Diastasis recti is the stretching and separation of the rectus abdominus muscle. It often occurs during and after pregnancy. If affected, you may feel a gap between your abdominal muscles and have a protruding belly. It can also weaken your core muscles. This article explains why and what you can do to address this condition.

What is Diastasis Recti?

Diastasis recti (also known as rectus diastasis) occurs when there is stretching and separation of the rectus abdominal muscles along the midline of the stomach.

Your rectus muscles are two large parallel muscles in the centre of your abdomen, covered with a thick sheet of fascia, and divided into two by a central band of connective tissue called your linea alba.

These muscles are the most superficial abdominal muscles (meaning: they are the closest to your skin) and run from your pubic bone up to your lower ribs. Some people call them your ‘six-pack’ muscles.

Diastases recti are incredibly common in women during and after pregnancy, but can also affect any gender after rapid weight gain, heavy lifting or chronic abdominal strain.

As your baby grows during pregnancy, your uterus expands, and your linea alba begins to pull apart. Once you deliver your baby, the linea alba can sometimes heal and come back together. It’s elastic and retracts back like a rubber band.

However, just as elastic bands can lose their elasticity, so can your linea alba.

With lost elasticity, the gap in your rectus abdominal muscles won’t close as much as it should. Both sides of your abdominals stay separated and appear pushed outward. This is called diastasis recti. It can range from mild to severe.

Diastases Recti Symptoms

If you have diastases recti, you may experience the following symptoms:

• You can place two or several fingers in between the two bands of muscle.
• The area between the two bands may feel soft.
• Your belly may stick out below your navel, making it look like you are still pregnant.
• Your belly domes outwards when you tighten your tummy muscles or lean back in a chair.
• You have poor posture or lower back pain
• You have difficulty lifting objects, walking or performing everyday tasks.

How To Test For Diastasis Recti

If you suspect you have diastasis recti, it’s recommended that you see your GP or a physiotherapist to have them check the diastasis, where it is located, and how severe it is. Diastases recti can occur above your belly button, below your belly button and at your belly button.

Your health practitioner will use their hands and fingers to assess your abdominal area for gaps in muscle tone, and may use ultrasound, a measuring tape, or callipers for more accurate measurements.

If your abdominal gap is wider than two centimetres, it’s considered diastasis recti. Often, it’s also measured in finger widths, with two fingers considered diastases recti.

You can also test for diastasis recti at home.

• Lie on your back with your knees bent and feet flat on the floor.
• Lift your head and shoulders off the floor, supporting your head with one hand and touching your tummy with the other.
• Place your fingers in the belly button area. See how many fingers you can fit in the gap between your right and left abdominal muscles.
• If you feel a gap of two or more finger widths, you should discuss this with your health practitioner. They can then confirm your diagnosis and recommend treatment.

Why Does Diastasis Recti Affect Core Strength?

Having diastasis recti affects more than just your appearance. It also disrupts the structural integrity of the abdominal wall.

As these two large muscle bands are now separated, they can no longer anchor to each other during flexion, thereby compromising their strength and function.

Let’s take a closer look at why:

• Lost muscle anchor: Your (stabilising) side muscles, the external and internal obliques and the transversus abdominus, start from your back and insert into the central tissue (linea alba) at the front of your abdomen. When this band of connective tissue is separated, these stabilising muscles lose the taught, central anchor they need to contract efficiently, potentially leading to partial muscle weakness.
• Impaired force transfer: Your core acts like a corset, creating tension to support your trunk during exercise or when lifting heavy loads. When the linea alba thins and separates, your core cannot transfer this tension properly, making routine movements feel unstable.
• Compensatory strain: As your abdominal muscles are compromised, your body overcompensates by placing greater strain on other muscle groups, often resulting in discomfort in the lower back and pelvic floor.

Additionally, this inefficient contraction can cause partial muscle atrophy (shrinkage) and weakness. Although the condition is not life-threatening, it can significantly affect your quality of life and is therefore worth addressing.

How to Treat Diastasis Recti

If you have diastases recti, the first line of action is exercise. Before you start, though, it’s recommended that you seek the advice of your health practitioner. Ideally, choose a practitioner who is familiar with the condition. They can create a suitable treatment program, carefully monitor you, and adapt it where required.

Typically, you’ll need to perform gentle movements that tighten and flatten your abdominal muscles as you exhale. Avoid exercises that can easily bulge your abdominals, such as traditional sit-ups and crunches, or double-leg lifts.

Many women can heal their diastases recti over time with the right exercise program. Some will take longer than others, depending on the extent of your abdominal separation and your diligence with your exercise program.

However, some women, despite their best efforts or due to the severity of their condition, require surgery to address the condition.

Surgically Repairing Diastasis Recti

Diastases recti surgery (rectus diastases repair), tightens and sutures the separated parallel bands of the rectus abdominal muscles back to their midline position. This can be performed in one of three ways:

• Abdominoplasty: One or more incisions are made before elevating the skin, repairing the muscles, and then excising excess skin.
• Minimally Invasive/Robotic Surgery: For patients with smaller gaps or those seeking less scarring, a surgeon creates a few tiny incisions to repair the muscles from the inside without lifting the external skin.
• Hernia Repair: If a patient has an umbilical hernia or ventral hernia, the rectus muscle can also be corrected during the same surgery.

Repairing your diastasis recti aims to address core stability, functional strength, posture and back pain, and to increase your ability to perform daily tasks and exercise.

Resolving Diastases Recti With A Tummy Tuck (Abdominoplasty)

Following childbirth, many women consider a Tummy Tuck (Abdominoplasty) as they have loose, excess skin and tissue and excessive stretch marks in the abdominal region. Some also have a persistent diastasis recti.

A Tummy Tuck addresses the above concerns. Excessive skin can be removed (including most or all of the lower abdominal wall stretchmarks), the fatty tissue associated with that excess skin is removed, and additional fatty tissue may be liposuctioned away.

Muscle separation can also be surgically addressed during Abdominoplasty. The outcome is an abdominal region with less excess skin and stretch marks, and potential functional improvements in core stability.

The type of Abdominoplasty suggested will depend on the amount of excess skin and tissue you have. However, below are the more common Abdominoplasty procedures:

• Mini Tummy Tuck (Abdominoplasty) > 
• Standard Tummy Tuck (Abdominoplasty) >
• Fleur De Lis Tummy Tuck (Abdominoplasty) >
• Open Book Tummy Tuck™ (Abdominoplasty) >
• Reverse Tummy Tuck (Abdominoplasty) >
• Belt Lipectomy (Lower Body Lift) >

Potential Risks and Complications

All surgical procedures carry risks, including Abdominoplasty procedures. It’s important to understand these risks before proceeding with surgery. To learn about general surgical risks, please visit this page.

Additionally, Abdominoplasty risks and complications include navel deformity or malposition, skin irregularities, poor circulation, fatty tissue damage or neck process, seromas, significant scarring, asymmetry, temporary and permanent changes in skin sensation, prolonged swelling or pain, and the need for further surgery (to fine-tune the results).

How Much Is a Tummy Tuck (Abdominoplasty) in Sydney?

The cost of your Abdominoplasty will depend on your physical presentation and the type of procedure you require. Every surgical procedure is tailored to the individual, and no two surgeries are the same.

For example, an Abdominoplasty on a smaller patient who requires a less invasive procedure may only take two hours, while a more involved Abdominoplasty on a larger patient may take up to five hours. Therefore, the surgical and anaesthesia costs would be higher.

Other financial factors to consider include the number of overnight hospital stays required and eligibility for Medicare and Private Health Insurance rebates.

Does Medicare Cover a Tummy Tuck (Abdominoplasty)?

Medicare may cover Abdominoplasty surgery if your procedure is deemed medically necessary, and you present the correct documentation that strictly meets the criteria outlined in the Medicare Benefits Schedule (MBS).

If met, they may provide small rebates for hospital costs, the surgeon’s fee and the anaesthetist’s fee.

NB: Medicare will only cover a portion of these fees. Dr Dona can provide more detailed information about your costs during your initial consultation.

Does Private Health Insurance Cover a Tummy Tuck (Abdominoplasty)?

Your Private Health Insurance fund may cover reconstructive Abdominoplasty procedures deemed medically necessary. However, you typically need to have the highest level of hospital cover and have maintained it for at least 12 months.