The Post-Pregnancy Belly Bulge You Should Be Concerned About
By Robert Perez, MD, General Surgeon—Virtua Surgical Group
Michelle Peshick, MPT, CLT, PRPC, CAPP-P, Physical Therapist, Pelvic Rehab Specialist, Certified Lymphedema Therapist—Virtua Physical Therapy & Rehabilitation
You gain weight over 9+ months of pregnancy, so it’s normal to take 9+ months to get back your pre-pregnancy body after your baby is born. However, a belly bulge that doesn’t go away for months after delivery can be a sign of diastasis recti—a separation of your abdominal muscles.
The normal separation between your abdominal muscles is about 0.5 – 1 centimeter, or about one finger-width. Diastasis recti causes your belly to bulge because the gap between your left and right abdominal muscles widens to the width of two fingers or more.
What causes diastasis recti?
Your abdominal muscles normally meet in the middle of your abdomen. When you’re pregnant, hormonal changes allow the connective tissue to thin and stretch so your belly can expand. As a result, your growing uterus causes your abdominal muscles to separate and move aside. In the case of diastasis recti, your abdominal muscles are so stretched that they don’t fully come back together after pregnancy.
Although diastasis recti is common after pregnancy and affects about two-thirds of pregnant women, it also occurs in newborn babies and men. Men can develop diastasis recti from straining during exercises such as sit-ups or weightlifting, or during other activities that cause abdominal strain.
Who’s at risk for diastasis recti?
You might be at a higher risk for developing diastasis recti if:
- You have more than one child
- Your children are close in age
- You’re older than age 35 when you’re pregnant
- You’re pregnant with multiples (twins, triplets)
- You have a heavy baby
- You have a small body frame
- You had diastasis recti during a previous pregnancy
What are the symptoms of diastasis recti?
A belly bulge that doesn’t go away eight weeks after delivering your baby is the most noticeable symptom of diastasis recti. You may see a bulge pop outward or a sunken space along the midline of your abdomen. This can occur with even minimal activation of your belly muscles. However, because your spine, bowels, bladder and other internal organs aren’t getting the necessary support from your abdominal muscles, diastasis recti can lead to pelvic organ prolapse (when your pelvic organs drop out of their proper place) and cause other problems, including:
- Low back pain
- Urinary incontinence
- Abdominal soreness
Severe cases of diastasis recti can lead to a hernia, which occurs when your internal organs or tissues poke out of a hole that develops in your abdominal wall. If you develop a hernia, you’ll need surgery to correct it.
Can I prevent diastasis recti?
Your risk for developing diastasis recti depends on several risk factors that you can’t control. However, you might be able to lower your risk by avoiding excess strain on your abdominal muscles during pregnancy.
- Avoid doing crunches and other intense abdominal exercises after your first trimester.
- Use proper body mechanics when lifting older children, sitting up in bed and exercising.
- Maintain abdominal strength during pregnancy with gentle abdominal exercises like pelvic tilts and by doing Kegel exercises.
After pregnancy, give your belly time to heal and avoid doing any abdominal exercises—especially crunches—until you get approval from your healthcare provider. You also should ask your doctor what exercises are safe for you.
How is diastasis recti treated?
The first step in treating diastasis recti is figuring out the extent of your abdominal separation. Your healthcare provider will measure the separation by checking to see if he or she can fit two fingers in the space between your abdominal muscles. Treatment often includes physical therapy that focuses on exercises, core stability, and proper bracing. In more severe cases, surgery may be necessary.
Physical therapy for diastasis recti
After your healthcare provider assesses your condition, he or she may recommend physical therapy. A Virtua Health physical therapist will develop a treatment plan that may include:
- Gentle abdominal exercises
- Wearing an abdominal binder, or a support belt that is worn around your belly
- Manual physical therapy techniques to loosen tight or tender abdominal muscles
- Taping for abdominal support and to cue core strengthening
- Learning to monitor abdominals during exercise and activities to prevent worsening the gap in the muscle
Because every woman’s body responds differently to physical therapy and each case of diastasis recti is different, the length of physical therapy treatment is different for everyone. Physical therapy can be especially beneficial for women who have smaller abdominal separations and want to treat diastasis recti before becoming pregnant again.
Surgery for diastasis recti
If you have a large abdominal separation and it hasn’t responded to physical therapy, surgery may be an option. Surgery to treat diastasis recti often is performed on an outpatient basis using robotic technology.
When compared to traditional open surgery, robotic techniques can offer a faster recovery time, less pain and a lower risk of complications. However, surgery to treat diastasis recti isn’t recommended for women who plan to become pregnant in the future.
If you think you have diastasis recti, talk to your OB/GYN for a treatment recommendation.
Updated March 31, 2021