Diastasis recti symptoms: What are the early signs of diastasis recti?

Overview: What does diastasis recti look like?

Diastasis recti, or “mommy tummy,” is a common, normal spreading of the abdominal muscles during pregnancy. Usually, the abdominal muscles on either side of the midline (the rectus abdominis muscles) are held close together by a narrow band of connective tissue called the linea alba. During pregnancy, this connective tissue stretches to make more room for a growing baby, so the space between the abdominal muscles widens. However, the connecting tissue doesn’t return to place once a baby is delivered. Instead, the abdominal separation persists. Because it’s loose, abdominal pressure pushes the tummy outward. Women will notice a bulge or pot belly centered around the navel, sometimes called a “mommy pooch.” The bulge gets worse when a woman sits up. If a woman presses down on the bulge, it will feel flabby or squishy, not hard like a muscle. Fortunately, the connective tissue slowly tightens over the next few weeks. The abdominal separation gets narrower. Most women's abdomen returns to normal, but sometimes it doesn’t. It’s usually no cause for worry other than cosmetic, but it may cause some problems. Unresolved diastasis recti may be associated with back pain, pelvic pain, urinary incontinence, and postural abnormalities

What are the early signs of diastasis recti?

Diastasis recti is a normal part of pregnancy in adults, but both men and women with excessive weight can develop the condition. All women who carry a baby to term will develop diastasis recti. However, most will not notice it until after the baby is born. Therefore, the earliest signs of diastasis recti aren’t apparent until right after childbirth. These include:

• Abdominal weakness

• A visible bulge centered around the navel

• A “soft” or squishy feeling in the area around the belly button

Other diastasis recti symptoms

After childbirth, the symptoms of diastasis recti include:

• An abdominal bulge or “mommy pooch” centered around the navel

• A feeling of squishiness, flabbiness, or softness when pushing down on the center of the tummy

• A visible “dome” or “crevice” down the central line of the abdomen when flexing the abdominal muscles

• Abdominal weakness that causes difficulties when lifting objects or sitting up

• A palpable separation between the abdominal muscles down the centerline of the abdomen, particularly around the belly button

Diastasis recti symptoms in newborns

Newborns also commonly have diastasis recti because of incomplete development or inherited disorders. The abdominal separation usually resolves within a few weeks. The most common sign of newborn diastasis recti is a ridge that runs down the center of the abdominal wall. This ridge usually gets bigger if the baby tightens its abdominal muscles. 

Diastasis recti vs. hernia symptoms

Based on its appearance, diastasis recti is easily mistaken for a hernia. Both diastasis recti and hernias involve abnormalities in the connective tissues that keep abdominal muscles together. Diastasis recti is a stretching of connective tissues that causes abdominal separation. On the other hand, a ventral hernia is a defect in the abdomen’s connective tissue. This defect allows the intestines to protrude through the abdominal wall. Diastasis recti is not a serious medical condition, but a hernia is.

When to see a doctor for diastasis recti symptoms

Diastasis recti is not a health threat but may cause emotional distress or physical complications, such as poor posture or back pain. If these are concerns or if the condition does not improve after several months, talk to a healthcare professional. Most people will start by talking to their regular doctor or a doctor specializing in women’s health, such as an OB/GYN. However, some may eventually end up in the care of a physical therapist or plastic surgeon. 

Healthcare providers diagnose diastasis recti based on a medical history and physical examination. They usually diagnose diastasis recti by observing the abdominal bulge. The clinician may try to measure the gap between the abdominal muscles at the navel with calipers or another measuring device. Anything over 2 centimeters (about two finger widths) is diastasis recti. Belly fat may interfere with a clinician’s ability to measure the gap, so an ultrasound may be used.

Complications of diastasis recti

Untreated diastasis recti do not commonly cause complications. When it does, those complications are usually not health-threatening. The most common complications of unresolved diastasis recti include:

• Emotional distress

• Decreased self-image

• Abdominal weakness

• Pelvic floor dysfunction, such as urinary incontinence, pain, or constipation

Back pain may be a complication of diastasis recti. Some studies have found a correlation between diastasis recti and lower back pain, but most studies have concluded no relationship. 

How to treat diastasis recti symptoms

In most cases, diastasis recti will resolve by itself. Even if it doesn’t, the gap will narrow, and the bulge will decrease in the weeks following childbirth. Even though all pregnant women will develop diastasis recti by the end of the third trimester, diastasis recti will completely resolve in about half of women four to six weeks after childbirth. After eight weeks, most women will not see any more improvement. 1 in 3 women will still have abdominal separation six months after childbirth. 

Daily abdominal exercises can help repair diastasis recti after childbirth. A physical therapist can demonstrate the most effective exercises. Diastasis recti exercises will strengthen abdominal core muscles, tighten the linea alba, narrow the gap between the muscles, improve the belly’s appearance, and help prevent complications.

Surgery is usually medically unnecessary, but plastic surgeons routinely perform surgery to correct diastasis recti. They often combine diastasis recti correction as part of a “tummy tuck” (abdominoplasty) that includes removing excess skin and fat from the abdomen. Diastasis recti surgery can be an open or less invasive procedure involving a laparoscope. In the procedure, the surgeon will fold the connective tissue between the abdominal muscles and connect the folds to narrow the gap. The surgeon will then keep the fold in place with a mesh. This procedure will strengthen the abdominal wall, improve its appearance, and prevent complications. Insurance companies consider surgical diastasis recti correction cosmetic surgery, so most will not pay for it.

RELATED: What pain medications are safe to take while pregnant?

Living with diastasis recti

Most women can improve or heal diastasis recti through daily postpartum exercises. The purpose is not to close the gap between the ab muscles or get “six-pack abs” by exercising the superficial abdominal muscles. Sit-ups, crunches, bicycle crunches, and crossover crunches won’t help. Instead, the goal is to strengthen the inner abdominal muscles and tighten the linea alba, the connective tissue that joins the abdominal muscles along the midline. 

The best diastasis recti exercises include:

• Transverse abdominis exercises (Tupler technique)

• Pelvic floor muscle exercises (posterior pelvic tilt)

• Multifidus exercises

• Diaphragm exercises

All of these exercises can be found online or demonstrated by a physical therapist.

FAQs about diastasis recti

When is diastasis recti considered severe?

Diastasis recti is not considered to be a severe medical condition.

Does diastasis recti get worse with age?

Diastasis recti usually does not worsen with age. However, significant weight gain may worsen the abdominal separation. 

Does diastasis recti cause belly fat?

Though it may look like a fat bulge in some people, diastasis recti is not related to fat deposition.

What’s next? Additional resources for people with diastasis recti symptoms

Test and diagnostics

• Diastasis recti, Cleveland Clinic (2022)

Treatments

• Abdominoplasty, StatPearls (2023)

• Diastasis recti rehabilitation, StatPearls (2023)

• Diastasis rectis abdominis, Physiopedia (2023)

• Treatment options for abdominal rectus diastasis, Frontiers in Surgery (2019)

Scientific studies and clinical trials

• Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: A randomised controlled trial, Journal of Musculoskeletal and Neuronal Interactions (2019)

• Is diastasis recti abdominis associated with low back pain? A systematic review, World Neurosurgery (2023)

• Postpartum characteristics of rectus abdominis on ultrasound imaging, Manual Therapy (2008)

• Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbopelvic pain, Manual Therapy (2015)

More information on related health conditions

• Hiatal hernia treatments and medications, SingleCare (2020)