month, with maintenance treatments every three to six months thereafter. Also, there’s a bit of a waiting period: “New moms should wait at least six months after delivering and should have clearance from their obstetrician before treatment,” notes Dr. Katz, adding that Emsculpt Neo can help moms at any stage postpartum but especially when diastasis recti is caught early.
Still, just like working out can only do so much to strengthen your core, Emsculpt Neo has its limitations too, and you’ll have to keep at it to maintain your results—which could get costly in the long run. If your diastasis recti hasn’t improved enough to your liking with fitness or HIFEM, “[then] the only cure is surgery,” says Dr. Imber.
Diastasis recti treatment option #3: abdominoplasty, aka tummy tuck
By now, it should be clear that once stretched out, the linea alba can’t totally go back to normal without physical intervention. “The best treatment for a diastasis is abdominoplasty,” says Dr. Peters. (This is also known as a full or traditional tummy tuck). During that procedure, the entire rectus abdominis is exposed. “In addition to removing skin and fat, the lining of the rectus abdominis muscles is sutured in the midline, to close the gap between them and bring them back to their normal position,” she says. (Tummy tucks are so popular post-pregnancy that, according to Dr. Imber, diastasis recti is often discovered during surgery, which goes to show that DRA is often minimally noticeable.)
A full tummy tuck targets the entire zone from the pubic area to the xiphoid, where your ribs attach to the breast bone—so yes, your belly button will likely be relocated during your procedure—and the incision can span from hip to hip. If you’re curious about what an extended tummy tuck is, it just means that the incision may be wider than that of a traditional abdominoplasty. “It’s usually used for patients who have more skin laxity in the flank and around the lower back,” says Dr. Celestin. If you’ve experienced massive weight loss, this may be the right procedure for you.
If you’re hoping for a smaller tummy tuck scar and your case of diastasis recti is below the belly button (which is most common, says Dr. Imber), you may be a candidate for a mini abdominoplasty, but it’s unlikely. Mini tummy tucks don’t address the muscle, skin, or fat of the upper abdomen and often don’t even address the underlying muscle at all (but of course, be sure to consult with your plastic surgeon). Most surgeons would find it strange to suture a diastasis below the belly button without tightening the muscles above it. “You don’t want the lower abdomen to look too flat, relative to the upper abdomen,” says Dr. Peters. For the most part, mini tummy tucks are best suited to those whose muscles and belly button have recovered well after pregnancy and who need to remove lax skin only on the lower stomach in order to achieve flat abs, advises Dr. Celestin. (Bonus: mini tummy tuck scars are about the same size as one from a C-section.) However, to most effectively treat severe diastasis recti, there’s a good chance that you’ll need to commit to the real deal. Says Dr. Peters, “in my practice, if the patient has a rectus diastasis and needs a repair, even if there’s not a lot of extra skin and fat, they need a full abdominoplasty to address it.”
