Diastasis Recti
The silent abdominal separation. Almost 100% of women will experience abdominal separation by the 3rd trimester and around 45% of women still have this separation up to six months postpartum.
There can be factors which can make you more prone to the separation which are:
- Being over the age of 35.
- Carrying multiple babies.
- Having children close together.
- A weak core.
- Having a narrow pelvis.
The abdomen has connective tissue which runs along the midline from sternum to pubic bone. This connective tissue is called the Linea Alba. The abdomen expands and the distance between the two sides of the rectus abdominis muscles usually increases and the linea alba softens and becomes more lax. This all to accommodate the growing baby.
By 8 weeks postpartum the gap will usually have recovered to approximately 2 finger widths apart. Many women will find that recovery will plateau at this point. Correct core breathing and the right exercises can help reduce the width of the gap.
This is a normal process in pregnancy and should not be considered to be abnormal.
Assessing your diastasis during pregnancy can be difficult, but you can certainly check your abdomen after pregnancy to see how your abdominal wall is healing.
During pregnancy
Diastasis Recti is so very common and it only makes sense that it will occur. However I do feel that it is a good idea to keep an eye on your abdominal wall for any doming/bulging of the linea alba between the two sides of the rectus abdominis muscles during exercise or daily activities.
If you’re wearing a tight top you may see the outline of your abdominal muscles and will be able to notice if any doming occurs. You can also place your fingers above your belly button and feel for any doming.
If you notice any doming occur whilst performing a particular exercise then modify that exercise or eliminate it completely. Be more mindful when you’re getting up off the floor or out of bed. Roll onto your side to get up or out, doing so will avoid too much pressure being placed on your abdominal wall.
Diastasis Recti for some women may show as pelvic pain or back pain. The pelvic joints rely on the core for stability, this includes muscles and connective tissue. Weakening of the linea alba may reduce the ability of the abdominal muscles to provide enough stability to the pelvic joints and may lead to pain in some women. Keeping your glutes strong during pregnancy can help reduce severity of lower back pain.
Core breathing
Performing core breathing will do wonders for engaging your deepest core muscles including your pelvic floor and will therefore help reduce the amount of internal abdominal pressure. It also can be used as an excellent stress reliever!
Please click the link below to take a look at core breathing.
https://youtu.be/MC4CPO8pifU
This exercise can be done on all fours, laid down or seated. Find a position which is most comfortable for you. I'd recommend incorporating this everyday for 5 rounds.
- Start in an all fours position.
- Let your tummy relax and breathe in gently.
- As you breathe out, gently draw in the lower part of your stomach like a corset, narrowing your waistline.
- Squeeze your pelvic floor muscles at the same time.
- Aim to keep your back still throughout.
Postpartum
You can assess your own Diastasis Recti (wait until at least 2 weeks postpartum) but I would always get a professional to check first and then you can self check from there on.
Follow this step by step instruction to check yourself
Step 1 - lie on your back with your knees bent and your feet flat on the floor and lift your top up.
Step 2 - touch up and down the midline of your abdomen to get a feel of the abdominal walls. Start as high up as your sternum and work your way down towards your pubic bone.
Step 3 - using your two middle fingers press down to where your belly button is. Tuck your chin in and as you exhale lift your head up off the floor (almost like you’re doing a half crunch). Feel the distance between the two abdominal walls and the tension of the connective tissue.
Step 4 - repeat again above the belly button.
Step 5 - repeat again below the belly button. You can repeat these steps as much as you need to.
It’s not just about the size of the gap. It’s also about the tension between the 2 abdominal muscles.
It’s good to feel over time how strong and taut the connective tissue feels. Pay attention to the quality of the linea alba, not just the width of the gap.
From there on check every 2-3 weeks the tension between the gap (how squishy or far your fingers sink between the midline). This is how you’ll know if the exercises which you’re doing are working. The quality of the connective tissue is what’s important in assessing the healing process. You can still have a gap with a healed diastasis. That’s why it’s important to assess yourself regularly and feel for the progress.
Abdominal doming as I’ve mentioned above is put as something to be avoided, an indicator that an exercise is too challenging and may lead to negative consequences. But so far, the research hasn’t concluded that doming is harmful.
You’ll know when you have really good tension
If you don’t feel good tension, you might feel squishiness, or like you can press down easily into the abdomen. A pelvic health physiotherapist can help you with assessing and treating your diastasis recti, and depending on the severity, you may only need a session or two. I would advise all postnatal mums to book an appointment with a pelvic health physiotherapist, doing so could save you a lot of hassle years down the line.
How can I heal myself?
During pregnancy you need to focus on minimising the severity of diastasis recti. Postpartum, you need to focus on healing it.
If you’ve been diagnosed with DR then there are a few things you can do to help:
Maintain proper posture, perform breathing exercises and correct core exercises which help to strengthen the deep core muscles and the pelvic floor. Avoid anything that puts a strain on your abdominal wall, which will create pressure on the connective tissue, therefore widening the gap.
You can still train your core, but this will be done in a different and safer way to what you’re used to. In my coaching I advise minimising any twisting, crunching and full body planking exercises, which will only create added pressure to your abdominal wall.
In the postnatal period, some women’s diastasis recti will “heal” without any intervention. More than half of women still have a wide separation eight weeks after delivery, and although some recover by six months, many have not recovered after even one year. That is why it is so important to visit a pelvic health physiotherapist. You may have the gap, lack tension and not even realise.
Rebuilding a strong core could save you from things such as back pain and incontinence years down the line.
Can Diastasis Recti Be Avoided?
There is no definite answer to this very popular question. Some studies show that women who exercise regularly throughout pregnancy have a reduced risk of having a wide diastasis in pregnancy. Pretty much every woman will have a diastasis of greater than 1.6 cm by weeks 35 to 39 of her pregnancy. At this point in time, what makes a diastasis more pronounced during pregnancy isn’t known, but it is believed that genetics probably play a large role.
Is there anything I can do?
Make modifications to exercises and other physical activity in order to potentially reduce the severity of this abdominal separation.This might include eliminating some exercises altogether, but this can depend on the individual and how well trained they were leading up to the pregnancy.
By the middle of the second trimester, it’s best to remove any heavy front loaded abdominal exercises (anything which puts too much of a strain on the abdomen) such as planks. If you have been performing these in the full plank position, you can then modify them to be done in a half plank position with your knees on the ground.
Some women may feel they can continue with certain exercises without any problems and they look ok doing so. All women and their exercise history are different, so exercises can be modified to fit them.
As your pregnancy progresses I recommend reducing the weights used when exercising. When you take into account all the changes happening in the abdominal wall and pelvic floor, your body is already working so hard especially in the final stages to develop your baby. You may be feeling weaker in the final trimester and that’s no surprise due to all the extra weight you’re carrying around. Using lighter weights as your due date approaches is advised. You should never feel like a failure for doing so. The abdominal muscles are actually unable to produce as much force in the final trimester as they were in earlier stages of pregnancy or pre pregnancy. So now more than ever work with your body and not against it.
What Does Healing Mean For Diastasis Recti?
A lot of what you read on the internet defines “healing” as the distance between the two sides of the rectus muscles becoming narrower. However, like I have mentioned above it’s not just about the width of the gap but about the tension between the gap. It’s now recognized that the biggest concern in diastasis recti isn’t purely the separation, but actually it’s the loss of ability to produce tension in the linea alba that can negatively impact the function of the abdominal wall.
It is important to remember that even if your gap remains wide, it may be still possible to regain what’s most important: the function. Just because the gap between the linea alba has narrowed or closed, doesn’t necessarily mean you’ve regained optimal function. Working to regain optimal function of the abdominal wall is crucial because if the deep central stability system doesn’t functionally recover, it could potentially lead to problems with organ and postural support. For some women this may mean that they feel weak, can’t perform as well as they used to, or they may experience pain in the back, pelvis or limbs.
I still look pregnant after giving birth
A large DR can cause your abdomen to still look ‘pregnant’ because there is less support for the abdominal contents. Many women call this the “mummy tummy”. Some women may think it’s excess fat and some say they feel bloated four months after giving birth.
This is usually the result of connective tissue being thin and wide, which causes the abdominal contents to drop forwards. As I’ve said above ‘ during pregnancy you need to focus on minimising the severity of diastasis recti. Postpartum, you need to focus on healing it.’ So just as exercise during pregnancy may help minimize the severity of diastasis recti, most women require some retraining of the abdominal and pelvic floor muscles during the postnatal period to help restore optimal core function. The length of healing time and rehab for your DR will depend on your genetics, age, number of pregnancies, and the size of your babies during those pregnancies. For some women, just a gradual return to activities and self-monitoring is all that is required, but for those with more significant diastasis or concerns, a more individualized program may be recommended.
