After having a baby, you may have worked hard to get rid of that baby tummy, only to be disappointed with the results. You exercised and ate healthy foods, so why does your tummy still look poofy and flabby?
It could be that you have a common condition called diastasis recti abdominus (DRA), which often affects moms during pregnancy or after childbirth. Fortunately, most cases can be repaired with a concentrated exercise program and healthy diet.
A Word About the Abdominal Muscles
DRA is a condition affecting your abdominal muscles, so it helps to understand how these muscles work.
The abdomen is home to four separate muscles that work together to form your “core” — that strong central area that supports the trunk, keeps your body stable and balanced, protects your spine and holds in your internal organs.
- Rectus abdominis: These are the long, flat, vertical muscles in the front of your trunk that run between the ribs and pubic bone. Parallel to each other, they are separated by a midline band of connected tissue called the “linea alba.” They’re the most well-known and prominent abdominal muscles. When you talk about a “six-pack,” these are the muscles you’re talking about.
- External obliques: These sit on either side of the rectus abdominis, running diagonally down from the lower ribs to the pelvis. Should you put your hands in your coat pockets, your palms would be next to these muscles. They are the largest of the abdominal muscles and allow the trunk to twist.
- Internal obliques: These oppose the external obliques and sit inside the hip bones, below the rectus abdominis. They attach at the lower ribs and go toward the lower back. They are also responsible for twisting and turning, but they work in opposition to the external obliques. You twist right, and then you contract the right internal oblique and the left external oblique simultaneously. Twist left, and the opposite happens.
- Transverse abdominis: This the deepest abdominal muscle, located under the rectus abdominis and obliques. It wraps around the torso from the ribs to the pelvis and from front to back, similar to a corset or wide belt. It helps with breathing.
Altogether, these muscles create your core strength — and they also help support the weight of the growing fetus during pregnancy.
What Is Diastasis Recti?
As your baby grows, the tummy must expand to make room. The uterus expands, putting pressure on your abdominal muscles — specifically on the rectus abdominis muscles.
These muscles stretch to accommodate the change, but if certain conditions are present, the muscles can separate from that central band (linea alba) that connects them, which creates a gap between them. The word “diastasis” means “separation,” and “recti” refers to the rectus abdominis.
The following are risk factors for diastasis recti abdominis (DRA):
- Weak abdominal muscles
- Carrying a large baby
- Carrying more than one baby
- Having a narrow pelvis
- Having more than one child or having babies close together
- Being age 35 or older when getting pregnant
The separation can occur anytime during pregnancy or in the first few weeks following childbirth. It’s quite common, so if it happens to you, it may help to know that a lot of women go through it. According to a 2016 study, DRA was found to affect:
- 1 percent of women at 21 weeks
- 60 percent of women at six weeks postpartum
- 45 percent of women at six months postpartum
- 6 percent of women at 12 months postpartum
In most cases, the space between the muscles gradually shrinks on its own after a woman gives birth, but it can also remain abnormal for months or even years.
Although pregnancy is the most common cause of diastasis recti, the disorder can also occur in men or in women who haven’t been pregnant. Typical causes may include:
- Rapid changes in weight
- Advanced age
- Swelling of the abdomen related to disease
Even babies can develop DRA, particularly if they’re born prematurely before their abdominal muscles are developed fully.
What Are the Symptoms of DRA?
You may not even realize you have DRA until you experience lower back pain, constipation, urine leakage or, in some cases, an abdominal hernia. All of these are potential symptoms related to DRA. Usually, the most noticeable symptom for moms is that poofy mom belly that doesn’t seem to go away after childbirth.
Here are some other signs of DRA:
- Lower back pain or a back that “goes out” frequently
- Abs that don’t get better with sit-ups and crunches — they seem to get worse
- Bladder leakage when sneezing, laughing, coughing or picking up heavy things
- A belly button that changes from an innie to an outie
- A middle that still poofs out months to years after having your child
- Flabby abdominal muscles
- Poor posture
How to Check for DRA
You can do an at-home check to see if you may have DRA. Lay down flat on the floor on your back, knees raised, feet flat on the floor. Place the fingers of one hand on the center of your belly, fingers pointed down, the heel of your hand pointed up toward your neck. Your fingers should be right on your belly button.
Now lift your head — only your head — off the floor. You should feel your rectus abdominals engage. The area beneath your fingers will get harder as the muscles contract. Now, feel with your fingers right in the middle of those two muscles. A small gap of about one or two finger widths is normal. If you feel a gap larger than that — more than two finger widths — you may be suffering from DRA.
Check right in the belly button, then below the belly button and finally above the belly button. The gap may measure differently in each place. Look also for any mound or bulge that may protrude along the midline — this could indicate a gap and a potential hernia.
Check too to see how deep you can press your fingers between the two sides. If your muscles are connected as they should be, you will be able to press down only a little bit. If you can press moderately or deeply into that gap in the middle, however, that’s another potential sign of DRA.
Although this test can help give you a general idea of whether you may be dealing with a muscle separation, it’s not a perfect test. So, if you feel a gap there, that’s a sign that you should check with your doctor. He or she can measure how far apart the muscles are using an abdominal exam or an ultrasound.
Exercises to Help Repair DRA
Fortunately, most cases of DRA can be improved with exercises meant to help strengthen the rectus abdominus and close the gap. With time and effort, your abdominal wall can become as strong or even stronger than it was before. You may want to obtain the assistance of a physical therapist, but you can also make progress on your own.
First, it’s important to understand that this isn’t about doing more sit-ups. In fact, you want to avoid sit-ups, crunches, and planks — all the normal abdominal exercises — because they can do more harm than good. The movement involved in these exercises increases abdominal pressure, pushing organs out through the gap and down into the pelvic floor, delaying healing and potentially making symptoms worse.
In addition to avoiding crunches, it’s also important to avoid the following until after you’ve healed your DRA:
- Lifting heavy things
- Straining when going to the bathroom
- Doing anything on your hands and knees, including exercises
- Yoga exercises that stretch the abdominal muscles, including up-dog, cow pose, and backbends
Below are seven exercises that can encourage the closing of the gap. As you’re doing each one, keep in mind that you want to avoid causing your abs to bulge forward or arching your back. These movements exacerbate that separation in the rectus abdominis. Furthermore, you should never feel your pelvic floor bulge down while performing the exercises. Instead, do a Kegel while pulling your tummy toward your spine. Do the series of exercises each day or every other day. Within a few weeks, you should notice improvement.
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1. Wall Sit
Stand in front of a wall with your feet hip-width apart. Bend your knees and squat down, keeping your back flat against the wall. Keeping your hips and knees at a right angle, perform two “core compressions.” (See instructions below.) Relax the compressions, then perform two more. Repeat for one-to-three minutes, then stand back up.
To do a core compression: Place your hands on your belly, then emit a small exhale forcefully while squeezing your abs and pelvic floor up into the spine. Feel your belly flatten toward the spine as you exhale. Relax on the inhale and repeat on the exhale.
2. Sitting Core Compression
Sit on the floor cross-legged and place your hands on your belly. Keeping your back straight, take a big breath, and let the belly fully expand. As you exhale, suck in the belly muscles as far back toward your spine as they will go. Hold this position, taking tiny breaths and, with each exhale, push the stomach back further as tight as you can. Hold for at least 20 seconds, then relax on the inhale and repeat on the exhale.
3. Standing Thigh Toner
Stand on your right leg with your knee slightly bent. Place your hands on your stomach and your left leg slightly out in front of you, toes on the floor and pointed slightly outward. Inhale and on a forceful exhale, lift your left leg toward the ceiling with only a slight bend in the knee. You don’t want your belly to protrude out. Instead, pull in and up toward your spine. Return your foot to the floor and repeat up to 20 times, then switch legs.
4. Heel Slides
Lit flat on your back, knees bent and feet flat on the floor. Place your arms straight down at your sides. While exhaling, extend one leg out in front of you slowly, sliding the heel down until you can lift your foot off the floor. Allow it to hover there a few inches off the ground while extending the opposite arm straight back above the head, just off the floor. Work on drawing your stomach in and back during the movement. Hold for 20 seconds, return your limbs to the starting position, and repeat on the other side.
Lie faceup with knees bent, about hip-width apart, feet flat on the floor, your arms by your sides. Press down through the heels and lift the hips up, squeezing the glutes. The movement will draw the belly button to the spine naturally. Hold for 20 seconds and release, then repeat.
6. Tap Toes
Lie flat on your back, knees bent. Lift your feet to create a 90-degree bend at the knees. Make sure your knees are aligned with your hips, your feet straight out from the knees. Holding that position, feel the abs moving back toward the spine. While holding, tap the toes on the ground 20-40 times, alternating feet.
7. Candle Blow
Sit down and imagine a birthday cake full of candles in front of you. Breathe in and, on the exhale, blow or hiss all the air out as if you were going to blow out all the candles. Keep the blowing/hissing slow and steady — as if you were going to blow out the candles with one long sweeping push of air. Don’t lean forward but keep your back straight. Exhale until all the air is gone, then relax and inhale. Repeat.
Dietary Tips to Help Heal DRA
While you’re doing your exercises, it’s also important to pay attention to your diet. Good nutrition helps get rid of fat that may be padding your poofy tummy and can also support the formation of stronger muscles. A poor diet, on the other hand, can not only add fat to your abdomen, but it can also make you feel tired and sluggish and less motivated to do your exercises.
While healing from DRA, follow these dietary tips:
- Avoid inflammatory foods like sugar, alcohol, caffeine, processed foods, and trans fats.
- Choose more whole, fresh foods where possible.
- Increase intake of foods rich in vitamin C, A, and zinc, which are important for collagen regeneration — just what your muscles need. Good sources include citrus fruits, tomatoes, red bell peppers, kiwis, carrots, sweet potatoes, kale, nuts, seeds, and beans.
- Get more essential fatty acids, as they help boost the immune system and energy. Good sources include oily fish, seeds, nuts, avocados, and eggs. Cook with olive oil, coconut oil, and hemp oil.
- Make sure you’re getting enough fiber. It helps keep your digestion flowing smoothly and, since constipation can increase abdominal strain, you want to avoid it as much as possible. Good sources include whole grains, nuts, flaxseeds, figs, beans, lentils, berries, broccoli, green beans, and zucchini.
- Drink at least eight glasses of water per day. Water helps improve circulation, which can improve connective tissue healing. It also keeps your digestion moving and maintains your energy levels.
- Look for foods filled with copper. Copper improves the strength of connective tissues and helps enhance the production of collagen for tissue repair. Eat more hazelnuts, almonds, soybeans, crabmeat, and pistachios.
If you want to strengthen your core and back, flatten your belly and achieve your dream abs while keeping yourself injury free, then check out the Invincible Core program.
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50 (17), 1092-1096. doi:10.1136/bjsports-2016-096065
Tobah, Y. B. (2017, August 5). Pregnancy and your stomach muscles. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/diastasis-recti/faq-20057825