Ab Separation and How to Treat It

Ab separation—also known by the clinical term diastasis recti—occurs when the long, vertical muscles that run centrally along the abdomen separate, creating a gap. Normally, these muscles are situated closely together along the length of the stomach, separated by a thin tissue known as the linea alba. But with expansion of the belly (or any time too much pressure is exerted within the abdomen), the muscles and tissue can thin and begin to pull apart. If the separation becomes severe, some problems can result; hernias—when an internal organ protrudes through the separated muscles and bulges outward—are the most frequent complication.

What Causes It

Ab separation is so common among pregnant women that some experts estimate it affects up to 68 percent of mothers. For pregnant women, diastasis recti can be caused by pressure from the growth of the fetus and uterus, which swells the belly, forcing the muscles apart. Separation can also occur from strain during the push phase of childbirth. The condition is made even more likely by the presence of certain hormones during pregnancy that relax muscles and ligaments, such as relaxin.

Despite being a common complaint of pregnancy, ab separation can affect either sex, and is even seen in newborn babies. For men, overly-enthusiastic exercise or improper form during activities like weight-lifting or calisthenics are often the cause. In babies, ab separation is usually caused by weakness of the abdominal muscles, with the problem usually resolving on its own as the baby grows and muscles strengthen.

While there is a possible genetic factor to diastasis recti—if a woman’s mother had it during pregnancy, it’s more likely her daughter will experience it, too—other causes exist. Obesity is one, with the strain of added weight around the stomach exerting pressure upon the muscles much like pregnancy does. Pregnancy with multiples is another potential trigger, as the need to accommodate multiple fetuses increases the stretch required of the abdomen. Pregnant women over the age of 35 are also more prone to ab separation.

Effects and Diagnosis

Diagnosis of diastasis recti is fairly straightforward. Many patients have strong visual indications of the separation between the ab muscles, with an apparent dip or trough appearing along the vertical axis of the belly button.

Even if there’s no visual confirmation of the separation, it’s possible to perform a simple self-test to see if ab separation is present, and, if so, how severe it is. This is done by lying on your back on the ground with knees bent and your head slightly elevated. Using one hand, gently probe the midline of the abdomen with your fingers, paying particular attention to whether or not your fingers sink into your abdomen. Do this just above, just at, and just below the belly button.

If you identify any indentations, see how many finger-widths can be inserted. A space of one finger-width is considered normal for some people. If you can insert two or more fingers into the indentation, it could be an indication of diastasis recti and you will want to mention it to your doctor.

It is important that any test for ab separation be done at least several weeks postpartum. All of the hormonal and physical changes going on in the body just after birth can muddy the diagnostic waters. Also, most mild cases of diastasis recti resolve on their own within a few months of giving birth, so there’s no sense in creating unnecessary worry by performing a self-test too soon!

Symptoms of diastasis recti can also help confirm a diagnosis. Typical symptoms you would want to mention to your doctor include:

• A feeling of looseness in the abdomen
• Visible vertical ridges or valleys along the center of the abdomen
• Pain in the lower back
• Constipation
• Sagging posture
• Urinary leaking

If, after confirming with a doctor, you are diagnosed with diastasis recti, remember that the condition is fairly common and usually relatively benign.

How It’s Treated

In all cases of diastasis recti, the overall goal for treatment is to strengthen the abdominal muscles enough to close the muscle gap and get the muscle wall of your abdomen back to normal.

For most mild and moderate cases caused by pregnancy, the best treatment is often time. After birth, as the body slowly returns to its pre-pregnancy condition and abdominal muscle strength is restored, the separation usually begins to close on its own. This can be aided by avoiding certain activities that could make the separation worse, so rigorous exercise and lifting heavy objects (including older children!) is usually a no-no until the separation resolves. During this time of rehabilitation, some women opt to reinforce their abdominal strength by wearing a belly band or belly wrap, which can limit strain on the muscles and help the ab separation heal.

To encourage the muscle gap to close, some medical experts advise gentle exercise that focuses on strengthening the transverse abdominals—a set of muscles that lie deep behind the rectus muscles and help stabilize them. It’s important to avoid certain exercises that can make the abdominal separation worse—crunches, sit-ups, certain yoga poses, and exercises done on the hands and knees can increase pressure on your abdominal wall, and make the situation worse. Working with a trained physical therapist can take the guesswork out of what exercises help (and which are harmful).

If time and exercise don’t do the trick, and the ab separation is causing problems in daily life, doctors may recommend using surgery to pull the separated muscles back together. This can be performed either as a minimally-invasive laparoscopic surgery or as a more major open surgery, depending upon the extent of the diastasis. Both methods will close the ab muscle gap and can eliminate certain symptoms and the threat of herniation.

Importantly, it is possible to live well and freely with diastasis recti, as many men and women do. Especially in mild and moderate cases, ab separation usually causes little more than aesthetic worry and doesn’t limit the patient’s activities or cause difficult symptoms. If you think you might be dealing with diastasis recti, it’s always best to confirm your diagnosis with your doctor and explore your treatment options together.