Diastasis Recti
Diastasis recti is a separation of the abdominal muscles along the midline, most commonly seen during or after pregnancy but also in people with increased abdominal strain. It isn’t harmful, but it can cause core weakness, lower back discomfort, or a persistent tummy bulge. Many cases improve with targeted physiotherapy, while surgery is only considered if symptoms remain troublesome.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is Diastasis Recti?
Under normal circumstances, the rectus abdominis muscles - often thought of as the “six-pack” muscles - run vertically down the front of the abdomen. These muscles are connected in the middle by a strong band of connective tissue called the linea alba, which helps maintain core stability, supports posture, and holds abdominal organs securely in place.
Diastasis recti occurs when the linea alba becomes stretched and thinned, causing the two rectus muscles to separate. Instead of sitting close together, they move further apart, leading to a visible or palpable gap down the midline of the abdomen. This separation most commonly develops during and after pregnancy due to hormonal changes and the pressure of the growing uterus, but it can also occur in men and women unrelated to pregnancy.
Although not dangerous in itself, diastasis recti can cause weakness of the abdominal wall, altered posture, and changes in the appearance of the tummy, and in some cases it contributes to discomfort or functional issues.
Understanding Diastasis Recti
Diastasis recti can present in several ways, and symptoms often vary depending on the degree of separation and how well the abdominal muscles are functioning.
Common symptoms include:
- A visible midline bulge or doming: Often most noticeable when rising from a lying position or straining the core.
- A gap or softness along the midline: You may feel a separation between the muscles when pressing gently along the centre of the abdomen.
- Core weakness: Difficulty with activities requiring trunk stability - lifting, twisting, or certain exercises.
- Lower back pain: Reduced core support can place more strain on the lumbar spine.
- Poor posture: Weak abdominal muscles may contribute to a more pronounced inward curve of the lower back.
- Abdominal discomfort or a feeling of instability: Particularly during movements that engage the core.
- Pelvic floor symptoms (in some cases): Such as heaviness or urinary leakage, due to associated changes in pelvic support.
- Cosmetic concerns: A persistent “pooch” or doming of the abdomen that doesn’t improve with exercise.
Causes & Risk Factors
Diastasis recti develops when increased pressure within the abdomen stretches and separates the linea alba - the connective tissue between the two rectus abdominis muscles. Several factors can contribute to this process.
| Pregnancy | The most frequent cause. As the uterus grows, the abdominal wall stretches to accommodate it. Hormones such as relaxin and progesterone soften connective tissues, making the linea alba more prone to widening. |
| Repeated or high abdominal pressure | Activities that chronically increase intra-abdominal pressure, such as improper heavy lifting or certain high-intensity exercises, can contribute to separation. |
| Rapid or significant weight changes | Can place strain on the abdominal wall and connective tissue. |
| Genetic predisposition | Some individuals naturally have looser connective tissue, which can make separation more likely. |
| Obesity | Extra weight in the abdomen increases tension on the abdominal wall and linea alba. |
Diagnosing Diastasis Recti
Diagnosing diastasis recti involves a combination of clinical assessment and, when needed, imaging to confirm the extent of muscle separation and rule out other causes of abdominal bulging.
Imaging tests if needed:
| Clinical Examination | Most diagnoses begin with a hands-on assessment by a clinician or physiotherapist. You will usually be asked to lie on your back and perform a gentle abdominal curl while the examiner feels along the midline of your abdomen. They will assess: - The width of the gap between the rectus muscles - The depth or firmness of the linea alba - Any bulging or doming of the abdominal wall when pressure increases - Core muscle activation, especially the transversus abdominis This assessment helps determine whether separation is present, how significant it is, and how well the connective tissue responds to tension. |
| Ultrasound | Although not always required, an ultrasound can provide a clearer and more accurate measurement of the separation. It can: - Precisely measure the distance between the rectus muscles at multiple points - Assess tissue quality of the linea alba - Rule out hernias or other structural abnormalities that may mimic diastasis Ultrasound is particularly useful when symptoms persist, when a physical exam is unclear, or when planning targeted rehabilitation. |
Treatment Options
Treatment focuses on restoring core function, improving abdominal wall support, and reducing symptoms such as bulging, weakness, or back pain. Most people improve with conservative measures, but a small number may require procedural or surgical input.
Conservative Management
| Targeted physiotherapy | Physiotherapy is the primary treatment for diastasis recti. A specialist focuses on retraining the deep core muscles, improving activation, breath control, and posture, while gradually strengthening the abdominal wall. With consistent, individualised exercises, most people notice better function and appearance. |
| Lifestyle and activity modification | Lifestyle changes can support recovery by reducing strain on the abdominal wall. This includes safer lifting, managing coughing or constipation, and avoiding high-pressure exercises early on. These adjustments help protect the healing tissue and prevent the separation from worsening. |
| Supportive devices | Abdominal binders or support belts may provide temporary comfort, especially in the early stages or postpartum. They do not close the gap but can help with posture and reduce strain while strengthening work progresses. |
Surgical Treatment
Surgery is generally reserved for significant separation that causes ongoing functional issues or when there is an associated hernia. Procedures typically involve plication (tightening) of the linea alba and repair of any hernia defects, often performed laparoscopically. Recovery requires a period of restricted activity, followed by structured rehabilitation.
How can Lanthorn help?
Abdominal Wall Ultrasound - £300
We can perform a focused ultrasound to assess the degree of abdominal muscle separation, the condition of the linea alba, and identify any associated issues such as small hernias. This helps confirm the diagnosis, measure the gap accurately, and guide the most appropriate management plan.
Referral to a specialist
If your symptoms are significant, persistent, or if a hernia is detected, we can arrange onward referral to a trusted physiotherapist, women’s health specialist, or general surgeon. This ensures you receive the right level of support - whether that’s expert rehabilitation, or discussion of surgical options when necessary.
