What is Diastasis Recti?
I’m sure at some point, you’ve heard someone mention diastasis recti or DRA. Are you still wondering what it is? Well, let’s start with a quick anatomy review.
Diastasis recti is a separation of the connective tissue in the middle of the large abdominal muscles known as the rectus abdominis (6-pack abs). The rectus abdominis runs from the sternum to the pubic bone. Therefore, diastasis can occur anywhere along that length of the connective tissue (the linea alba).
Often, the linea alba becomes softened and stretched during pregnancy due to hormonal changes and increased pressure in the abdomen from the developing fetus.
How Diastasis Recti Happens
When these tissues are softened and stretched, they become less efficient and thus more easily injured with various activities. This is especially true with activities that increase pressure in the abdomen or require forward flexion of our trunk, as this is the primary function of the rectus abdominis.
This can include certain core exercises during the second and third trimesters of pregnancy or early postpartum, excessive pressure with pushing during delivery, excessive straining due to chronic constipation, poor pressure management or breath holding with exercise, or poor pressure management with lifting during daily activities.
Risk Factors for Diastasis Recti
- DR can occur in the early postpartum phases from returning to activity too rapidly, especially high-intensity activity like running, HIIT classes, Crossfit, or powerlifting.
- Women who have had multiple births, especially those who have become pregnant again within 18 months of delivery.
- Women who are pregnant with multiples.
- High birth rate of the baby.
- Genetics – women whose mothers had DRA are more likely to develop DRA.
How to Help Prevent It
While several of these risk factors are outside of your control, there are still ways to help prevent diastasis and/or lessen its severity.
- Modify your activity early on in the pregnancy to limit your risk
- Reduce constipation and modify bowel voiding to ensure you aren’t breath-holding when you push
- Using slow, controlled exhale with all lifting to reduce a buildup of pressure in your abdomen
- Avoid activities that cause doming, conning, or pain in the midline of the abdomen
- Wear support garments like the baobei maternity postpartum support bloomers or the mom-ez support belt, as needed.
How Do You Know if You Have Diastasis Recti?
If you’re still unsure, here are some common signs and symptoms that are often associated with diastasis recti:
- Feeling of inability to activate your abs or feeling extremely weak (especially when you previously had good core strength and endurance).
- Pulling or stretching sensation in the middle of your abdomen with crunches, planks, or other high-level core exercises.
- Doming or conning with lifting during daily activities or exercise, with core/ab exercises, or with bowel movements.
Frequently Asked Questions About Diastasis Recti
Does DR Go Away?
Diastasis Recti will not resolve on its own. I repeat: diastasis recti will not resolve on its own. Having a football in your belly isn’t “normal postpartum.”
This abdominal separation is common during pregnancy and postpartum and can persist if not addressed. It can worsen if you return to exercise or activity without properly engaging your muscles to create tension across the gap.
Studies have shown pelvic floor muscle dysfunction can co-exist with DRA. This is why it’s essential to get your pelvic floor checked.
How Can You Fix DR Years Later?
You can likely fix your diastasis recti no matter how long it’s been since you gave birth. A pelvic floor physical therapist can walk you through the proper exercises to work on activating your core muscles. It’s never too late!
What Are Some Exercises for DR?
There are many exercises you can do to help heal your DR. However, strengthening your core is less about what you can or cannot do, but about how good you do it.
You may need to modify the way you move and learn to manage your intra-abdominal pressure and integrate a lower abdominal/transverse muscle contraction with your breath into day to day activity and exercise. Check in with a pelvic floor PT for exercises tailored to you, and to make sure you are managing that abdominal pressure.
In the meantime, if you are doing lots of walking, shopping, or standing, try Kinesio Tape to help support your diastasis recti.
Can I Have DR Without Being Pregnant?
It is possible to have diastasis recti without being pregnant (even males can get it!), though it is most common in pregnant or postpartum women. Incorrect exercise performance is a reason diastasis recti may be present without pregnancy.
How Do You Check for Diastasis Recti?
Let’s review how to perform a self-screen to see if you have diastasis recti. This can be done lying on your back, with your knees bent and feet on the floor. Without activating your abs, lift your head off the floor like you’re performing a chin tuck. Then take your fingertips and gently press along the midline of your abdomen. If you get a nice springy resistance and your fingers do not sink in, then it is likely your tissues are entirely intact.
On the other hand, if there is little to no resistance and your fingers sink in at least to the first knuckle, chances are you have some level of diastasis.
What Does Diastasis Recti Feel Like?
When you have diastasis recti (and maybe a hernia), your belly bulges in the shape of a dome or cone, and a certain amount of separation, about two finger-widths between the rectus muscle bellies, is considered within the normal range. However, it’s not about how wide the gap is; it’s about how DEEP.
As physical therapists we assess if our fingers can sink between the muscle bellies or if we feel tension across the muscle bellies. Tension is good. This can be assessed by lying on your back, curling your head and shoulder blades off the table, and evaluating the width and depth of a diastasis at a different point on the abdomen.
We assess the tension by getting out of a chair, out of bed, lifting weights, lifting babies, and all of the functional activities we do day to day and can help you work to improve the tension and restore your core correctly.
How Do I Get Out of Bed with Diastasis Recti?
If you are pregnant and have diastasis recti, you’ll want to bring your arm across your chest, roll to the side, swing your legs off the edge of the bed, and use your arms to push up. This helps protect your abs, back, and pelvic floor.
You can also get out of bed to help prevent diastasis recti (if you don’t already have it), pelvic floor weakness, and lower back pain. If your diastasis recti persists after the baby is born, continue to get out of bed this way until it’s healed.
Can Diastasis Recti Cause Other Issues?
Women with a diastasis recti may also have pelvic floor support problems (pelvic floor dysfunction), like leaking urine, having a hard time holding in feces, and their organs dropping down into their vagina (known as prolapse).
Half of the women have diastasis during pregnancy, and one-third have it afterward. Simple things like log rolling out of bed, avoiding crunches and avoiding straining when you pee or poop can help. You’ll also want to activate your abdominals during the day when you lift, stand, and exercise. This will help prevent DR from getting worse and will help you heal postpartum.
Seeing a PT Can Help
Seeing a pelvic PT can also help! We can:
- Assess for potential diastasis
- Give specific modifications that fit your lifestyle
- Assess the strength, motor control, and endurance of your deep core
- Help you prepare for childbirth by educating you on the proper breathing and pushing techniques during delivery
- Provide treatment to any weakened or tightened tissues that may increase your risk of diastasis
Noninvasive Treatment Options
If you are certain you have diastasis, don’t be alarmed. There are treatment options available. Pelvic PT is a great, noninvasive way to help improve diastasis recti. A pelvic PT can help educate you on proper breathing techniques to ensure you are not breath holding with activity and are properly engaging your deep core and pelvic floor. We can also assess your muscles and connective tissues for tightness and treat those restrictions with manual techniques.
Surgical Intervention
In some instances, the patient may require surgical intervention. This is typical if the patient has a DRA that has not improved in depth or width with PT, they are at least one year postpartum and not planning on having any more children, or if they develop a hernia that is causing significant pain. In those cases, the patient should consult a plastic surgeon to discuss treatment options.
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