Diastasis Recti (abdominal separation)

What is Diastasis Recti?
Diastasis Recti Abdominis (DRA) is separation of the abdominal wall. We have a line of connective tissue that goes down the center of our body separating the muscle bellies of our rectus abdominis (the “six pack” muscle). If the abdominal wall grows (due to weight gain there or growing a baby) or if excessive pressure is placed on the abdominal wall without proper core activation strategies, that can cause Diastasis Recti. It can occur in men and women who have not been pregnant. During pregnancy, as baby grows, the abdominal wall is stretched. This is why most women have DRA towards the end of their pregnancy. This a normal physiological change. But there are some things you can do to help during pregnancy and postpartum (yes, even years later) as well.

How do I know if I have it?
During pregnancy, if you notice bulging in the midline (a vertical line especially near your belly button) or discomfort in that area, you should check for diastasis. Bulging more often occurs during more strenuous activities such as heavier lifting or abdominal exercise. Postpartum the separation should come back together naturally. Research shows the time frame varies but usually around 6-12 weeks. But for some women, it can take longer or may not resolve on its own. One of the challenges is that DRA often goes undiagnosed. Diastasis Recti can contribute to back and pelvic pain, and is sometimes described as the “mommy tummy” or “pregnant pooch” that never went away. Sometimes there will be pain or discomfort on the abdominal wall or a feeling of generalized core weakness. You can check yourself for DRA, click here for a video. Keep in mind that in addition to checking the inter-recti muscle width (the amount of space horizontally between the two sides of your rectus abdominis muscle), you also need to assess the depth. Meaning, how deep do your fingers sink in and do you feel any firmness in that connective tissue. Note that up to two fingers wide can be considered normal- the abdominal muscles will always have some space in between. For depth, we want minimal depth and a firm feeling when we press down in the midline. DRA can occur anywhere between the sternum and the pubic bone so make sure to check in a few different places.

What can I do about it?
It is important to learn intra-abdominal pressure management strategies. Big words, right? What that means is learning how to use the inner core system functionally. The pelvic floor, abdominal wall, diaphragm, and deep back muscles all working together without putting excessive pressure on the abdominal wall or pelvic floor. A functional core system will not only help DRA, but can also help with back pain and other issues as well. Unfortunately, it is not as easy as just doing one or two exercises. It is truly understanding where these deep muscles are and how to apply these concepts into your daily activities as well as other types of exercise. The learning curve is different for everyone but in my opinion, worth the time and effort. During pregnancy, avoiding activities or positions that cause bulging and staying connected with your deep core muscles as pregnancy progresses can help. It is important to note that these deep abdominal muscles help to support your back and stabilize you. It is also the muscle that you want to use to help push during a vaginal delivery and is important to reconnect with postpartum. Also note that alignment and breath patterns can contribute to increased abdominal wall pressure. RIght after having a baby, give your body time to heal. The same core activation exercises and breathing techniques can help to reconnect with the core post-baby. I also recommend checking for DRA before returning to exercise. Remember that you are likely lifting and holding a growing baby, so your alignment when you are holding them can make a difference. For example, if you are leaning back and jutting your hips forward, you will notice more pressure on the abdominal wall, which is what we want to minimize as much as possible. If you had a baby months or years ago, it is not too late to make changes. Working on breath, alignment, core activation, and pressure management strategies is helpful. Not only learning exercises that can help, but also learning how to implement these concepts into everyday life (like lifting kids and laundry baskets) and how to carry over into exercise. You may have heard if you have DRA, do not do planks or crunches. That is not true for everyone, and most of the time you can work back to those exercises. Learning what exercises are appropriate for your body now, how to tell what you are not ready for yet, and how to modify/change those exercises is very important to facilitate healing. Working with a women’s health Physical Therapist can help to teach you all of the concepts and exercises noted above. It can also address other areas of weakness, pelvic floor issues, c-section scars, areas of stiffness such as the ribcage or low back, and much more. Pregnancy and birth is not easy on our bodies. Remember that you need to take care of yourself in order to take care of your family. Make the time and prioritize yourself.