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Pregnancy brings many changes to your body. For some women, torn abdominal muscles can leave you with a bulging belly long after giving birth. If you are experiencing muscle separation during pregnancy, you are not alone. Muscle separation doesn’t happen to all women, but it is surprisingly common. Diastasis recti affects as many as 60 percent of pregnancies.4

If you are pregnant, thinking of becoming pregnant, or have already given birth, this article is for you. Dr. Beldholm is a leading tummy tuck surgeon who has performed hundreds of postpartum tummy tucks. As an expert on abdominal muscle repair surgery, he has plenty of valuable information to share on the topic.

The information you are about to read is based on extensive medical research. When you have finished reading this article, you will have a much deeper understanding of why muscle separation occurs during pregnancy, surgical and non-surgical options for repair, recommended exercises, signs and symptoms, and much more.

Some doctors sweep this condition under the rug as a cosmetic concern. Others say there is little you can do about it. But ab muscle separation can take a toll on your looks and self-esteem. It can even cause low back and pelvic pain, leaking urine, constipation, weakness, and hernias, among other problems in many women.

Diastasis recti is indeed treatable. It is not something you simply must “learn to live with”. Today, we are going to answer all your most pressing questions on the topic. But first, a little background on what causes ab muscle separation during pregnancy.

 

What is abdominal diastasis recti?

Diastasis recti abdominis is a non-life threatening medical condition that occurs when the membrane that connects your abdominal muscles tears. For some women, it is simply a cosmetic defect on the belly that leaves an undesirable “pooch” and a visible gap between the abs. But for others, it can cause pain and diminished quality of life. Let’s take a closer look at how ab muscle separation happens.

Imagine looking at a set of well-defined six-pack abs. A fibrous vertical membrane called the linea alba is located at the center of the abs. It holds the two sides of your ab muscles together, where they meet in the middle. When the connecting membrane tears, it can cause the abs to become separated by an abnormal distance.

Ab muscle separation is generally caused by over-strained muscles. This can happen for various reasons, but pregnancy is a major cause. Nearly two-thirds of pregnant women are affected. Abdominal muscle separation can occur gradually during the course of pregnancy. It also may occur quickly when straining the stomach muscles during childbirth.

Diastasis recti can cause the belly to stick out in an unattractive way. It is a treatable condition.

Why the fancy name? “Diastasis” means separation, and “recti” refers to the ab muscles, also called the “rectus abdominis”.

 

Muscle separation is common during pregnancy

It is estimated that two-thirds of women experience muscle separation from pregnancy.3 Pregnancy and childbirth puts so much pressure on the abs that the muscles sometimes can’t hold themselves together.3 As a result, the muscles begin to split or tear in the middle, leaving a gap between each side of the abdominals.

During pregnancy, the linea alba that holds together both sides of your ab muscles has to soften and stretch to accommodate the growing baby. The linea alba is a tough, fibrous structure with some stretch to it, but it has limits. Like a rubber band, it can only stretch so much before it breaks.

Diastasis recti doesn’t always happen suddenly. In fact, many people can’t tell exactly when it started. During pregnancy, the belly stretches gradually. Pregnant women tend to experience it most often in the third trimester of pregnancy when the belly is stretched to maximum capacity.1 Some pregnant women don’t get muscle separation at all.

Torn ab muscles can also happen quickly. Immense pressure and straining occurs during labor, so it makes sense that the linea alba can tear in the delivery room.

 

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Can separated abdominal muscles heal on their own?

Abdominal muscle separation caused by pregnancy may heal on its own, but not always. It goes away in some women in the months following delivery. For many women, the process can be slow one. And for others, it never resolves without treatment. A 2016 study by Sperstad, et al. found that approximately one-third of affected women still had muscle separation twelve months after giving birth.7 Another study confirms this finding.5

The degree of muscle separation can contribute to a slow recovery. Patients who continue to overexert themselves after giving birth may never fully heal. In fact, the condition can sometimes worsen. When you have a newborn, it can be hard to give your core a break!

Often, women with the condition don’t even know they have it. This is a key reason why muscle separation gets worse in some individuals. Without giving the body time to repair itself or seeking appropriate treatment, the muscles can separate further.

Some patients are lucky enough to have minimal muscle tearing that heals on its own. But if you are struggling with a belly bulge months after giving birth, have symptoms such as lower back pain, or notice a wider-than-normal gap between your abdominals, you may wish to seek treatment.

 

Working out with diastasis recti

Every woman looks forward to getting back to their pre-pregnancy body It can be tempting to jump into an exercise routine soon after giving birth. But diastasis recti is very common, affecting an estimated 60 percent of pregnant women. Traditional belly exercises like crunches and planks can strain muscles further, leaving a wider gap between the muscles than before. It is wise to ask your doctor to check for the condition before starting up your postpartum beach body routine. While some kinds of exercises can hinder healing, certain types of exercises may actually be beneficial.

 

Physical therapy for ab muscle separation

This is a reliable and safe way to treat ab muscle separation for many women. A physical therapist can work wonders on torn abdominal muscles in many cases. Physical therapists specialize in using massage, heat therapy, and targeted exercise regimens to help people recover naturally from various conditions.

Research shows that physical therapy can help improve diastasis recti after pregnancy. Treatment typically lasts between four to six weeks, with patients coming in for an average of 1-2 sessions per week.

For new mothers, treating ab muscle separation involves a combination of physical therapy methods. Your treatment plan may include exercise and muscle manipulation or massage by a licensed physical therapist. A 2012 study goes to show the positive effects of outpatient therapy for the condition. Sixty-nine percent of subjects reported a healing success rate between 41 to 100 percent after undergoing postpartum physical therapy.4

With the right health care coverage, physical therapy can be an affordable and natural way to heal torn ab muscles after pregnancy. The only downside is that it requires regular weekly visits for up to six weeks on average. That can be difficult with a newborn at home. Mothers with extra help from partners or family may have an easier time keeping up with appointments.

With that said, outpatient treatment can be very effective for repairing ab muscle separation for many women. It can cure many, but not all, sufferers. Severe cases of muscle separation may need further medical intervention such as surgery.

 

 

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The Tupler Technique and The MUTU System

Physical therapists use a variety of techniques to help repair split ab muscles. But many women are taking diastasis recti repair into their own hands at home. There are several home exercise programs, but the Tupler technique and The MUTU System are two of the most popular.

The Tupler method has gained steam as one of the most popular at-home treatment regimens. Women perform a series of exercise modules for several weeks while wearing a belly splint, which is said to protect and hold the ab muscles together during exercise.3

Invented by Julie Tupler, RN, this “research-and-exercise based program” was created specifically to address split ab muscles. The splint may help keep the ab muscles in a controlled, perfect placement during recovery exercises.

Tupler’s technique is a decent option as far as an exercise program, but there isn’t conclusive evidence that using a splint actually helps. Dr. Beldholm’s top pick for repairing ab muscles after pregnancy is The MUTU System. This, too, is a home exercise program you can do at your own pace in the convenience and privacy of home. This three-month-long online program is designed to strengthen your core muscles safely and effectively with a series of target exercises. The program is divided into easy modules to keep you on track.

Disclaimer: Dr Beldholm believes in The MUTU System because it has helped so many women get their ab muscles back in good shape. Earlier this year, he decided to take part in the program by becoming an affiliate. This means he receives a commission on each sale.

 

Diastasis recti exercises you can do at home

Many women find having an exercise program designed for diastasis recti helpful. But you don’t need fancy exercises or formal regimens to get results. There are several simple exercises for ab muscle separation you can perform at home.

Physiotherapy is the use of exercise to help you heal. Some studies point to it as an effective remedy, while others seem unclear about its potential to bring muscles back together. However, most studies at least agree on the fact that performing the right kinds of exercises can return lost strength back to the body core.

Dr. Beldholm approves the following exercises for repairing diastasis recti. The best part is that you do not need any special equipment to perform any of these exercises.

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Dead Bugs

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Heel Slide

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Bent Knee Fall Outs

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Kegels

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Leg Raises

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Pelvic Tilt

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Clams

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Bridges

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Transversus Abdominus (TVA) Breathing

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Tabletops

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Wall Sits

Click this link for photos and simple instructions for each of these abdominis recti exercsises.

Keep in mind you must be careful when you exercise with diastasis recti. When exercising torn ab muscles, it is very important not to push yourself too hard. This will not give you faster results, and in fact might strain your ab muscles further.

Certain exercises are off limits, such as crunches, or anything too vigorous. Give yourself a day or two of rest between exercise sessions, and always pay attention to your body. Overexerting yourself will most certainly make diastasis recti worse. The lesson? Take your time, and go easy. The results from physiotherapy exercises don’t happen overnight.

 

Surgical treatment for diastasis recti

 

When time, physical therapy, and exercise fail to correct torn ab muscles after pregnancy, cosmetic surgery can give you the beautiful results you are looking for. Dr. Beldholm has performed a great deal of tummy tucks for women with torn abdominals. He has helped countless women achieve more attractive, slim figures after baby.

Pregnancy puts your body through quite a lot. It is not just the muscles that are stretched beyond their limit. The skin stretches too. For most women, things don’t simply go back to how they were before pregnancy.

A tummy tuck will not only repair split ab muscles, but can also remove excess skin and fat in one fell swoop.
VASER liposuction can even be added to give your belly ultra smooth results. All your problems can be wiped out with just one surgery.

Surgery for torn abdominals involves creating a plication (aka a fold) along the linea alba, which is the membrane that normally connects both sides of the abdominals. The two sides are then sutured together. This closes the gap and creates a tighter abdominal wall. Surgery can give exceptional results for patients seeking to get rid of diastasis recti after birth.

Dr. Beldholm knows that the decision to seek surgical treatment for torn ab muscles is an important one. That’s why he has created a comprehensive guide for what to expect after abdominoplasty. The average tummy tuck requires an overnight hospital stay and usually about 3-4 weeks off work. You can read more about tummy tuck downtime and recovery here.

Deciding whether to have surgery for torn ab muscles after pregnancy is a personal choice, but it helps to get the facts. Most women are thankful to get rid of the belly bulge, embarrassing urine leaks, pelvic pain, and digestive trouble that come with diastasis recti. The improvement in quality of life can be dramatic. Of course, having a flawless figure after baby doesn’t hurt either! For most patients, the confidence that comes along with that is priceless.

There is one caveat: If you are planning to have more children, you should wait until you are finished childbearing before getting surgery to repair torn abs. Women who get abdominal tears during one pregnancy tend to get them the next time around, too. If the ab muscles never healed after your first pregnancy, you should still wait until you are done having children.

 

Can muscle separation from pregnancy be avoided?

This is a tricky question. Ab muscle separation is incredibly common during pregnancy, suggesting it may be unavoidable to a degree. Some research has indicated that there are no obvious risk factors found in subjects who got diastasis recti during pregnancy compared to those who did not.7

But another study by researchers at Columbia University suggested a link between lack of exercise and the likelihood of getting it. The study was limited, consisting of just 18 pregnant women, but the results were overwhelming. It found that 90 percent of women who did not perform abdominal exercises during pregnancy ended up with torn muscles as a result of their pregnancy. Only 12 percent of pregnant women who exercised experienced ab muscle separation in the same study.2 Therefore, it is possible that ab exercises during pregnancy may reduce your risk of diastasis recti by strengthening your core.

 

Other factors that contribute to diastasis recti abdominis during pregnancy

Anyone who is pregnant can get diastasis recti. Having more than one child increases the chance of getting abdominal muscle separation, especially if you have one right after the other. Women over the age of 35, particularly those with a heavy baby, twins, or multiples are most at risk.3 Poor muscle tone, irregular posture, and petiteness can also make women more prone to the condition.

If you had diastasis recti in your first pregnancy, you are more likely to get it again. For this reason, you should put off surgical correction until after you are done having children.

 

Diastasis recti symptoms

Pregnant women who have diastasis recti often complain of the following symptoms. You may not have all the signs listed below, but it should raise a flag if you notice any of the following during or after pregnancy.

People suffering from the condition may notice a bulging belly, digestive trouble like constipation and bloating, poor posture, pain in the lower back, pelvis, or hips, an “outie” belly button, a vertical dimple between your ab muscles, hernias, pain during sex, difficulty bending, turning, or straining your body core, and more difficult than average vaginal delivery due to weak stomach muscles.

Not every doctor knows to look for diastasis recti. If you think you have the condition, don’t be afraid to speak up.

 

What does diastasis recti look like?

Muscle separation of the abdominals is often visible on the tummy. You may see a long, vertical depression at the center of your stomach, indicating a split between the abdominal muscles. It can look like a really large dimple. Your belly may also bulge outward with a telltale postpartum “pooch”.

New mothers may notice that they still look “pregnant” weeks or months after giving birth. If you have diastasis recti, you might notice that bulge in your abdomen. It can be particularly obvious when you tighten or contract your ab muscles.

But abdominal muscle separation isn’t always obvious. Pregnancy, weight gain, and belly fat can make it harder to spot since the abs are less prominent. Some people are totally unaware that they have diastasis recti, so it is important to keep an eye out for other signs of the condition.

 

Stages of diastasis recti

When diastasis recti is visible on the stomach, you can use the finger test to measure the gap between the ab muscles. Start by laying down flat on your back with your knees bent. Gently press your fingers into your stomach, just above your navel.

Are you having difficulty feeling the space between the muscles? Raise your head and shoulders slightly off the ground. This will prompt your ab muscles to engage naturally. When the ab muscles are engaged, it is easier to feel for irregularities. It can also help you get a better view of your belly.

A distance of one finger width or less is considered normal. A space of 2.5cm or larger indicates a larger-than-normal gap between the muscles, or diastasis recti. This is about the width of two fingers.

 

When is muscle separation most likely to occur during pregnancy?

Diastasis recti can begin as early as the second trimester, but it most commonly occurs in the third trimester of pregnancy. A 2016 study looked into the prevalence of the condition. Researchers found that 33.1 percent of participants had developed it by week 21, and 60 percent had it by the six month mark.7

Confirming this, a 1988 paper found that “diastasis recti was observed initially in the women in the second trimester group. Its incidence peaked in the third trimester group; remained high in the women in the immediate postpartum group; and declined, but did not disappear, in the later postpartum group.”1

 

Is muscle separation from pregnancy dangerous?

Diastasis recti is often dismissed as a cosmetic concern, but there are also health and wellness repercussions. Without the band connecting the ab muscles, your organs, uterus and bowels have less tissue coverage. This increases your risk of getting a hernia.

Ab muscle separation can also result in lower back pain, constipation, and breathing difficulty. The body core becomes weaker, which can result in mobility problems in some people. Many women report leaking urine after giving birth. While this may have other causes, torn abdominals is one of them. While not dangerous per se, these last few effects can reduce your quality of life.

Delivering your baby vaginally can also be more difficult for those with diastasis recti. Without the extra muscle support, you may have trouble pushing during labor.3 In some instances, a pregnant woman with diastasis recti may need to have a C-section delivery.

 

Is it unsafe for the baby if you get muscle separation?

It is not technically unsafe for your baby if your ab muscles separate during pregnancy. However, it may increase your likelihood of requiring a C-section delivery. A C-section is a major surgery with more possible risks and complications than vaginal delivery.

Other than this, it does not have an effect on the development of your baby’s growth in the womb. An article in the Manual Therapy journal found “No statistically significant differences were found in prepregnancy body mass index (BMI), weight gain, baby’s birth weight or abdominal circumference between women with and without [diastasis recti] at 6 months postpartum”.5

 

What happens if you don’t treat ab muscle separation?

When ab muscles remain separated, it can give you less range of motion. Your core will have less strength for movement and balance. The ability to lift, push, pull, and contract the abs is limited. Weak abdominal muscles may place additional strain on the lower back and pelvis, creating pain in some patients. This can make it harder to perform regular activities of daily living.

 

Is diastasis recti painful?

For some women, diastasis recti is indeed painful. Pain is most common in the pelvic region and low back.6 Interestingly, some medical research has not observed a difference in reports of lumbopelvic pain (aka low back and pelvic girdle pain) in pregnant women with and without the condition.5,7

While some medical literature points to the contrary, data is limited. In Dr. Beldholm’s experience as a tummy tuck specialist, he finds that many women with diastasis recti do indeed complain of pain, among other undesirable side effects of the condition. Perhaps it is not everyone who experiences pain, but those that do may be more inclined to seek medical treatment.

 

How to avoid making abdominal muscle separation worse

If you suspect you have diastasis recti, your first visit should be to your doctor. Taking it easy on your ab muscles is important as you heal. Muscle separation can be worsened if you strain yourself. Many patients who have diastasis recti suffer from constipation because of the condition, so straining the ab muscles may be inevitable, leaving you in more pain.

After giving birth, the body needs time to heal. This goes doubly if you have abdominal muscle separation in order to prevent it from spreading. Avoid lifting, carrying, pushing, or pulling heavy objects while you recover. One research study followed 300 first-time pregnant women from the time they were pregnant until 12 months postpartum. The results showed a higher likelihood of ab muscle separation among women who reported heavy lifting ≥20 times weekly.7

Taking a break from intense ab exercise regimens may seem obvious, but many women don’t know they have the condition. This can add extra strain to your abdominals if you aren’t careful. Crunches and planks are a no-no.

For women who are trying to be careful, it can still be difficult to take it easy on your abs. Even standing up and sitting down can count as heavy lifting because you’re lifting your body weight.3 Place your hand on the chair or a nearby table for support when sitting or standing to reduce tension on weak ab muscles.

 

Can men get diastasis recti?

Pregnancy is not the only cause of abdominal muscle separation. Men can suffer from torn abdominal muscles, too. While muscle separation is a common occurrence during pregnancy, there are several other causes that can affect men and women alike. Women are only more likely to get the condition because pregnancy increases the risk dramatically.

 

Other causes of diastasis recti besides pregnancy

While muscle separation is a common occurrence during pregnancy, there are many unrelated causes. Both genders can be affected. Weight lifting, carrying heavy objects, or straining the abdominal muscles during exercise or other activities can all cause ab muscle separation.

In addition to rigorous exercise, repetitive ab stretching and weight gain are two commonly reported causes (whether or not the person is pregnant). Some people can even develop diastasis recti gradually thanks to poor posture.

Babies can even be born with separated abdominal muscles. Such a condition almost always resolves without medical treatment in newborns.

 

The final word on diastasis recti

Diastasis recti can cause cosmetic and medical issues for a large number of pregnant women. The condition can be mild or severe. It just depends on how far the muscles have separated and each individual’s natural aptitude for healing.

When time does not remedy the situation, there are steps you can take. Certain exercises, physical therapy regimens, and cosmetic surgery can all be used to repair torn ab muscles. Exercise and physical therapy help heal some, but not all women.

If you still have diastasis recti one year after giving birth despite therapy and exercise, it may be time to look into other options. This is especially so if ab muscle separation is affecting your quality of life or looks in an undesirable way. Tummy tuck surgery with abdominal repair has a higher success rate by comparison.

REFERENCES

  1. Boissonnault, Jill Schiff, and Mary Jo Blaschak. “Incidence of Diastasis Recti Abdominis During the Childbearing Year.” Physical Therapy, vol. 68, no. 7, 1988, pp. 1082–1086., doi:10.1093/ptj/68.7.1082.
  2. Chiarello, Cynthia M., et al. “The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women.” Journal of Women’s Health Physical Therapy, vol. 29, no. 1, 2005, pp. 11–16., doi:10.1097/01274882-200529010-00003.
  3. “Diastasis Recti: Why Ab Separation Happens and How It’s Treated.” WebMD, WebMD, www.webmd.com/baby/guide/abdominal-separation-diastasis-recti#1.
  4. Keeler, Jessica, et al. “Diastasis Recti Abdominis: A Survey of Women’s Health Specialists for Current Physical Therapy Clinical Practice for Postpartum Women.” Journal of Womenʼs Health Physical Therapy, vol. 36, no. 3, 2012, pp. 131–142., doi:10.1097/jwh.0b013e318276f35f.
  5. Mota, Patrícia Gonçalves Fernandes Da, et al. “Prevalence and Risk Factors of Diastasis Recti Abdominis from Late Pregnancy to 6 Months Postpartum, and Relationship with Lumbo-Pelvic Pain.” Manual Therapy, vol. 20, no. 1, 2015, pp. 200–205., doi:10.1016/j.math.2014.09.002.
  6. Parker, Meredy A., et al. “Diastasis Rectus Abdominis and Lumbo-Pelvic Pain and Dysfunction-Are They Related?” Journal of Women’s Health Physical Therapy, vol. 33, no. 2, 2009, pp. 15–22., doi:10.1097/01274882-200933020-00003.
  7. Sperstad, Jorun Bakken, et al. “Diastasis Recti Abdominis during Pregnancy and 12 Months after Childbirth: Prevalence, Risk Factors and Report of Lumbopelvic Pain.” British Journal of Sports Medicine, vol. 50, no. 17, 2016, pp. 1092–1096., doi:10.1136/bjsports-2016-096065.

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