The ultimate guide about diastasis recti in pregnancy and postpartum
There is so much fear around diastasis recti. I want you to know that help and resources are available.
What is diastasis recti (DRA)?
Pregnancy-related diastasis is described as a physiological change that occurs during pregnancy in the midline connective tissue (widening and stretching of linea alba) to accommodate the needs of a growing baby. Linea alba is the connective tissue that holds your six-pack muscles in the middle.
Diastasis recti occurs in almost 100% of women.
Diastasis recti is also known as ‘ab separation’, ‘mummy tummy’, or mom pooch (I personally do not like using these words but you will find these words on the internet).
What does diastasis recti look like?
A distended abdomen (also referred to as a pooch)
Coning/bulging in the midline (above, at, or below the belly button)
Sucking in of the abdomen in the midline
Some women may have associated pelvic floor symptoms (leaks, prolapse, pain) and low back pain. DRA may not be the reason for these symptoms. A pelvic physiotherapist can help you to treat your associated symptoms.
How to prevent diastasis recti?
Diastasis recti is a normal part of pregnancy. We CAN NOT prevent diastasis recti, we can only MANAGE the pressure and preserve the integrity of the tissues with ADJUSTED STRATEGIES. There is a lot of fear-mongering on the internet, which has pathologized this normal adaptation process in pregnancy.
How to check for diastasis recti?
Lie down on your back with your knees bent and feel your abdominal wall with your fingers. Check in the midline and feel the distance between the 6-pack muscles on both sides. Perform a crunch and palpate your midline while performing a crunch and measure the distance between two rectus muscles. Traditionally, 2 cm or less is considered within the ‘normal range. However,
It is NOT just about the GAP.
We know that gap does not matter. The focus should be more on the density of the fascia, strength, and load management capacity of the abdominal wall. We want the diastasis to be ‘functional, ' meaning that you may have a gap > 2cm, but your fascia and muscles respond well to physical demands.
Your pelvic physiotherapist will do a detailed assessment of your abdominal wall in a variety of positions (not just lying down) and will assess your core activation strategies.
What are the risks for diastasis recti?
Genetics
Fascia
Baby size
Chronic straining or bearing down
Structure
Heavy or poor lifting techniques exercise habits, or tendencies
Previous pregnancies
Posture etc.
What is the treatment for diastasis recti?
In some cases, diastasis recti may heal by itself within 6 to 8 weeks postpartum. This can vary from person to person. It is never too late to work on core muscles and function.
The approach will be person-specific because diastasis recti (DRA) differs from person to person. There are no set exercises or ‘one-size-fits-all’ approaches.
Consider how you are managing your intra-abdominal pressure. Do you bear down a lot?
When someone gets an ACL tear, we do not just focus on the knee, we focus on the hip, knee, and ankle. In the same way, diastasis needs the focus on the structures around it- your hips, rib cage, core muscles, and the whole system.
There are no SAFE or UNSAFE exercises, it is usually how you perform an exercise that matters. Some movements may generate a lot of pressure and tension that may not be beneficial for managing DRA.
Small adjustments in the breath or position alignment strategies can significantly affect how your core and pelvic health is managed.
PROGRESSIVE LOADING EXERCISES AND PRESSURE MANAGEMENT STRATEGIES help to manage and treat diastasis.
FAQs
Is diastasis recti a hernia?
A hernia is when the tissue in the midline rips or tears. In diastasis recti, there is thinning of the midline tissue (linea alba). So, DRA is not a hernia.
Is diastasis recti normal in pregnancy?
Yes, almost every woman gets diastasis recti by approx 35 weeks of pregnancy. Some women get early on in pregnancy and you can learn strategies to manage the abdominal wall.
Can diastasis recti be fixed without surgery?
Yes, diastasis recti can be managed by progressive strengthening exercises, and breath and position strategies.
How much ab separation is normal?
Traditionally, 2 cm is considered ‘normal’. However, someone may have more than 2 cm and a very strong and functional abdominal wall.
What are the best and safe exercises for diastasis recti?
There are no specific BEST exercises for diastasis recti. Exercise selection depends on your individual tendencies. You can start with the basic core foundation exercises and progress to more functional movements.
How do I know if I have diastasis recti?
You can look at or palpate your abdominal wall for the symptoms of doming, coning, sucking in, or lack of fascial tension in the midline. It is best to see a pelvic physiotherapist for a detailed assessment.
If you have any questions, feel free to contact me.
Roopdeep Kaur,PT, FRCms, MSc. PT, BPT
Registered Physiotherapist
Ortho & Pelvic Physiotherapist