Diastasis Recti is a common concern for many women during and following pregnancy but can also occur in infants, when the abdominals are not fully developed yet, and when the abdomen becomes enlarged, the ‘beer gut’ is a prime example of this. During pregnancy diastasis recti occurs when the linea alba which is the connective tissue between the two sides of your rectus abdominus (6 pack abs) separates due to the stretch placed on it by the growing and expanding uterus.
Diastasis does not usually cause any pain so often goes un-diagnosed and will only require medical or surgical intervention for cosmetic reasons or if it progresses to a abdominal hernia where some of the abdominal contents may protrude out through this space. It will however affect the ability for the abdominal wall to provide postural support, maintain intra-abdominal pressure, and effectively contract such as when sitting up from lying; if left unmanaged then this has the potential to progress to an abdominal hernia. Key signs that you have a diastasis is that your innie is now and outie meaning that if you can easily feel the inside of you navel when previously you could not, or if you can see a bulge in the mid-line of your abdomen when performing an abdominal crunch.
To assess this for your self lie down on you back and feel the rectus abdominus muscle, try to find the inside edge of each side of the muscle; if you’re doing this early postpartum try not to fret when you feel the soft cushy mass that once was your abs! Then starting from 1-2cm below the bottom of your breast bone lift you head and shoulders off the floor (as if performing an abdominal crunch) and feel for a separation between the two sides of the muscle. Measure this by counting how many fingers you’re can fit in this space and then repeat this process just above the navel, at the navel level, and 1-2 points between the navel and pubic bone. A space of 1-2 fingers is easily managed with abdominal retraining and strengthening, 3 fingers or greater may require a professional assessment and advice by a physiotherapist, preferably one with an interest in women’s health. Early post-partum there can be a significant palpable gap between the muscles but working on re-engaging the muscles correctly over the first 4-6 weeks post-partum can considerably improve this.
The best way to reduce the chance of developing a diastasis is by avoiding abdominal exercise that involve crunching and twisting/rotating beyond the first trimester and in the first 4-6 weeks weeks postpartum, and to take care when sitting up to get out of bed or off the floor and avoid straining to get out of a low chair. Instead use your arms to help you up and roll to your side then push up with your arms when getting off the floor or out of bed. Learning how to activate your transversus abdominus also known as you deep or lower abdominals is also very important as the aponeurosis from this muscle blends with that if the obliques and rectus abdominus to knit the abdominal wall together. Contracting your pelvic floor muscles as if you were slowing the flow of urine will help activate the lower abdominals and then try to draw your lower stomach in and back toward your spine or draw your pelvic bones together at the front without sucking in or holding your breathe. If you detected a seperate during the ab crunch test then try contracting you pelvic floor and deep abdominals as if trying to ‘knit’ the abdominals together again and retest yourself to see if you can successfully reduce the separation. If you are unsure if you are correctly doing this then it is important to see a physiotherapist trained to assess and treat diastasis. Try to use this abdominal and pelvic floor contraction whenever you have increased intra-abdominal pressure I.e lifting, coughing, sneezing, resistance training, abdominal exercises, abdominal planking, push-ups, getting out of bed etc.
Some women use compression garments like tubular support bandages and ‘tummy tuck’ under garments postpartum which may help restore normal abdominals length sooner, however I would advice waiting until staples or stitches have been removed after a cesarean and at least 2 weeks post-vaginal birth before wearing these as the increase compression around the abdomen can place more strain on the pelvic floor so ensure the pelvic floor can cope with this and only wear compression for 1-2 hours at a time; it’s important not to become dependent on these supports and to ensure the pelvic floor and abdominal muscles are correctly strengthened.
Learning and feeling how your abdominals contract and knowing how to use them effectively is hugely important in restoring core strength and body confidence especially following pregnancy so be sure to invest a little time in pulling everything back together.
Written by Karen Donaldson-Barron
Physiotherapist & Pilates Instructor
Peak Pilates and Physiotherapy -Millwater
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