Diastasis Recti Abdominis (DRA) is a common condition where the two halves of the outermost abdominal muscles separate. This occurs when the connective tissue joining these muscles stretches and thins, creating a gap along the midline of the abdomen. While DRA is most frequently associated with pregnancy, affecting an estimated 60% of individuals during the third trimester, it can also occur in men and infants. The separation itself is generally not the source of direct pain, but the resulting loss of structural support can lead to functional issues that manifest as various forms of discomfort, including abdominal pain.
Defining the Separation of Abdominal Muscles
Diastasis recti involves the widening of the linea alba, the fibrous structure that runs vertically down the center of the abdomen, connecting the left and right sides of the rectus abdominis muscles (the “six-pack”). When the body is subjected to sustained intra-abdominal pressure, such as during pregnancy or chronic straining, the linea alba stretches and loses its ability to recoil.
Diagnosis of DRA is based on measuring the distance between the two muscle bellies, known as the inter-rectus distance. A separation is generally considered clinically significant DRA if the gap is wider than 2 centimeters, or roughly two finger-widths, at rest. This measurement is most often taken at the level of the navel, where the separation tends to be widest, though the width can vary significantly along the entire length of the linea alba. Objective assessments use tools like ultrasound or calipers to confirm the distance and evaluate the quality of the stretched connective tissue.
Instability as a Source of Pain
The abdominal pain experienced with DRA is an indirect consequence of core instability, not a direct result of the separated muscles. The abdominal wall is a crucial component of the core cylinder, working with the back muscles, diaphragm, and pelvic floor to manage intra-abdominal pressure (IAP) and stabilize the trunk. When the linea alba is compromised, the abdominal wall cannot effectively generate tension, leading to a loss of structural integrity.
This lack of central support forces other muscle groups to compensate, frequently leading to musculoskeletal pain. The most common complaint is persistent lower back pain, which develops as deep postural muscles strain to stabilize the spine without necessary front-side support. This compensatory pattern can also cause discomfort in the hips and pelvis, often referred to as lumbo-pelvic pain.
Dysfunctional IAP management can also create abdominal discomfort, particularly digestive issues. The altered mechanics of the abdominal wall may contribute to chronic constipation, as weakened muscles struggle to assist with bowel movements. The lack of containment can also allow abdominal contents to push forward when straining, creating uncomfortable pressure or bulging often described as generalized abdominal pain.
Other Potential Causes of Abdominal Pain
While DRA creates instability that leads to discomfort, not all abdominal pain is solely attributable to the condition. It is important to consider co-occurring or differential diagnoses, as true abdominal pain can signal other issues. A common complication seen alongside DRA is an umbilical hernia, where a portion of the intestine or other abdominal tissue pushes through a small opening near the navel.
Unlike DRA, which involves tissue stretching, a hernia is a distinct hole that can become a medical concern if tissue gets trapped. Sharp, localized abdominal pain, or pain accompanied by nausea, warrants immediate medical evaluation to rule out a hernia. Core dysfunction associated with DRA often coexists with pelvic floor dysfunction, causing pelvic pain, urinary incontinence, and pain during intercourse. These symptoms are part of a connected functional system and should be addressed holistically.
Management and Treatment Options
Treatment for DRA focuses on restoring the functional integrity of the abdominal wall and the entire core system, rather than simply closing the gap. The standard first-line approach is specialized physical therapy (PT) targeting the deeper core muscles. A physical therapist teaches specific techniques to activate the transverse abdominis, the deepest layer of abdominal muscle, in coordination with proper breathing mechanics and the pelvic floor.
These exercises aim to improve postural control and teach the body to manage IAP effectively during daily activities. Consistency in core retraining can significantly reduce indirect pain symptoms, such as lower back and abdominal discomfort. For severe separations or cases requiring hernia repair, surgical intervention may be considered. This procedure typically involves plicating, or stitching together, the stretched linea alba to narrow the gap. Even after surgery, specialized physical therapy is necessary to ensure the repaired abdominal wall is functionally integrated into the core support system.