Am I bloated, or is it diastasis recti?

Posted on June 21, 2022 | by

Concerned woman looking in mirror wondering if her stomach is bloated or if it is diastasis reci

Many people, especially women, find targeting the lower abdominal area or “pooch” difficult despite best efforts with diet and exercise. Without definitive results, it is natural to want answers as to why the belly seems immune to improvement. Bloating can certainly play a role in a protruding midsection—but a medical issue may also be a contributing factor: Diastasis recti is a condition in which the rectus abdominis muscles and supporting tissues are stretched and vertically separated down the midline and thus unable to contract to their original positions. We have dedicated this blog to support our readers in assessing if their “belly bloat” may actually be an indicator of abdominal separation.

Risk factors for diastasis recti

Diastasis recti can affect anyone, but is especially prolific among mothers, affecting 60% during pregnancy, with 40% continuing to experience the condition postpartum. Abdominal separation in pregnancy is normal to accommodate a developing baby, and many mothers grow accustomed to having stretched abdominal muscles, not realizing it could be affecting their health. Often, women who are frustrated by their shape after giving birth will overlook this condition, thinking it is simply post-pregnancy bloat or excess abdominal fat.

These risk factors can influence the presence and severity of diastasis recti in women:

  • Multiple pregnancies (particularly if experienced close together)
  • Vaginal delivery (abdominal strain and pressure is increased by pushing)
  • Having a particularly small frame
  • Carrying multiples (i.e. twins)
  • Having a larger baby

Other risk factors for diastasis recti

Women are not the only people who experience diastasis recti: men with weaker internal core muscles (transverse abdominis), hyper-developed external core muscles, or who have been notably overweight can experience muscle separation.

For both men and women, comorbidities and lifestyle choices that can increase your chances of experiencing diastasis recti include:

  • Obesity (causes reduced collagen production, essential for skin elasticity)
  • Diabetes (reduces muscle mass and function, weakening the core abdominal muscles)
  • Smoking (weakens connective tissues and inhibits collagen production)
  • Poor workout/weightlifting techniques (placing unnecessary strain on the abdominal muscles)

Interestingly, infants can experience this condition as the umbilical cord is naturally released from the abdomen, though it almost always resolves within a few weeks without complications.

Signs of diastasis recti

Knowing the signs of diastasis recti will help you determine if the distended appearance of your lower abdomen is a result of stomach bloating or diastasis recti. Keep in mind that you may not experience all of these signs with abdominal separation.

  • Persistent bulge or “pooch” that is unaffected by diet and exercise
  • A bulging dome-like shape that is formed when contracting the lower abdomen
  • A jelly-like softness around the navel
  • Abdominal weakness
  • Umbilical herniation
  • Lower back pain
  • Hip and Pelvic pain
  • Urinary incontinence when coughing, sneezing, or jumping

Diastasis recti can sometimes be mistaken for a hernia, which is a protrusion of the bowel or other tissue through the abdominal wall. It is not uncommon to experience abdominal separation and herniation simultaneously.

Checking for diastasis recti

It is possible to feel for diastasis recti at home. Here are some simple steps to determine if you have any degree of separation between the left and right sides of your abdominal muscles:

  1. Lie down with your feet flat on the floor and your knees slightly bent.
  2. With one hand supporting your head, slightly lift your shoulders up enough to see your stomach.
  3. Starting above the navel, gently use your fingertips to feel for any gap between the left and right side of your abdominal muscles.
  4. If you do feel a gap, see how many of your fingers fit within that space.

Separation that is two centimeters or wider is considered diastasis recti. Your doctor or a board certified plastic surgeon will be able to properly diagnose the severity and location if diastasis recti is present.

How to repair diastasis recti

Surgery, specifically a tummy tuck (abdominoplasty) remains the only proven solution for both repairing diastasis recti and creating a more aesthetically pleasing abdominal shape. It is a two part procedure: first, your surgeon will treat the underlying musculature, repairing your abdominal separation. After the abdominals are surgically tightened and repositioned, they will then remove excess skin and fat across the midsection. Thus a tummy tuck will address diastasis recti, fat, and loose skin, leaving a slimmer, more defined midsection.

There is some evidence that very specific exercise and breathing methods can help alleviate mild diastasis recti—however, patients should take care as traditional core strengthening techniques can potentially worsen this condition. We recommend seeking an accurate diagnosis with a medical provider to see if you have diastasis recti, the degree of severity, and what, if any exercises would benefit you.

Diastasis recti repair in Boston

Board certified plastic surgeon Dr. Fouad Samaha has over 20 years of experience helping patients who suffer with this troublesome condition and wish to reshape their midsection. We invite you to call our practice at 617.786.7600 or contact Boston Plastic Surgery online to schedule a personal consultation; we look forward to discussing proven diastasis recti treatment options with you.