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Diastasis Recti

Postpartum, did you have a feeling that you just weren’t as strong? That you were straining to lift your baby or the carseat? That your abdomen felt blobby, clothes weren’t fitting or tummy wasn’t going down, even though you lost weight? Or maybe you noticed a lump in the center of your belly when you did a sit up?

These are all signs of diastasis recti, a separation in the rectus abdominus muscles that is incredibly common (up to 100% in some studies) in the final weeks of pregnancy and often times does not resolve on its own postpartum. Research suggests approximately 55-60% of women at 6 weeks postpartum and 35-45% of women at 6 months postpartum will present with the separation. A diastasis recti can leave you feeling like you still have a belly pooch, but, more seriously, can put you at risk for hernia and destabilize your spine and trunk, leaving you feeling weak or even with pain in the back or abdomen.

Additionally, your pelvic floor and abdominals are good friends. They function together to create a really impressive pressure-regulating system that allow you to do things like have a bowel movement, breathe and cough, or push something heavy. But that means if one of those components has a large separation through the center, it’s difficult for pressures to regulate and that diastasis can end up being a large player in symptoms like urinary leakage or incomplete bowel emptying.

To test whether you may have a diastasis recti, lay on your back and bend your knees, feet resting on the floor. Take your pointer and middle finger and lay them at the midline of your abdomen, above your belly button, pointing down toward your pubic bone. Lift your head, as if doing a crunch, and gently press your fingers down into the tissue above your belly button. Now scoot your fingers down over the belly button, and finally below, doing the same at each point. Do you feel a gap between the 2 sides of your abdominal muscles? Do your fingers sink into a crevice or a hole? That’s likely a diastasis recti.

If you do find a diastasis recti, what should you do?  Most importantly are things not to do. Sometimes when people discontinue activities that are aggravating the separation, it allows the healing to progress on its own. Movements of crunches and sit ups, planks, pushups, and burpees will all worsen the separation. Additionally, leaning backwards, as in backbends or cobra pose, will keep the separation open, as will big twists.

Does that mean that all abdominal work is out? Absolutely not. There are lots and lots of ways to effectively strengthen your abdominals and get you looking awesome and feeling strong and stable that don’t involve the above motions. Think exercises that are tightening your abdominals without forcefully bending in half or that accidentally turn on your abdominals during activities like balancing.

Depending on what your separation looks like and the demands of your daily life, sometimes a mechanical support, such as taping or bracing can be helpful in addition to good habits. But a brace alone will not teach your muscles to function the way they should. The best option is to seek assessment from a pelvic floor physical therapist that is specialized in assessing and treating this issue. You’ll learn more about what’s going on with your body and how symptoms you’re experiencing may be connected, as well as progress back to all of your activities safely. Diastasis recti, like so many of the issues we encounter postpartum, is common, not normal. Get checked, get fixed, get on with your life.


Christina McGee PT, DPT is a pelvic floor physical therapist at Sullivan Physical Therapy in Austin, Texas.

References:

Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Sep;50(17):1092-6.

Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bø K. Effect of a Postpartum Training Program on Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Phys Ther. 2018 Jan 17.

Gitta S, Magyar Z, Tardi P, Füge I, Járomi M, Ács P, Garai J, Bódis J, Hock M. [Prevalence, potential risk factors and sequelae of diastasis recti abdominis]. Orv Hetil. 2017 Mar;158(12):454-460.

Fernandes da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002. Epub 2014 Sep 19.