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Bulging Stomach When Sitting Up - Diastasis Recti Information & Exercises

  • Synopsis: Published: 2014-03-27 (Rev. 2017-05-24) - Information and exercises regarding Diastasis Recti which generally presents as a mid-line domed or bulging stomach when rising from a lying position but is not a hernia. For further information pertaining to this article contact: Ian Langtree at Disabled World.
Diastasis Recti

Also known as abdominal separation or recti split - is a disorder defined as a separation of the rectus abdominis muscle into right and left halves. Normally, the two sides of the muscle are joined at the linea alba at the body mid-line. It is essentially a cosmetic condition, with no associated morbidity or mortality. A diastasis recti may appear as a ridge running down the mid-line of the abdomen, anywhere from the xiphoid process to the umbilicus. It becomes more prominent with straining and may disappear when the abdominal muscles are relaxed.

Main Document

Quote: "Diastasis Recti often reveals itself with pooching or doming of your stomach, sometimes making you appear as if you are pregnant - men included."

A Diastasis Recti looks like a ridge, which runs down the middle of your belly area. The protruding bulge can stretch from the bottom of your breastbone to your belly button, and increases with muscle straining. Diastasis Recti is not a hernia - a umbilical hernia and diastasis recti can co-exist, but are not related.

Many people have a diastasis recti and don't know it. A Diastasis Recti, also referred to as Divarication of the Recti or Rectus Distension, is the widening of the gap between the 2 sections of the Rectus Abdominis (or 6 pack) abdominal muscle at the Linea Alba (mid-line connective tissue) at the front of the abdomen. The rectus abdominis muscle, also known as the "abs and lower abdominals," is a paired muscle running vertically on each side of the anterior wall of the human abdomen. There are two parallel muscles, separated by a mid-line band of connective tissue called the linea alba (white line). Diastasis Recti often reveals itself with pooching or doming of your stomach, sometimes making you appear as if you are pregnant - men included.

The condition is common in newborns. Women who are pregnant may develop Diastasis Recti due to increased tension on the abdominal wall, (The risk is higher with multiple births or many pregnancies), however, no treatment is needed for pregnant women with this condition. Males can also develop the condition, often caused by heavy lifting, weight lifting, sudden weight gain, etc. When men have significant pain or associated hernias, a mesh repair can be performed, but typically with a scar placed from the breastbone to the umbilicus. Some cases of diastasis recti in men can be treated with physical therapy alone. You should discuss this with your doctor, who may be able to refer you to a physical therapist who can suggest strengthening exercises for your abdominal muscles. If exercises do not work, then you should talk to a plastic surgeon about a possible abdominoplasty, or "tummy tuck", procedure.

Fig 1. Diagram of the Human Rectus Abdominis muscle.
About This Image: Fig 1. Diagram of the Human Rectus Abdominis muscle.
Performing a Quick Test for Diastasis:

  • Lie on your back with knees bent, feet flat on the floor.
  • Place a hand behind your head for support.
  • Place the index and middle fingers of your other hand just above your belly button, pointing them downward.
  • Raise your head and neck off the floor and press your fingers into the separation between your muscles.
  • If you can fit more than two fingers into the opening, you likely have a diastasis.
  • Your doctor can diagnose this condition with a simple physical exam.

Diastasis Recti Repairs

Healing the connective tissue is all about putting it in a better (narrow) position, bringing blood flow to it and protecting it when doing any type of activities so it is not being stretched nor does it have any intra-abdominal force or pressure on it.

A study in 1988 was conducted to determine if exercises could reduce the amount of separation in the rectus abdominis muscles. After a six week trial, results were shown that exercising greatly reduced the amount of the distasis.

Exercises Shown to Reduce Distasis Recti Separation

NOTE: Incorrect exercises, including crunches can actually increase the distasis recti separation. All corrective exercises should be in the form of pulling in of the abdominal muscles rather than a pushing of them outward. Consultation of a professional physiotherapist is recommended for correct exercise routines.

Various Exercises for Females and Males with Diastasis Recti:

  • Squat with squeeze - A variation to the "Squat against the wall" is to place a small resistance ball between the knees, and squeeze the ball as you lower your body to the seated position - 20 repetitions.
  • Seated squeeze - Again in a seated position, place one hand above the belly button, and the other below the belly button. With controlled breaths, with a mid-way starting point, pull the abdominals back toward the spine, hold for 2 seconds and return to the mid-way point - 100 repetitions.
  • Core contraction - In a seated position, place both hands on abdominal muscles. Take small controlled breaths. Slowly contract the abdominal muscles, pulling them straight back towards the spine. Hold the contraction for 30 seconds, while maintaining the controlled breathing - 10 repetitions.
  • Head lift - In a lying down position, knees bent at 90 degree angle, feet flat, slowly lift the head, chin toward your chest, (concentrate on isolation of the abdominals to prevent hip-flexors from being engaged), slowly contract abdominals toward floor, hold for two seconds, lower head to starting position for 2 seconds - 10 repetitions.
  • Upright push-up - A standup pushup against the wall, with feet together arms-length away from wall, place hands flat against the wall, contract abdominal muscles toward spine, lean body towards wall, with elbows bent downward close to body, pull abdominal muscles in further, with controlled breathing. Release muscles as you push back to starting position - 20 repetitions.
  • Squat against the wall - Also known as a seated squat, stand with back against the wall, feet out in front of body, slowly lower body to a seated position so knees are bent at a 90 degree angle, contracting abs toward spine as you raise body back to standing position. Optionally, this exercise can also be done using an exercise ball placed against the wall and your lower back - 20 Repetitions.
  • Lying on floor - Begin by lying down on the ground on your back with both legs bent and both feet flat on the floor. Tighten the muscles of your lower abdomen and lift your hips off the floor. Perform 10 repetitions.
  • Stomach press - This exercise is performed by lying down with both legs bent at about a 90 degree angle with the soles of both of your feet flat on the floor. Put both hands on your lower stomach around your belly button, and be sure that the fingers of both of your hands are pointing down toward your genitals. Breathe out and use a slow and controlled motion to lift your head and shoulders off the ground while pressing down on your lower abdomen with your hands and fingers.
  • Leg Extension - Lie down with both legs bent and both feet flat on the floor. Breathe in and slowly begin to exhale while simultaneously straightening one leg and sliding it down on the floor. Use the muscles of your lower abdomen to help stabilize your straightened leg. Extend your leg as far as possible without serious pain, then inhale and return to the starting position. Repeat using both legs.

Surgery

In extreme cases, diastasis recti can be corrected during a cosmetic surgery procedure known as an abdominoplasty by creating a plication or folding of the linea alba and suturing together. This creates a tighter abdominal wall.

The skin is lifted near the pubic hair, and elevated to the level of the breast bone. The muscles are tightened in the mid-line where the tissue had been stretched. Permanent stitches are often used. In the most severe cases, mesh is used to reinforce the central repair area.

Splints, Belly Binders and Abdominal Wraps

Postpartum abdominal binding has also been traditional practice in many parts of the world for generations. This is the process of wrapping or binding your mid-section to draw the split recti muscles back together. Belly binding may 'hold you in' and provide support to your lower back. But wearing a splint or binder won't strengthen or tighten the muscles.

( Engelhardt, Laura (1988). "Comparison of two abdominal exercises on the reduction of the diastasis recti abdominis of postpartum women". ProQuest Dissertations and Theses. UMI Dissertations Publishing. )

Facts: Diastasis Recti

  • Diastasis recti is a separation between the left and right side of the rectus abdominis muscle. This muscle covers the front surface of the belly area.
  • A diastasis recti looks like a ridge, which runs down the middle of the belly area. It stretches from the bottom of the breastbone to the belly button. It increases with muscle straining.
  • Diastasis recti is commonly seen in women who have multiple pregnancies, because the muscles have been stretched many times.
  • Pregnancy-related diastasis recti often lasts long after the woman gives birth. Exercise may help improve the condition. Umbilical hernia may occur in some cases. If pain is present, surgery may be needed.
  • In most cases, diastasis recti usually heals on its own.

Related Information:

  1. Common Hernia Symptoms - Disabled World - (Jan 29, 2009)
    https://www.disabled-world.com/health/hernias/common-symptoms.php
  2. Hiatal Hernia Information - Disabled World - (Jan 29, 2009)
    https://www.disabled-world.com/health/hernias/hiatal-hernia.php
  3. Congenital Diaphragmatic Hernia - Thomas C. Weiss - (Jan 28, 2009)
    https://www.disabled-world.com/health/hernias/congenital-diaphragmatic-hernia.php




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