This bulge could be a diastasis

Weak core muscles can lead to diastasis recti in men and it's best not to neglect a beer belly or weight gain, suggests Shazia Shadab

While diastasis recti is routinely recognised as an issue that women face during and after pregnancy, the condition can also affect men. Although diastasis recti is often considered only an issue with prenatal and postpartum women, it is commonly seen in men with ongoing functional core weakness and muscle imbalance.

Functional Core Weakness (FCW)

Due to this weakness, there is an inability of the muscles of the core to effectively function and support the body for everyday physical demands without pain or dysfunction. In fact, it has the same diagnostic criteria in both male and female patients and can cause similar symptoms, including a bulging belly and lower back pain. However, there are also some distinct differences, and that’s why it’s important for guys to be aware of the causes, indicators, and ways to improve diastasis recti in men.

What is diastasis recti?

Diastasis recti is a condition in which an abnormally wide distance separates the two rectus muscles. The anterior abdominal wall consists of the abdominal rectus muscles separated by the linea alba, which is a fusion of the external and internal abdominal oblique muscle and transverses abdominis aponeuroses. The normal distance would be 2 cm so, any separation more than 2 cm is considered abnormal.

It occurs when excess pressure is exerted on the abdominal muscles. It can cause them to separate and allow contents to protrude through the abdominal wall. It’s also associated with a stretching and thinning of the connective tissue that binds the vertical muscles on each side of your belly button, known as abdominis recti. In particular, males with obesity are at a greater risk of diastasis recti, as the extra weight can place increased pressure on the abdominal muscles and lead to separation. In addition, prior abdominal surgeries or having a history of an abdominal aortic aneurysm may also cause the abs to weaken and lead to split stomach muscles in men.

What causes diastasis recti in men?

Diastasis recti in men develops gradually over time and is often misdiagnosed as a beer belly or weight gain. While it’s usually caused by pregnancy in women, researchers have identified causes of the condition in male patients including muscle imbalance.

The core consists of three layers of muscle. The internal-most is your transverse abdominis which functions like a natural corset — designed to elongate the torso and balance the entire body.

Typically, men with diastasis recti have over-developed external core muscles (the recti and obliques) and a neglected internal abdominal muscle (transverse abdominis). Over time, this lack of strength or stability forces your body to recruit other muscles to function. We call this a compensation pattern.

Typical compensation patterns in men are holding your breath tensing when straining to brace the muscles and recruiting upper and lower body muscles to stabilise the core.

All of these strategies actually push out the abdominal wall (even slightly) instead of drawing in and elongating the core.

Over time, this habitual outward pressure makes the connective tissue of your abdominal wall (the linea alba) stretch, causing that midline separation known as diastasis recti. The most common contributing factor is improper exercise and weight-lifting, especially when it comes to:

Sit-ups, crunches

Push-ups, and

Front planks

In addition, excess weight and obesity can also place undue stress on abdominal muscles and cause them to separate and weaken. It’s important to note that this can be caused by muscle or adipose tissue and that’s why it’s commonly seen in heavy-weight body-builders.

Family history is another reason that men may encounter diastasis recti, and if their father or grandfather had it, then they are more susceptible to it as well.
Finally, age and certain medical conditions such as cirrhosis of the liver and abdominal wall cancer may be other culprits of diastasis recti.

What are the associated symptoms?

The hallmark sign of diastasis recti in men is a vertical bulge that appears between abdominal walls when men do a crunch or get up from lying or sitting down.
Typically, men experience abdominal wall separation in the upper portion of their stomach while women usually feel it below their belly button, closer to the uterus.
In addition, abdominal muscle separation can cause several other symptoms,

Including lower back or hip pain

It may also lead to poor posture

Sexual pain

Or difficulties with bowel or bladder incontinence in less common cases.
Other symptoms that may be less distinguishable, but can signal abdominal separation include:

Constipation, lower back pain, urinary incontinence.

Difficulty in breathing, discomfort in body movements, and a weakened core.

Erectile dysfunction: Diastasis recti in men decreases the ability of the pelvic floor muscles to contract efficiently and effectively and this inefficiency leads to sexual dysfunction in men.

What does it feel like?

Trench or football-shaped bulge down the midline of your tummy when you do crunch like movements or cough.

Bulging tummy that gets worse with traditional abdominal exercises.

Back pain (lower, mid or even upper back). Overall weakness in your core — affecting your posture, your ability to lift or exercise. Lower back or SI joint instability — where your back randomly “goes out.”

Sluggish intestinal function, constipation, the need to bear down to go.

Flared rib cage or barrel chest.

Diastasis recti exercises

While each person’s situation is unique, incorporating specific core-strengthening exercises into your day may help to resolve your diastasis recti symptoms. Unlike what most people are told, diastasis recti does not require surgery and can be corrected with core rehabilitation exercises structured by a physiotherapist.

Such exercises will strengthen the core, minimise movements making it worse, reconnect you to your body, close the separation, flatten your belly, relieve back pain and other symptoms, as well as retrain your body mechanics, posture, and alignment for long-term success. The goal is not to get you stronger for exercise, but stronger for life.

(The author is a physiotherapist with a leading chain of hospitals.)