An astonishing 60% of women are affected by diastasis rectus abdominis (DRA), and most of these women are first-time moms. When you have diastasis recti, you may still look pregnant even though you're not. In a world where body image is everything, diastasis recti can impact confidence, body image, and overall body function.
As common as diastasis recti is, most women still don't know what it is, how to determine if they have it, or how to fix it. And if they do know what diastasis recti is, most are too nervous about knowing what exercises are safe to attempt fixing diastasis recti on their own.
What is Diastasis Rectus Abdominis?
Diastasis rectus abdominis, or abdominal separation, occurs when the rectus abdominis muscle (the 6 pack muscle) becomes separated due to a gap in the connective tissue holding the two halves of the muscle together.
Anatomy
The rectus abdominis muscle is just one muscle in the collection of core muscles. Other muscles that make up the core are the:
Transverse abdominus
Internal oblique
External oblique
These muscles work together with your diaphragm and pelvic floor to provide support and stability to your entire body, including all the internal organs they protect. It is crucial to maintain balance within this core system to allow your body to function optimally.
Who Gets Diastasis Recti?
Abdominal separation is often associated with pregnant and postpartum women due to the growing baby causing increased abdominal pressure. This increased abdominal pressure is what is thought to cause the separation to happen. But pregnant women are not the only ones that can be affected by diastasis recti. Some men, newborns, and women who aren't pregnant can have diastasis recti as well. While research isn't plentiful on the actual cause of abdominal separation, a few common reasons are:
Increased abdominal pressure
Pregnancy
Obesity
Weightlifting without proper form and technique
Genetics
dysfunctional breathing patterns
Inefficient abnormal posture
Any of these reasons can contribute to the separation of the connective tissue between the rectus abdominus muscle. The separation can occur anywhere along the length of the connective tissue, not just at the belly button, as is commonly thought.
Symptoms of Diastasis Recti
When a person is affected with diastasis recti, they may experience
Leaking of bowel/bladder
Pain in spine, abdomen, pelvis, or pelvic floor muscles
Weakness, especially in the core
Incontinence
Constipation
A bulge or protrusion of their stomach
Testing for Diastasis Rectus Abdominis
Testing for diastasis rectus abdominis can be done from the comfort of your own home. When testing for DRA, we look and feel for any separation of the linea alba (the connective tissue) between the 2 bellies of the rectus abdominus muscle. We use our hands to feel (or palpate) how deep and how wide the separation is. The distance of the separation is referred to as the degree of separation.
Mild DRA - Less than 4 cm gap (2 fingers wide)
Moderate DRA - 4-8 cm gap ( 2-3 fingers wide)
Severe DRA - 8+ cm gap (3-4+ fingers wide)
The best way to test for DRA is using everyday life, functional positions. Testing for diastasis recti in multiple positions is best because you may not notice a gap or difficulty in one position. But, you may notice increased difficulty or more gaping in your abdomen in a different position.
To determine a positive test, you are looking for doming or bulging of your abdomen.
Bulging is a lack of control of your abdominal muscles. As a result, they tend to push out as you do a movement.
Doming is a separation, or a ridge, between your abdominal muscles.
(For a video demonstration, click here)
Testing Position 1
Lie down on the floor or your bed with your knees bent and feet flat on the floor. Now lift your head like you are performing a crunch. Feel and look along the entire length of your abdomen using your fingertips. Start at your belly button and move up towards your ribs. Then return to your belly button and move down along your pelvis. You are looking for doming or bulging and feeling with your fingers for any soft areas or separation of your abdominal muscles.
Testing Position 2
Lie down with one leg straight and one leg bent. Lift your straight leg while you feel along your belly, as in position 1. Again you are looking for any doming or bulging or any separation of the muscle. Also, take note of the challenge of this position or if one leg is easier to lift than the other.
Testing Position 3
Sit on a chair without a backrest. Lean back until it starts to feel challenging to support yourself. Again, feel along the midline of your stomach, starting at your belly button and moving up, returning, then moving down toward your pelvis. As always, you're feeling for any separation or looking for bulging or doming.
Testing Position 4
This time sit as in position 3, but this time you're going to first twist left while feeling along your midsection. Rest, then repeat, turning to the other side. Take note of any changes in your abdomen or if twisting one way is more challenging than the other.
Testing Position 5
Standing up tall, arch backward lifting from the breastbone, not the low back. Again, feel along your midsection and make any observations.
Testing Position 6
Standing tall, you're going to twist as you did in position 4.
Take notes in a notebook of any separation or difficulties you have with these movements. If you have pain with any of these movements, stop and make a note. If you have pain, you may not be ready for these movements yet. If you have questions about testing, reach out to your local women's health PT or feel free to contact me at becky@budandbloomptaustin.com.
Healing Diastasis Recti
Physical therapy is very effective in treating diastasis recti! It doesn't matter if you are 6 weeks or 6 months or 6 years postpartum. Your body can heal from abdominal separation.
There are a few different focuses of physical therapy treatment for women with abdominal separation.
Breath work
Breathing with the correct sequencing and firing of the core, what I refer to as Piston Breathing, is critical to balancing and reconnecting the core system. As mentioned earlier, the core is made up of the abdominal muscles, pelvic floor, and diaphragm. There is pressure within this system that maintains the balance of the organs and muscles. Often in DRA, this system is thrown off, causing increased pressure within the system when performing lifting or straining tasks. Retraining this system is the first step in correcting your abdominal separation.
Posture Work
Learning proper posture to "stack" your rib cage directly and efficiently over your pelvis is another essential component of balancing your system. During pregnancy, the posture system often becomes unbalanced to accommodate a growing baby belly. After the baby is born, the body can forget what 'normal' is and retains the swayback pregnancy posture. Holding your baby after birth and as they grow can also cause your posture to change as you accommodate for their growing size
Exercise
Once you have reconnected your core system and become mindful of what the abdominal muscles, pelvic floor, and diaphragm are doing, you're ready to start moving into the exercise phase. And this is where most women become scared to start. Many women are unsure of what exercises are safe and won't make abdominal separation worse, so they avoid core strengthening altogether.
The key to performing safe core exercises with abdominal separation is to avoid any that will increase intra-abdominal pressure- at least to start. This would include exercises such as:
Sit-ups
Crunches
Planks
Lifting heavy weights (free weights or machines)
Double leg lifts
Rotation or twisting exercises
Jumping or high impact exercises
Another way to tell if the exercise is too much or is causing increased pressure is to ask yourself the following questions:
Are you able to maintain pelvic floor contraction during it?
Do you have any leakage during it?
Do you feel a bulging or heaviness in your abdomen or vagina?
Do you have pain?
If the answer is yes to any of these questions, your body isn't ready for that exercise.
If you're still unsure which exercises to avoid, a pelvic health physical therapist can help you determine the appropriate exercise progression and intensity level for your current level of fitness.
Nutrition
As with any recovery process, nutrition is an important component of the healing process as well. A diet that incorporates more collagen, omega 3s and protein can help rebuild the connective tissues and muscles weakened and stretched from diastasis recti.
Surgery
Surgery is an option for diastasis rectus repair. However, it should be considered only in the most severe cases. This would be an abdominal separation greater than 8 cm or for someone who is not getting relief from pain or other life-altering symptoms with physical therapy work.
Even if your abdominal separation is 8 cm, it's recommended to try consistent physical therapy treatment for 18 months before opting for surgery. Even if surgery is the route you decide to go, strengthening your core as much as possible before the surgery will be beneficial to your recovery. Following up with physical therapy afterward is strongly recommended for the ultimate healing benefit.
Next Steps
If you suspect you have diastasis recti or have any of the symptoms listed above, I encourage you to seek help from a pelvic health physical therapist. With a few visits, you can be on your way to healing and feeling more confident and strong in your body to be the best mom you can be.
I also created a core program to specifically heal diastasis rectus. CORE+ Healing Diastasis Rectus Masterclass is a safe, scientifically-backed 12-week exercise progression designed to fit into a busy mom's schedule. If you're looking for a comprehensive program full of knowledge and education about healing diastasis recti, this program is perfect for you.
I am also available to answer any questions you may have about any information in this article. You can email questions to becky@budandbloomptaustin.com.
You can also visit my website for more information or follow me on Instagram, where I provide more daily tips and tricks to preparing your body for pregnancy and healing your body postpartum.