Health Care

Healing Mommy Pooch (Diastasis Recti) the Right Way in Physical Therapy

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Motherhood is full of changes, many of which are physical. As the belly expands during pregnancy, the abdominal muscles shift and stretch apart to accommodate the growing baby. When these muscles don’t rejoin after childbirth, women have diastasis recti, nicknamed the mommy pooch or mommy tummy.

However, diastasis recti isn’t something that women have to simply accept as part of motherhood. Beth Northrop, a board-certified specialist in pelvic health at AdventHealth Sports Med and Rehab, helps women prevent and heal from diastasis recti to regain their strength and confidence.

We asked Northrop what happens in the body with diastasis recti, who is most likely to have it, how it can be prevented and more.

What Is Diastasis Recti?

“Diastasis recti is a separation of the two rectus abdominus muscles, which are the muscles that run vertically — not horizontally — up the abdomen,” Northrop says. As a baby grows, so does the belly, pushing the abdominal muscles apart.

After the baby is born, a woman might see that she has a visible space or valley in the midline of her abdomen, or she may see it as a bulge in the middle of her abdomen, Northrop explains.

How Common Is Diastasis Recti?

“Diastasis recti happens naturally as pregnancy progresses, due to hormonal changes and because the growing baby and growing uterus are causing the abdomen to stretch, so those muscles will naturally stretch apart,” Northrop says.

“It’s something that affects most women by the end of their pregnancies and generally, once they’re postpartum, should improve, but nearly 40% of women will still have it six months postpartum.”

Which Pregnancies Put Women at a Higher Risk of Diastasis Recti?

When the abdomen grows, it also stretches more. While most women develop diastasis recti, the severity of it can depend on how far the belly stretches. “Women may be more likely to have diastasis recti if they have a pregnancy with multiples, like twins or triplets, or if they have a larger baby,” Northrop says.

What Are the Symptoms of Diastasis Recti?

A visible space or valley in the midline of the abdomen or a bulging in the abdomen are the most notable signs of diastasis recti.

“Generally, a separation of two finger-widths or more is what we consider a significant diastasis. Women can place their fingertips in the middle of their abdomen and feel how far apart the muscles are,” Northrop explains.

“A new mother with diastasis recti would notice the feeling of weakness, too, if she’s trying to lift her baby or the car seat and she’s having trouble or feeling like she’s not getting support in her abdomen.”

Diastasis recti isn’t just a feeling of weakness. Weakening of the abdominal muscles can cause back pain and pelvic floor issues, too. “Because the abdominal muscles help support the back and pelvis, if a woman has weak muscles there or the muscles are separating, they’re not going to give her the same support,” Northrop says.

Does Diastasis Recti Cause Pelvic Floor Issues?

The abdominal muscles work alongside the pelvic floor muscles, so women may experience pelvic floor dysfunction or urinary incontinence from diastasis recti.

“When the abdominal muscles separate, they don’t work as well with the pelvic muscles. The pelvic floor muscles are part of the core, so they work along with the deep abdominal muscles, the lower back muscles and the respiratory diaphragm. If one of those components isn’t working correctly, then it can harm the pelvic floor,” Northrop explains.

Who Diagnoses Diastasis Recti?

Unfortunately, diastasis recti isn’t something that’s typically discussed at doctor visits. “Women go back for a postpartum six weeks after giving birth, but I don’t think it’s something that the doctor or the midwife necessarily screens for,” says Northrop.

“Usually, when I see patients, it's because they’ve read about it somewhere and they say something to their midwife or doctor about it and then they’ll get referred to physical therapy.”

But at AdventHealth Sports Med and Rehab, direct access makes it easier for women to get the physical therapy they need and get back to feeling better, faster — no physician’s referral necessary. Direct access empowers women to go straight to physical therapy with professionals like Northrop, where they can receive an accurate evaluation for issues like diastasis recti and begin treatment without waiting to get a referral.

A physical therapist in the Pelvic Health Program at AdventHealth Sports Med and Rehab, Northrop has specific training to work with pregnant and postpartum women, and in treating pelvic floor dysfunction.

Northrop believes that better patient education before and during pregnancy would empower expectant mothers. “If women can do the appropriate exercises during pregnancy, it’s going to help them recover quicker, so that they’re not having issues with prolonged back and pelvic pain and pelvic floor dysfunction once they’re postpartum.”

How to Prevent and Heal Diastasis Recti

Having strong core muscles before pregnancy is helpful but maintaining that strength during pregnancy is what counts to reduce diastasis recti, Northrop explains. “If they do core-strengthening exercises during pregnancy, then the diastasis is more likely to resolve quicker postpartum.”

Northrop says that going to physical therapy during pregnancy is the best way to prevent diastasis recti. “If a woman comes to therapy during pregnancy, she can learn the appropriate way to use her core muscles and learn some exercises that will keep her core strong. That’s the best way to help prevent issues from persisting postpartum.”

Strengthening the Core, the Right Way

Strengthening the core before childbirth is key, Northrop says. “Doing the core-strengthening exercises during pregnancy helps diastasis recti resolve within the first few weeks of postpartum and prevent it from persisting beyond that.”

In physical therapy, expectant mothers can learn how to strengthen their abdominals during pregnancy, the right way. Northrop guides women through the proper techniques to help restore the normal abdominal muscle function.

“Particularly, I’m addressing the deep layer of the abdominals, called the transverse abdominis, and I teach women how to do the correct types of core-strengthening exercises,” she explains.

But what are the right exercises? “A lot of times, when women hear the term core strengthening, they think of doing sit-ups, crunches and leg-lifts, and those generally are not the appropriate exercises to start with for diastasis recti,” Northrop says.

“The core is, essentially, the deep muscles in the abdomen. Doing sit-ups and crunches isn’t really the best way to strengthen your core. Doing exercises to help with the deeper core, like Kegel exercises and drawing in the lower abdominals are better ways to strengthen the core,” she says.

Complementary to proper core-strengthening exercises, Northrop also uses different taping methods for the abdomen and abdominal binder braces that help women feel more supported in their abdomen while their muscles get stronger.

Which Exercises or Movements Should Women Avoid?

In general, women should avoid any exercises where they’re holding their breath or straining, Northrop says. “We say to avoid lifting anything heavy until they’re able to use their core muscles correctly,” she says.

“However, we know that new mothers can’t really avoid lifting their baby, car seats and strollers. When they come to therapy, we can teach them how to properly use their core muscles when they are doing those activities so that they don’t worsen the diastasis recti.”

Treating Diastasis Recti Postpartum

Women can heal from diastasis recti, even if they didn’t do core-strengthening during pregnancy. Northrop and her team can help women through the same core-strengthening education and exercises.

“If they’re not able to come in during pregnancy, I would recommend that they come six weeks postpartum. Once they see their obstetric provider and are cleared, they can get a referral to physical therapy.”

How Long Does Diastasis Recti Take to Heal?

If a new mother does nothing about her diastasis recti, it might resolve on its own, or it will persist, causing back and pelvic pain and dysfunction.

If new mothers are doing physical therapy and approved diastasis recti exercises, “they should notice changes in how their abdomen is feeling within the first couple of weeks of therapy because they’re starting to use their core muscles more efficiently,” Northrop says.

It may take a couple of months to get where they want to be, though. “With any muscle-strengthening program, though, it takes eight weeks or so for there to be a more measurable change in the strength of the muscles.”

Is Surgery an Option for Diastasis Recti?

Most women can heal their diastasis recti through proper core-strengthening techniques, and surgery isn’t usually recommended. “It would need to be a severe diastasis,” Northrop says, “typically, surgeons want women to try conservative therapy for a year before they would do surgery.”

Empowering New Moms to Feel Healthy and Whole

You deserve a lot of TLC after baby. Your body does, too, as it worked so hard to bring your new bundle of joy into the world. If you have diastasis recti or want to learn how to prevent it during pregnancy, whole-person care is close by, with no physician’s referral necessary to get started.

In the Pelvic Health Program at AdventHealth Sports Med and Rehab, Northrop and her team can help you preserve or regain your strength so you can feel healthy and confident throughout this new chapter of your life. Reach out to us to get started.

Unsure whether you have diastasis recti? Having other uncomfortable physical symptoms? Take our body after baby quiz to identify common, physical postpartum symptoms and see whether the Pelvic Health Program at AdventHealth Sports Med and Rehab is right for you.

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