You may not know you have it. It’s the separation of your abdominal muscles, and it causes a bulge that just won’t go away.

What is it?

If you’re struggling with a belly bulge that won’t go away no matter how well you eat or how much you exercise, you may have a condition called diastasis recti. It is the separation of your abdominal muscles, and it is permanent unless fixed by surgery. But how does this happen? Let’s discuss a little bit of your anatomy so we can understand the process better.

What is causing my stomach bulge?

First of all, it is important to understand that a stomach bulge can be caused by several different anatomical factors.    

Extra skin and/or fat

Having extra skin or fat on your stomach is common, especially if you’ve had children, lost or gained weight, or simply from aging.  Some people just have extra skin, without much extra fat. Others have extra fat, without much extra skin. Many people, however, have both extra skin and extra fat.

Muscle separation

Your stomach muscles are what you see when someone has a “six pack”. The muscle that makes up the “six pack” is called the “rectus abdominis”.  It is long and extends from the lower part of the ribcage to your pubis, down the middle of your belly. You have a left and a right rectus abdominis and they are joined together by a thin piece of connective tissue, called the “linea alba”.   

The linea alba get get stretched out, most commonly due to pregnancy and weight gain.¹

This stretched out condition is called “diastasis recti”.  “Diastasis” means “separation” and “recti” is for those rectus abdominis muscles that get separated.

What this looks like visually, is that when you look at yourself from the side, your stomach will bow outward. Some women say that they “look pregnant”, even if they aren’t.  Even when you try to “suck in” your stomach while standing, it may not be possible to make your stomach look flat. This outward bulge of your stomach will be there when you are standing up, but your stomach will go flat when you are lying down. These are clues that you may have diastasis recti.

Extra fat around the Internal organs

What’s inside your abdomen has just as much of an impact on your belly as the outside. Your internal organs take up space, and push against your rectus abdominus muscles. There’s also fat on and around your internal organs, as well as what’s called the omentum, which is like an apron of fat over your organs. Your internal fat (also called “visceral fat”) is there to act as a cushion so your organs aren’t jostled or injured while you’re moving around in your daily life. Too much internal fat can lead to health problems, in addition to being a cosmetic concern.  

Can you picture a man with a “beer belly”?  Many times they don’t have extra skin or fat, yet their belly is as “tight as a drum”.  This is due to excess internal fat. When you have this condition, your belly does not get much flatter even when lying down.  Excess internal fat cannot be helped by a tummy tuck. The only way to reduce visceral fat is through diet and exercise.

What Is Diastasis Recti?

Let’s focus on #2 above – muscle separation, also known as “diastasis recti”.

As we’ve talked about, when there’s pressure against your abdominal wall, it causes your muscle, fascia, and skin to stretch over time. Your muscle and skin have more elasticity, so if you only have minor stretching, your belly can “bounce back.” Your linea alba between the stomach muscles, on the other hand, does not have that same elasticity, so it doesn’t return to its shape. This leads to a gap between the stomach muscles. This may not be noticeable if it has been stretched only a little. But, If your abdominal wall has stretched a lot, the loose fascia creates a gap between your rectus abdominis, leading to a belly “bulge”. That “bulge” is your abdominal contents, your organs and internal fat, pressing against that widened linea alba and causing a bulging belly. The degree of diastasis is different from person to person, depending on how stretched out their belly gets. 

Let’s talk in-depth about the 2 most common causes of diastasis recti: 

Pregnancy and childbirth

As your baby grows, your body needs to adjust to create room for it. The growth shifts your organs around, and also presses against the inside of your abdominal wall which forces it to expand. The expansion stretches the linea alba, causing your stomach muscles to move further away from each other. Because the linea alba is not elastic, once it stretches, it never goes back to the way it way it was.   

After delivering your baby, your skin and fascia remain loose, and you’re left with diastasis recti.

Major weight gain and loss

Gaining excessive amounts of weight can cause you to develop diastasis recti as well.²

When people gain weight from excessive fat, that fat can be stored in the belly area, buttocks, hips, thighs, arms, or pretty much anywhere that there are fat cells, including internally. When you’re storing more and more fat in your belly area, it’s building up in your abdomen as well as under your skin. That puts pressure on your abdominal wall, also stretching out your linea alba. When you lose the excess fat, you can be left with loose fascia, skin, and separated muscles.

How Can I Tell If I Have Diastasis Recti?

Your doctor can let you know if you have diastasis recti, but there is a test you can do on yourself if you’re suspicious that you might have it. It’s a very quick test that you can do at home, the gym, or anywhere you can comfortably lay down.

Finger Test

Lay down on your back with your knees bent, and your feet flat on the ground. Place your fingers, palms facing you, at the midline of your belly. Lift your head, neck, and shoulders off the ground, like you’re doing a crunch, engaging your ab muscles. While you’re “crunched” feel for a separation between your muscles right above and below your belly button. If you feel a gap, you may have diastasis recti.

What Can I Do To Fix It?

Now that you think you have diastasis recti, you might want to jump into correcting it. Unfortunately, you’ll find that there’s not much you can do to reverse the problem. A stretched out linea alba is permanent.

Diet Doesn’t Work

There’s no miracle diet that will help fix diastasis recti, despite the multitude of different dietary products that are marketed at postpartum women. You’ll benefit from a healthy, balanced diet by improving your overall health, and diminishing your body fat, but that can’t bring your muscles back together.

Exercise Doesn’t Work

You might think that exercise will be the answer, but that won’t resolve the issue either. Exercise is an important part of living a healthy life, but it can’t fix the separation of your muscles. Core-strengthening exercises can make the six-pack muscles stronger, but think of them like columns in a building – the muscles themselves can be very strong and firm, but nothing is going to move them closer together from where they’re built into.

Binders, Waist Trainers, Corsets Don’t Work

There are a lot of garments marketed towards postpartum women, especially those that promise to correct diastasis recti. The truth is that these act as support garments at best. They’ll give you the appearance of a smoother, flatter belly, but your diastasis recti is still there, and it’s still noticeable when you take off the garment.

What Will Fix It?

There’s really only one way to truly fix diastasis recti, and that is with surgical muscle repair.

Muscle Repair

A surgeon can fix diastasis recti by stitching the two sides of your abdominis recti together. Typically, the repair extends from just below your ribs, down your midline to your pubic area. This tightens your loose fascia and that prevents the belly bulge.³

Muscle repair can be done by itself, but it’s usually done with a tummy tuck. A tummy tuck has the added benefits of removing extra fat, loose skin, and some stretch marks, which are usually things that accompany diastasis recti.

A surgical muscle repair has other benefits as well, including:

A Stronger Abdominal Wall

The stitches bring your separated muscle back together, which is stronger than the stretched out, loose fascia.

Flatter, More Narrow Waist

Your belly will look flatter since there will be no loose fascia for your abdominal contents to bulge against. The stitches act like a corset, which can slim down your waistline and give you a more hourglass shape. The effect is much more noticeable with a tummy tuck, since extra skin and fat is removed from your belly.

Possible Improvement In Your Back Pain

A strong core is just one factor that can help reduce your back pain. In some patients with wide diastasis recti, muscle repair relieved their back pain by strengthening their abdominal wall and correcting their posture.⁴

There are many different reasons why you might experience back pain, however, so diastasis recti repair may not help your back pain at all.  It’s important to discuss this with your surgeon before surgery.  

Get rid of it!

If you have a belly bulge, and you’re concerned that you might have diastasis recti, do a quick self-check with the finger test. If you feel a separation between your muscles, make an appointment with a plastic surgeon for a consultation. A tummy tuck with muscle repair might be what you need to get rid of that “pooch” once and for all.

1. Gutowski, Karol A. “Evidence-Based Medicine: Abdominoplasty.” Plastic and Reconstructive Surgery 141, no. 2 (2018): 286e-299e.
2. Temel, Metin, Arif Türkmen, and Ömer Berberoğlu. “Improvements in vertebral-column angles and psychological metrics after abdominoplasty with rectus plication.” Aesthetic surgery journal 36, no. 5 (2016): 577-587.
3. Gama, Luiz José Muaccad, Marcus Vinicius Jardini Barbosa, Adriano Czapkowski, Sergio Ajzen, Lydia Masako Ferreira, and Fábio Xerfan Nahas. “Single-layer plication for repair of diastasis recti: the most rapid and efficient technique.” Aesthetic surgery journal 37, no. 6 (2017): 698-705.
4. Temel, Metin, Arif Türkmen, and Ömer Berberoğlu. “Improvements in vertebral-column angles and psychological metrics after abdominoplasty with rectus plication.” Aesthetic surgery journal 36, no. 5 (2016): 577-587.