Diastasis recti (DR) is the separation of the rectus abdominis muscles, the “six-pack” muscles, along the midline of the abdomen. This separation occurs because the connective tissue joining them, the linea alba, stretches and weakens. While most commonly associated with pregnancy, DR can affect anyone, including men and newborns, often linked to factors like obesity or improper abdominal pressure. The physical separation itself is not typically the source of acute pain, but it creates a functional core deficit leading to significant discomfort and secondary physical issues.
The Difference Between Separation and Pain
The linea alba, which is stretched in diastasis recti, is not heavily supplied with pain-sensing nerves. Because of this, the physical gap between the muscles rarely causes a sharp, direct pain sensation. Instead of acute pain, people with DR often report weakness, instability, or a “hollow” or “flabby” sensation in their midsection.
The discomfort arises from a functional deficit, as the core muscles can no longer stabilize the trunk effectively. The abdominal wall regulates intra-abdominal pressure, a system that works with the diaphragm and pelvic floor to support the spine. When the integrity of the abdominal wall is compromised by the separation, this pressure system becomes mismanaged, leading to instability and compensatory strain on other structures.
This loss of structural support forces the body to recruit other muscles to maintain posture and stability during movement. The resulting sensation is often a deep, persistent ache or pulling, especially during activities requiring core engagement, like lifting or getting up from a chair. The inability of the core to generate adequate tension to support the trunk is the root cause of the discomfort, not the tissue separation itself.
Understanding Secondary Physical Discomfort
The most common secondary symptom of diastasis recti is persistent lower back pain. When deep core muscles, particularly the transverse abdominis, cannot stabilize the spine from the front, the lower back muscles are forced to overwork. This constant, excessive compensation leads to fatigue and chronic aching pain.
Diastasis recti is linked to pelvic floor dysfunction and associated pain. The abdominal and pelvic floor muscles work together as a unit, and a weak core exerts mismanaged intra-abdominal pressure downward onto the pelvic floor. This can cause pelvic pain, pressure, and issues like urinary incontinence or, in severe cases, pelvic organ prolapse.
The body often shifts posture to compensate for the lack of central abdominal support. People may adopt a slumped or overly lordotic posture to feel more stable, which strains the neck and shoulder muscles. This altered alignment can result in tension headaches, chronic mid-back pain, and general discomfort throughout the upper body.
A secondary effect is digestive discomfort, such as bloating or constipation. The weakened abdominal wall lacks the necessary integrity and pressure to assist with proper internal organ function and movement. This lack of support can contribute to a distended abdomen or difficulty with bowel movements.
Identifying Diastasis Recti and Initial Steps for Relief
You can perform a simple self-check for abdominal separation at home. Lie on your back with your knees bent and feet flat, then place two fingers just above your belly button, pointing toward your pelvis. Gently lift your head and shoulders slightly, as if starting a small crunch, and feel for a gap or depth between the two ridges of muscle.
A separation allowing two or more finger widths to sink into the gap is generally considered diastasis recti. Visible bulging or “doming” along the midline during this motion is another indication of the condition. However, the most accurate diagnosis and assessment should always be confirmed by a healthcare provider or a specialized physical therapist.
The first step for relief involves modifying movements to avoid worsening the separation. This includes temporarily avoiding traditional core exercises like crunches and sit-ups, which increase pressure on the linea alba. It is also important to roll onto your side when getting out of bed or standing up to prevent unnecessary abdominal strain.
The primary non-surgical route for managing the associated pain is specialized physical therapy. The goal of these exercises is to restore functional core strength, beginning with gentle exercises that promote deep core engagement and awareness. A physical therapist develops a plan focused on strengthening the transverse abdominis to provide internal support and stabilize the spine, which directly addresses the source of the secondary pain.