Written by Laura Justin, Physiotherapist in Australia
What is Diastasis Recti?
Diastasis Recti is commonly known as abdominal separation or DRAM (Diastasis Rectus Abdominus Muscles). It is the separation of the connective tissue that runs down the middle of the abdomen and connects the two bellies of the rectus abdominus muscle.
Why does Diastasis Recti occur?
During pregnancy, the abdomen has to make room for the growing baby, which means that the abdominal muscles have to stretch. The pressure of the growing uterus as well as hormonal effects on the tissue can cause the linea alba (connective tissue) between the muscles to separate.
Diastasis Recti can also happen outside of pregnancy in cases of weight loss after being overweight over a long period of time.
Is it normal?
A small abdominal separation (2 finger width) is considered a normal change during pregnancy, with 100% of women having some degree of separation during or immediately after pregnancy.
For some women, the separation will resolve itself without specific work after delivery.
For other women, a separation means that the muscles of the tummy may be weaker, and can lead to bulging or doming and even pain or discomfort.
Signs associated with Diastasis Recti:
Belly bulge or doming appearance in the middle of tummy
Feeling of “core” weakness
low back or pelvic pain
pelvic floor weakness or incontinence
Multiple pregnancies without recovery of abdominal muscles in between increases the risk for developing diastasis due to repeated and prolonged stretch on the abdominal wall.
How do I know if I have Diastasis Recti?
An assessment by a trained Physiotherapist, obstetrician or midwife can usually determine the presence of abdominal separation after having a baby.
What do I do if I have Diastasis Recti?
After having a baby, reducing excessive pressure on the abdominal wall can help to reduce the look and feel of Diastasis Recti.
Generally, through pregnancy and early postpartum is is best to avoid:
Sit up type motions ie. when getting out of bed. Try rolling to the side and then pushing up as a safer alternative
Constipation and straining on the toilet
Heavy lifting
Crunches or sit ups
Gentle abdominal exercises that don’t involve ‘crunching’ can increase the strength and function of the abdomen, and reduce the visual concerns of the abdomen as well as risk of developing other back or pelvic pains.
Some women with a severe Diastasis Recti may have concerns about the cosmetic change to their abdomen, and surgical repair may be an option in these cases.
Other tips for Diastasis Recti in the early period after having a baby include:
Wearing compression garments over the abdomen. A Women’s Health Physiotherapist can prescribe and provide abdominal supports or compression garments.
Practice good standing position. You should be upright and tall, with a small curve in your lower back. Try to reduce excessive sway in the lower back and try not to push your hips forward.
Pelvic floor and specific abdominal exercises – such as light pilates or exercises prescribed by your Physiotherapist.
Diastasis Recti and Pelvic Floor Training
For women with a Diastasis Recti, light rehabilitation exercises for your abdominal wall and pelvic floor muscles are usually prescribed by your healthcare professional.
As it is important not to ‘bear-down’ or strain in the early post-partum (especially with Diastasis Recti), it is best to be assessed and ensure you can safely do a correct pelvic floor contraction.
Even with Diastasis Recti, further pelvic floor muscle exercises (including using pelvic floor trainers) can then commence once you know that you can comfortably ‘brace’ and support your abdominal wall using your deep abdominals and pelvic floor muscles.