Women often ask us, “Does diastasis recti cause back pain?” And they are often surprised to hear that not only can diastasis recti cause back pain but diastasis recti can also cause pelvic floor dysfunction. With so much information out there about diastasis recti, it can be really confusing what to believe and where to start. We get it! So let’s talk about: what is diastasis recti is, does diastasis recti cause back pain, and how to fix a diastasis recti.
What is Diastasis Recti?
Diastasis recti is a condition where the connective tissue between both rectus abdominis muscles (aka the “6 pack ab muscle”) separates down the middle of the abdomen. Most often this separation can occur during pregnancy, but it can also occur with significant weight gain or increased muscle tone in the abdomen.
The effects of diastasis recti are most commonly noticed postpartum. Some women may notice a “dome” or “bulge” when attempting to sit up from lying flat. Other women may notice a distended abdomen or feel a bloated sensation that doesn’t go away. Some may even experience pain in the belly or abs. You can read more about how to know if you have a diastasis recti here.
For some, living with a diastasis recti might be no big deal. They don’t deal with any restrictions and might not even notice their diastasis. However, the majority of women with a diastasis recti will notice some limitations. They can have difficulty pushing a stroller, lifting anything heavy, or doing activity without pain. In fact, most will experience low back pain with these activities. This may happen shortly after having your baby or months or even years later. Every woman is different, and diastasis recti affects each person differently.
Does diastasis recti cause back pain?
As mentioned, women often experience back pain in conjunction with diastasis recti as well as pelvic floor dysfunction. In fact, most of the time they feel more limited by the back pain or pelvic floor dysfunction they are feeling rather than the actual abdominal separation.
There are a few reasons that diastasis recti can cause back pain:
A weak core means the spine has to work overtime
Our bodies require strong and intact abdominal muscles to provide the proper support to the trunk and lumbar spine. Without proper support from the abdominal muscles, more demand gets placed on the spine during activity. The spine is not designed to do all of the work, so pain begins as the spine fatigues. This is why you may experience back pain after being on your feet for an extended period of time.
Lack of support can lead to degeneration over time
Weakened and separated core muscles that don’t give the proper support to our lumbar spine can also lead to degeneration of the joints of the spine. This can happen over time and lead to worsening low back pain as time goes on.
The connective tissue can’t do its job.
If it’s not repaired, the damaged connective tissue on the abdomen from the separation of the rectus abdominus will be unable to function properly and provide support between the upper and lower body. This will also place increased demand onto the abdominal muscles and the spine.
The start of back pain is different for every woman. But once the diastasis recti occurs, it’s only a matter of time before the spine will be impacted. If several years have passed before back pain begins, there has already been some break down of the spine. While the pain can be improved, it is likely that the degeneration will stay the same. This is why it’s key to address your diastasis recti sooner rather than later to help protect your spine long term.
We have noticed for most women who experience low back pain, there are also other areas of weakness in the hips, glutes, and pelvic floor. If these areas are also weak and there is an abdominal separation, the spine undergoes even more aggressive wear and tear.
So the short answer to the question, “Does diastasis recti cause back pain?” is YES! And it’s key to try to heal the diastasis recti before it starts causing back pain.
Could my diastasis recti also be causing me to leak?
Stress incontinence is the leakage of urine that occurs with extra stress or exertion to the body. Activities that can bring on this leakage include coughing, sneezing, laughing, running, jumping, squats, jumping jacks, etc. It's a little-known fact that when functioning properly, your pelvic floor and abdominal muscles should work together to avoid this type of incontinence.
If your abdominal muscles are unable to properly support the abdomen because they are separated from a diastasis recti, the abdominal pressure caused by these activities is too much for the pelvic floor to withstand on its own and incontinence can occur. We need the pelvic floor muscles to support our bladder and keep it sealed so leakage doesn’t happen. And they can’t do this without properly functioning abdominal muscles. In fact, 50% of women that have a diastasis recti also have incontinence!
If the pelvic floor has to do all of the support work, these muscles can become too tight over time. If pelvic floor tightness occurs, it can become problematic. When the pelvic floor muscles are already in a contracted or tightened state, they can’t contract any further to prevent leakage. We need our diaphragm, abdominals, and pelvic floor to work as a team and to function normally to help prevent issues with leakage and other pelvic floor issues.
Can I prevent back pain and incontinence?
If you are pregnant or have recently had a baby, the first step is to determine whether or not you have a diastasis recti. Over 60% of women will have a diastasis recti after pregnancy (but some statistics suggest 100% of women have one). In order to prevent back pain and incontinence, it is crucial that you start healing the diastasis recti right away. Part of this process also includes retraining your posture. It is common for women to get stuck in a bad posture after pregnancy (ever noticed the postpartum flat booty??). Correcting bad posture will also help prevent back pain and incontinence. Another aspect of prevention includes a comprehensive look at your back, pelvis, hips, and pelvic floor by a physical therapist to resolve all root issues.
How can I heal my diastasis recti?
There is so much information out there about what to do to “fix” a diastasis recti, and it can be really confusing. Most sources tell women to avoid sit ups, twisting movements, or any abdominal exercise or contraction against gravity.
These suggestions just aren’t realistic or functional for new moms!
With that being said, it is beneficial to limit sit-ups or twisting exercises during the healing phase postpartum or while undergoing physical therapy. However, it doesn’t mean you can never perform those exercises again.
Core exercise is also very dependent on a woman’s baseline level of strength and how her diastasis recti responds to certain movements. It is key to work on retraining the transverse abdominis muscle in order to take some of the load off of the obliques and give deeper core support to the low back. Deep core strength is key when it comes to providing support to the spine and pelvis. Check out our video of a diastasis recti safe exercise that targets the transverse abdominus.
It can also be helpful to stretch the obliques if they are too tight. When the oblique muscles are tight, they pull on the separation in the middle of the abdomen since they are linked to the same connective tissue. This often leads to the “distended” appearance that can be common with a diastasis recti. In addition, most women require hands-on, manual treatment to help heal the damaged connective tissue and return to their prior level of activity. Working with a pelvic floor physical therapist will address these contributing factors that limit healing of the diastasis recti.
For more information on diastasis recti and how to heal it, download our FREE REPORT, "Everything You Need to Know About Diastasis Recti" to help get you started now.