Around 60% of women are affected by diastasis rectus abdominis (DRA), making it one of the most common postpartum conditions women suffer from.
Diastasis rectus abdominis, or abdominal separation, occurs when the rectus abdominis muscle (the 6-pack muscle) becomes separated and a gap forms in the connective tissue holding the two halves of the muscle together.
Pregnant and postpartum women are among the highest at risk for developing abdominal separation due to the intense pressure placed on the abdominal muscles during pregnancy. But don’t think this is just a pregnant-person condition. Men and women who have never been pregnant can also develop diastasis rectus abdominus. Development of DRA can be due to postural inefficiencies, increased weight, increased intrabdominal pressure, and genetics to name a few.
When a woman has diastasis recti, they may still look pregnant even though they're not. In a world where body image is everything, diastasis recti can impact confidence, body image, and overall body function.
Mild vs Severe DRA
Diastasis rectus abdominus is classified as mild, moderate, or severe. The severity is determined by how many finger widths can be placed between the two halves of the rectus abdominus muscle. (Link here to testing for DRA).
A mild form of DRA is classified by less than 3 cm separation
A moderate form of DRA is classified by 3-5 cm separation
A severe form of DRA is classified by 5+ cm separation
Symptoms of DRA
The severity of the symptoms of DRA can vary depending on how much separation is present.
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
Repairing Diastasis Rectus Abdominus
When it comes to repairing or healing abdominal separation, there are two options available: exercise or surgery.
Exercise
As a pelvic health physical therapist, I 100% recommend working on repairing your abdominal separation with a trained pelvic floor therapist as the very first step you take.
While exercises alone may not fully close your abdominal separation, what exercise does do is build strength and stability in the musculature to improve your function and symptoms enough that you can return to normal daily activities.
According to Diane Lee, an expert in the field of women’s health physical therapy, closure of the gap between the rectus abdominus muscle is not essential for the restoration of function and performance. What is essential is the ability to generate tension synchronously between the right and left rectus abdominis, allowing for control and function of the trunk.
To summarize, “closing the gap” is not what is important in restoring function in day-to-day life. It’s about strength and creating tension across the midline. Physical therapy intervention with someone trained in creating an individualized program to facilitate this strengthening and tension production can help you survive a 5 cm gap without surgical repair.
Pelvic health physical therapists can also recommend numerous binders or external support garments to wear while working on strengthening your core muscles.
In addition, nutrition is also a key component of healing without surgery. Making sure your diet has key components of omega 3, protein, collagen and water is essential to provide the tissues with the component it needs to repair itself.
Surgery
Surgery should be reserved for severe cases of abdominal separation that aren’t improving with physical therapy intervention or for those who are after improved aesthetics of their abdomen.
When someone opts for surgical intervention, an incision is made in the abdomen, and the two halves of the rectus abdominus muscle are sewn together to close the gap. A tummy tuck is usually performed at the same time to “tighten up” the loose skin and remove excess fat.
Surgical repair of DRA is not always covered by insurance as it’s usually considered a “cosmetic procedure”.
While your gap will definitely be “closed” after the surgery, you’re not out of the woods yet. There are many risks of taking the surgical route including:
Infection
Swelling
Dehiscing of the incision
numbness/tingling at the incision site
Scar adhesions
Loss of belly button
And the surgery doesn’t strengthen the muscles or necessarily take care of symptoms such as back pain or leaking. Working with a pelvic floor physical therapist before surgery is beneficial to prepare your body for surgery. Recovery will be faster if you are already starting from a strong base. Following up after surgery with a pelvic floor physical therapist is also recommended to facilitate healing and continue to strengthen the core musculature to get you back to optimal function.
Before you undergo a major reconstructive operation such as closing the gap & tummy tuck surgeries, you must do my CORE+ Healing DRA Masterclass. This masterclass is a comprehensive educational, self testing, motivation, and deep dive into all things exercise to heal your DRA. This class is a 12 week class leading you through 10 minute exercise videos that you do 3-5 days per week. Each exercise video is more challenging than the previous so you will always be pushing your muscles and nervous system to grow and change.
Learn more details about the CORE+ Healing DRA Masterclass.
Try some of the 10 minute exercise classes included in CORE+ Healing DRA Masterclass.
Resources:
Reinpold, Wolfgang et al. “Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS).” Frontiers in surgery vol. 6 1. 28 Jan. 2019, doi:10.3389/fsurg.2019.00001
Sperstad, Jorun Bakken et al. “Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain.” British journal of sports medicine vol. 50,17 (2016): 1092-6. doi:10.1136/bjsports-2016-096065
Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract. 2021 Sep;37(9):1018-1033. doi: 10.1080/09593985.2019.1675207. Epub 2019 Oct 23. PMID: 31642725.
Chen B, Zhao X, Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon. 2023 Oct 12;9(10):e20956. doi: 10.1016/j.heliyon.2023.e20956. PMID: 37867827; PMCID: PMC10589864.
Nahabedian MY. Management Strategies for Diastasis Recti. Semin Plast Surg. 2018 Aug;32(3):147-154. doi: 10.1055/s-0038-1661380. Epub 2018 Jul 24. PMID: 30046291; PMCID: PMC6057788.