Can You Prevent A Diastasis Recti In Pregnancy?
If you’re pregnant, planning a future pregnancy or already have little ones, you may have heard of a diastasis recti - a structural change in the core that can lead to changes in strength, aesthetics and may contribute to common pregnancy symptoms. Up to 60% of pregnant people experience a diastasis recti during or following pregnancy and it’s a common source of concern. The good news? While you can’t necessarily prevent a diastasis recti, there are evidence-based ways to support your core, reduce the significance and impact on your body and minimize the likelihood of any associated symptoms. In this post, we’ll break down what diastasis recti is, what causes it, and most importantly—what you can do during pregnancy and postpartum to keep your body strong and resilient to all life throws your way.
What is Diastasis Recti?
A diastasis recti abdominis is a widening in the space between the two rectus abdominis muscles, also known as your 6-pack muscles. As your belly grows during pregnancy, the tissue between the rectus abdominis muscles stretches and thins allowing for more space between the two muscles. This tissue is called the linea alba. As your belly grows, the rectus abdominis muscles also become inhibited and underutilized, leading to atrophy. This muscular atrophy further compounds the presentation of a diastasis recti.
There is no universally agreed upon ideal distance between the rectus abdominis muscles, but a separation of 2cm or greater typically meets the diagnostic criteria for a diastasis recti. More severe diastasis recti can present with much wider separations.
While roughly 100% of people will experience a diastasis recti by the end of the third trimester, the prevalence of this separation is around 35% by 6 months postpartum.
Can You Prevent Diastasis Recti?
The short answer? No, you cannot prevent diastasis recti from occuring during prergnancy. Remember, 100% of people will experience a widening in the gap between the rectus abdominis during pregnancy. This change in tissue shape is a normal and necessary part of making a baby. As the baby grows, they need space and the abdomen stretches to accommodate their growth. This is a good thing!
In cases where the individual is pain and symptom free, a diastasis recti may be considered a normal change that occurs as a result of a pregnancy.
With that said, not everyone continues to have a diastasis recti postpartum and there are things you can do during and following pregnancy to reduce the severity of a postpartum diastasis recti and the likelihood it’s associated with symptoms.
What increase the risk of postpartum diastasis recti?
A number of factors have been found to be associated with higher risk of diastasis recti in the longer term postpartum period, defined as 3+ years postpartum. The factors associated with risk of longer term diastasis recti includes:
Higher BMI: BMI is an imperfect measurement, but research has found an association between BMI and diastasis recti. BMI’s impact is considered to be a result of the increased intra-abdominal pressure associated with visceral adipose tissue.
Higher number of childbirths: Each pregnancy creates stress and strain on the linea alba and the abdominal wall. Repeat stress on the same tissue can exacerbate existing areas of weakness and thus contribute to widening of a diastasis recti.
Twin pregnancies: Twin pregnancies typically create larger bellies, potentially contributing to increased stress on the linea alba.
Diabetes: There’s evidence that suggests that those who have gestational diabetes mellitus have higher risk of postpartum diastasis recti abdominis as well.
What can help minimize a diastasis recti?
While we can’t prevent a diastasis recti in pregnancy, there are things we can do to minimize the risk of longer-term postpartum diastasis recti and any associated symptoms. Here are a few things you can do to reduce the likelihood of postpartum diastasis recti:
Strengthen your core during and following pregnancy
While core strengthening can feel intimidating in pregnancy, this is one of the best ways to minimize a postpartum diastasis recti. Your core has four muscles layers - the rectus abdominis, external obliques, internal obliques and transverse abdominis. By strengthening all four layers, you can minimize the strain in your linea alba, support your core and simultaneously reduce the likelihood of common pregnancy symptoms like back and pelvic pain.
In the past, conventional wisdom encouraged folks to avoid exercise that worked their rectus abdominis and obliques and instead recommended only focusing on the transverse abdominis(TA). We now know that strengthening the whole core system, including the rectus abdominis and obliques, gives us the best chance of reducing the significance of a diastasis recti. Don’t take my word for it - this article used ultrasound to visualize the change in width of a diastasis recti with an abdominal crunch versus when people were cued to just activate their TA. Drawing in your core, the cue typically given to activate the TA, did not change the width of the separation whereas an abdominal crunch did!
There’s no set of exercises that is appropriate or inappropriate for everyone. Consider working with a pelvic floor PT or perinatal fitness specialist if you’re wondering where to start.
Modify exercise as needed
Folks are often fearful of exercise during and following pregnancy as a result of all of the arbitrary rules they’ve been dealt. Like previously mentioned, there’s no specific set of exercises that is good or bad for all pregnant or postpartum people. But one rule that holds true? Movement is medicine.
Everyone enters pregnancy and recovery with different levels of fitness, underlying medical conditions and histories. What you do matters less than that you do something. Focusing on building strength and meeting your body where it’s at is how you will get results. For some that’s going to mean bodyweight exercise, for other that may look like olympic lifts.
When it comes to diastasis recti, if movement feels good and you’re able to maintain form, it may very well be appropriate for you. If you start to notice a change in shape in the center of the belly as you workout, urinary leakage, sensitivity or pain in the abdomen, back or pelvis, these are signs you want to consider modifying your movements. You can try less weight, simplifying the movement, reducing sets or reps. There are so many benefits to exercise in pregnancy but listen to your body and modify based on what it’s telling you.
If you need help, that’s why pelvic floor physical therapists exist.
Manage intra-abdominal pressure
Managing intra-abdominal pressure is one way to protect your core during pregnancy. Intra-abdominal pressure is something that exists in your abdomen at all times. During pregnancy, the increased fluid, blood volume and weight of the fetus causes an increase in this pressure. Being mindful of managing increased intra-abdominal pressure can reduce strain on your abdomen and pelvic floor. Here’s what you can do:
Avoid holding your breath when you exercise: While breath holding is common when lifting heavy loads and may be appropriate for some in pregnancy, exhaling through movement reduces pressure and stress on the abdomen and pelvic floor.
Avoid bearing down during bowel movements: This is the same principle as breathing while exercising. If you hold your breath and bear down, you’re intentionally creating increased downward strain. Instead, try taking deep breaths to relax your pelvic floor during bowel movements. As a bonus, this is excellent preparation for pushing!
Engage your core before lifting heavy things: Remember that as your baby grows, your abdominal wall stretches and these muscles become inhibited. This is a common cause of back and pelvic pain in pregnancy! Before you lift something heavy, remind your core to engage and support you.
What kind of symptoms are associated with diastasis recti?
Diastasis recti has become largely over pathologized in the media and in many cases, there are no symptoms associate with this tissue change. Remember that for many of us, a diastasis recti is a normal change associated with pregnancy. The baby needs to grow somewhere and better they stretch out your abdominal wall then place pressure on your spine.
With that said, in some cases, a diastasis recti can be associated with common postpartum symptoms like:
Abdominal weakness
Urinary incontinence
Heaviness in the pelvis
Back or pelvic pain
Prolapse symptoms
Abdominal pooching: This one isn’t actually a symptom, but it is a sign of abdominal weakness and a common aesthetic complaint associated with a diastasis recti.
If you’re experiencing these symptoms alongside a diastasis recti, or if you’re worried about how the changes in your core are impacting your body, consider talking to a pelvic floor physical therapist to create a personalized treatment plan. While your diastasis recti may be contributing to your symptoms, it’s likely not the entire picture.
Can you close or heal your diastasis recti?
There are so many programs out there claiming to “close the gap” or heal your diastasis recti. It really depends. In many cases, with exercise targeted exercise, postural modifications and habit changes, we see a reduction in the width of the separation between your rectus abdominis. In other cases, we don’t. Whether or not your gap closes depends largely on your collagen tissue make up which varies from person to person.
With that said, you can regain strength and function of your core whether or not that gap persists. I once had a patient with a 5 finger width gap who could hold a two minute plank. Conversely, I’ve seen far more folks with no diastasis recti who cannot hold a plank for 15 seconds. The distance between your rectus abdominis means little to nothing about your fitness level, the strength of your core or your ability to participate in the activities you love.
Final thoughts: support your core without fear
We can’t prevent a diastasis recti during pregnancy, but there are things we can do to reduce the likelihood this persists postpartum. Whether you’re pregnant, recently postpartum or gave birth years ago, strengthening your core can help reduce any symptoms associated with diastasis recti and it’s excellent for your long term health, too.
Have questions about your pelvic health or core? Send us a message to get started.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.