When is Diastasis Recti Considered Severe?

An image describing diastasis recti, transverse abdominis and the linea alba

The mommy Pouch

Do you still look pregnant for months or even years after giving birth? You might have a diastasis recti.

Or Are you a mommy and you have a pooch? The pooch is the less technical term we use when referring to diastasis recti. It presents itself in form of a bulge, much more like someone who is pregnant. The condition develops in the latter months of pregnancy. Approximately wo-thirds of pregnant women are affected by this problem. Thus, having a mommy pooch is a symptom of diastasis recti.

Diastasis recti is the separation of the abdominal muscles from the midline. The term diastasis actually means separation. It is a problem that can affect anyone.

Diastasis recti variations
Diastasis Recti Variations

If you’re pregnant, or you’re considering having a baby, by all means, you should research on diastasis recti symptoms in pregnancy. So, what should you know about diastasis recti? Well, the condition is different from one person to the other. The Separation can happen in both the upper and the lower regions surrounding the belly button. That being said, how can you differentiate a diastasis recti pouch from a pregnancy pouch. This can be difficult; however, you can tell if you have diastasis recti during pregnancy by how you look and you feel. If you’re mostly bloated during a pregnancy, especially during second and third trimester and noticed a fridge or a more of bulge, then you need to consult with your doctor to test any possibility of diastasis recti.

Diastasis recti can also cause poor posture. Due to the separation, the body might bend forward during any attempt to move or walk. Similarly, the shoulders may hunch making your back angle, causing poor posture. When you have diastasis recti, abs seem to worsen when you do sit-ups, planks or crunches.


What causes diastasis recti?

a. Pregnancy

This is the most common cause of diastasis recti. In a study that was done involving 300 women, 45% of these mothers had a mild case of abs separation at 6 months separation.

According to a study published by PubMed Central (PMC), M39-45% of pregnant women get diastasis recti and it continues up to six weeks after delivery with about 50 to 60 %. Prevalence. The abdomen has a connective tissue between the recti muscles. A normal gap is between 1 to 2 fingers in width; therefore, a gap that is 2.5 or more fingers with is considered a diastasis recti.

b. Obesity

Having so much fat, i.e the visceral fat (fat underneath the abdominal wall) in your stomach, can cause pressure against the linea alba which can result in abs separation. Visceral fat is one of the most dangerous type and it is linked to a number of health issues including poor metabolism, diabetes, insulin resistance cancer, and even heart diseases.

c. Heavy lifting

Lifting weight that is too heavy can be the reason behind your diastasis recti. It important to engage your core fully when lifting objects. Avoid any movement that can cause a bulge or corning on you belly.

All You Need to Know about Diastasis Recti

What is diastasis recti, when does it occur, do you have control over it and when you need to take action? The abdominal muscles stretch during pregnancy to make space for the growing fetus. As a result, the abdominal wall at the center of the abdomen weakens. Continued stretch can lead to the separation of the rectus abdominal muscles on the midline of the tissue connecting the two halves leaving a gap that allows your belly to pop out.

In most cases, after pregnancy, the stretched muscles come back to normal since the levels of the hormone is up. If it does not happen within 3-6 months, the gap (Diastasis Recti) might be existing and cannot close back without treatment.

How can you tell if you have one?

To measure Diastasis Recti;

  • Lie with your face up, bend your knees while your feet remain on the floor.
  • Relax and place your palm on the navel on your bare skin with the fingers pointing towards the toes.
  • Lift your head, drawing your chin towards the chest and your shoulders slightly off the floor to help your abdominal muscles contract.
  • Use your fingers to feel the distance between the right and left abdominal muscles and the tension of the lineal Alba.
  • If the gap is 2 or more fingers in width as you contract, you have Diastasis.

Repeating the procedure for places above or below the belly button will help in identifying if the gap is wider in different places. In a situation where you find that your gap is 5 or more fingers wide, then this case of diastasis recti is considered severe and require an immediate process of treatment.

Avoiding Further Damage and Solution for Healing

For women for whom Diastasis Recti is detected, it is never too late to correct Diastasis Recti. With the help of a physical therapist who has specialized in postpartum recovery, you can get recommendations of physical exercises to improve the condition. For instance, standing pushups, bridge pose, and diaphragmatic breathing can help in rectifying the problem.

If the process does not aid, recovery surgery is the next option. Doctor’s advice is always recommended.


Before getting pregnant, it is vital to do exercises that strengthen the core. Additionally, it is important to continue with simple exercises within the first trimester until when you feel uncomfortable when exercising. Staying active prevent the occurrence of Diastasis Recti.

Chances that Increase its Likelihood

  • If you are beyond 35 years and give birth to a weighted baby.
  • Having twins or more during pregnancy
  • Straining to bend or twisting your torso increases the likeliness of abs separation
  • Cesarean section
  • Increase or prolonged abdominal pressure, for instance, due to superficial breathing pattern as a result of pushing hard.
  • Performing excessive abs exercise after the first trimester
  • Weak abdominal muscles before pregnancy
  • Genetic (Having a family history of diastasis)

How to tell if you need a surgery

Not all women require to take a surgery to close the gap, some women will have severe diastasis recti, while other will have less significant cases that can be corrected by exercises. Diastasis recti is considered severe if the abdominal muscle weakness is interrupting your daily activities.

So, when is diastasis recti considered severe?

Severe diastasis recti conditions are usually life-threatening and they might prevent you from carrying out your daily activities.

 symptoms of severe diastasis recti

  1. The gap is 5 fingers or more in width. This is the first sign that shows that your separation is severe and require a medical attention.
  2. You experience bowel pains
  3. You experience pain after eating
  4. You have back pains. This is the most prevalent symptom in patients with diastasis recti. The pain may start as early as during the third trimester and continue until after delivery. Thus, it may be considered a common symptom. Due to that pain, a person suffering from diastasis recti may find it difficult than usual to push or move objects, or even move with the same motion that they used to enjoy before their pregnancy.
  5. Leaking bladder when you sneeze, laugh, cough, or lift things.
  6. Pelvic or hip pain
  7. Urinary incontinence
  8. Pain during sex
  9. Hernia

Does diastasis recti heal on its own?

If you already have an ab separation, you may be wondering; does diastasis recti go away on its own? or can diastasis recti heal on its own?

Yes, diastasis recti can heal on its own if you learn how to engage your deep core muscles properly or improve it to a point that it is functional. By being functional and mean that you may still have some spacing but the tissue between the abdominal walls are strong and well connected. Thus, you will no longer feel the pain and you will able to move throughout your days and exercise with ease.

Some Severe Diastasis Recti Cases Require Surgery

If diastasis recti symptoms are severe or they are life-threatening then there is a need to consider surgery. However, in most cases the answer is, no. Cases of severe diastasis recti are rare and the most common separations can heal on through simple exercises. It is true that time heals all wounds, and this is so particularly in mild to moderate distances recti. Therefore, unless your physicians recommend a surgical treatment, surgery is not always appropriate. In fact, most health practitioners feel that Justice is rectal surgeries are mostly done for cosmetic reasons.

Case scenario

Below is a case study of two Korean women who had severe diastasis recti. the two cases involved herniation, and thus, the best treatment method was a surgery.

Case 1

Severe diastasis recti
Source: Won Ha et al.

 The first case involved a 33-year-old woman, who had previously delivered twins with the combined weight of 5.4 kg. She had a height of 156 cm, 54 kg weight, and a BMI of 22.19. the scan showed a gap of 5 cm upwards and 15 downward towards the umbilicus. There was no recurrence of diastasis recti after 12 months of follow-up.

Case 2

She was 88 years old woman who had previously delivered a large baby (5 kg) via cesarean section. She weighed 64 kgs with a BMI of 26.62. She was diagnosed with a severe bulge of the abdominal wall which intensified after meals. Her gap was 10 centimeters upward and 5 cm downwards from the umbilicus. Like in the first case, there was no recurrence after 13 months of follow-up.

The cases 13 months after surgery

Severe diastasis recti after surgery

The above study also revealed that the severity of diastasis recti can be affected by genetics of a person. During pregnancy, diastasis recti is favored by factors that are common to menstruation such as hormonal influences. The separation of the abs’ tissues does not happen at in the first trimester, but I can develop in the second trimester downwards.

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