Diastasis recti is a condition describing the abnormal separation of the rectus muscles of the abdominal wall. It is common in women who have given birth. The separation often occurs in pregnancy when the tissue between the rectus muscle stretches causing a bulge from the abdominal contents.  About a third of women still have a diastasis 1 year after giving birth. However, we also see diastasis recti in men and athletes. What is diastasis recti and is surgery the only answer?

illustration of diastasis recti

Symptoms

Generally, you see a visible bulge or lump between the rectus muscles. Usually, the bulge is worse when standing and lessens when lying flat. As a result of the bulge, men and women have weaker abdominal muscles potentially leading to the following problems:

  • difficultly lifting objects
  • low back pain
  • abdominal discomfort
  • pelvic pain and potential for pelvic prolapse
  • urinary incontinence

What causes diastasis recti in men and women?

Overall, elevated abdominal pressure is the overriding cause.

In pregnant women, the growth of the baby in the womb stretched the abdominal walls. In addition, high levels of hormones such as oestrogen and relaxin contribute to stretching. The risk of diastasis is increased with larger babies, twins, and older women. Overall, younger women are less likely to have diastasis recti.

However, we also see diastasis recti in men and athletes. Non-pregnant causes include lifting heavy weights, sudden weight gain, and connective tissue disorders (eg genetic conditions) causing laxity.

risks for diastasis recti

Diagnosis of diastasis recti in men and women 

Firstly, your doctor should take a history of past tummy surgery, childbirth problems (forceps use, size of baby), and any symptoms of bowel or bladder problems.

Generally, a diastasis is visible to the eye. However, a physical examination is important to confirm the diagnosis. Separation can occur above or below the navel.

Usually, investigations are useful. Traditionally, a CT scan has been used to confirm and grade the separation of the rectus muscles. More recently, ultrasound gives good information about the extent of the separation without the radiation or costs. Measurement of separation in the tummy is performed at 5 points above and below the belly button. Generally, a separation of greater than 3 cm is thought to be abnormal. Also, imaging can confirm if there is a true hole in the wall, often called a hernia. Finally, scanning will also show whether the tummy muscles are contracting properly, which might tell us whether exercises will help.

ultrasound to confirm diastasis recti

Treatment options 

Generally, we treat smaller-sized diastasis less than 5mm with rehab. Conversely, diastasis greater than 5cm usually requires surgery.

Usually, rehab involves exercises to reduce the separation between the muscles. Also, education about what exercises to avoid is important. Overall, rehab takes about 4 weeks to start working and up to 12 weeks for full effect.

Exercises to avoid 

In general, you should avoid excessive abdominal exercises. these include sit-ups, abdominal twists, backward bends, and certain Yoga poses that stretch the abdominals – at least initially. However, some people can build up the strength of their inner muscles before moving to more advanced tummy exercises.

Best exercises for diastasis recti in men and women 

Which exercises are best for diastasis recti? Generally, tensing the deep abdominal muscles with a neutral spine and your back on the floor reduces the separation. You should hold the exercises for longer and with greater loads. Other exercises to try include planks, push-ups, and pelvic floor exercises. Some therapists use braces and neuromuscular electrical stimulation. Research shows that the use of muscle stimulators with exercises is better than exercises alone. 

Do you need surgery? 

Generally, surgery is recommended if the gap between the muscles is greater than 5cm or rehab has failed to improve the separation. The procedure can be performed open or keyhole. Usually, stitches are used to pull the muscles back together. If you have a hernia, the surgeon will repair this as well.

Often, you can return to work in 2-4 weeks and avoid heavy lifting for at least 4 weeks.

Final word from Sportdoctorlondon about diastasis recti in men and women 

Diastasis recti is common in women who give birth. But we also see diastasis recti in men and athletes. Surgery is not the whole answer. Rehab should be tried first if the gap between the rectus muscles is less than 5cm.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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