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Diastasis Recti AKA Ab Separation

Diastasis recti, also referred to as ‘Divarication of the Recti’, DRA or ‘Rectus Divarification’, is the widening of the gap between the 2 sections of the Rectus Abdominis (or 6 pack) abdominal muscle. The split occurs at the Linea Alba, the mid-line collagen structures of connective tissue at the front of the abdomen.

A gap bigger than 2cm occurs in over 60% of all pregnancies in the 3rd trimester, and in more than 30% of postpartum women.

Why does it happen?

During pregnancy an increase in hormones and an expanding uterus puts pressure on the connective tissues around the abdominal walls.

It is after labour that a woman’s hormone levels will return to normal and muscles move back into position.

In some cases, a women’s tissue gets so stretched during her pregnancy that the muscles lose their ability to contract back to normal.

Who is at risk?

  • Women pushing in labour for a long time
  • Women who are having a multiple pregnancy i.e. Twins
  • Women with poor muscle tone
  • Women who get pregnant later on in life
  • Women who have had a number of pregnancy’s
  • Women having abdominal procedures where their bellies are inflated with air
  • Women having a C-section

Importantly, for many women the gap remains widened at 8 weeks, and left untreated, this distance at 8 weeks remains unchanged at 1 year postpartum.

 

66% of women with diastasis recti have some level of pelvic floor dysfunction.

Diastasis
Diastasis Recti

Diastasis recti and pelvic floor problems tend to occur together. The Linea Alba (seam of tissue structures that form the meeting point of the 2 sides of all the core musculature) no longer provides tension and stability.

ALL the muscles of the abdomen- Transversalis, internal and external obliques, as well as Rectus Abdominis – meet at this centre midline. So, all are compromised. This lack of protection and stability affects the whole body both aesthetically and functionally.

What does a diastasis look like?

You may see a ‘pooching’ or ‘doming’ of your stomach, especially when coming up from a lying position on your back. Sometimes you appear still a few months pregnant.

Diastasis 2
Telltale Signs

As well as the aesthetic concerns, diastasis recti is associated with a weak core (and pelvic floor). This can lead to a lack of strength and stability in the entire pelvic region and midsection.

What causes diastasis recti?

Diastasis Recti is the result of excessive intra-abdominal pressure or loading. It is common in the later stages of pregnancy, particularly second or subsequent pregnancies. It is important to note though, that pregnancy does not cause a diastasis. The increased load and further shifts in alignment of pregnancy exacerbate the root problem: excessive, ‘un-contained’ intra-abdominal pressure.

The Rectus Abdominis is only 1 of 4 layers of abdominal muscles: The Transverse Abdominis (deepest muscle layer) the Interior and Exterior Obliques (next 2 layers) that form your waist, and then the Rectus Abdominis is on the outside.

Unfortunately, when the 2 parts of the muscle separate or come apart, the connective mid-line is stretched and weakened as it takes all other muscular and fascial support structures along with it. This leaves the front of the abdomen unsupported and unstable. This seam of connective tissue is designed to be taut, at full length and aligned in a vertical (breastbone to pubic bone) plane. But it cannot perform or function optimally when alignment is ‘out’. So it’s alignment we need to address to address a diastasis!

Diastasis Recti is a symptom of excessive and unsupported intra-abdominal pressure. This is the same issue that creates other pelvic and abdominal problems including hernia and prolapse. DR should therefore be treated as part of an integrated program designed to re-align, re-connect and then strengthen the entire core musculature, rather than be addressed in isolation. The focus should not be only on ‘closing the gap’).

Diastasis recti test – how to do it.

Lie on your back with your knees bent and your feet flat on the floor. Relax your head and shoulders and place your fingers (palm facing you) just above your belly button.

Lift your head and neck very slightly off the floor and press down with your fingertips. If you feel a gap, that’s the diastasis. You will feel the muscles close around your fingers as you lift your head and neck. Don’t lift your shoulders. Repeat the test in two other places: directly over the belly button, and a couple of inches below.

A diastasis recti gap is measured in finger's width. You are aiming for a 1-2 finger gap or less, but don’t panic if it’s much bigger at first.

Even more important than the width of the gap though, is the tension (or lack of tension) in the midline – the linea alba. Contracting the muscles should create tension and resistance when you apply gentle pressure with your fingers to the midline. If it doesn’t – you have some re-connecting to do…

Should you use a splint, belly binder, or abdominal wrap to bring a diastasis together?

Postpartum abdominal binding has been traditional practice in many parts of the world for generations. In my experience, supporting the abdomen during and immediately after pregnancy may be helpful in some cases, and, used correctly, can help with awareness of the abs and for lower back support.

However, wrapping it up tight, pulling the two sides together… “>won’t make them heal or stay there. Don’t use a wrap or splint as a substitute for actually engaging the right muscles… otherwise you’re going to wearing that splint for a very long time.

Remember the diastasis is caused by excess loading and pressure within the abdominal and pelvic ‘canister’. A pressure that your body can’t withstand as it should. Wrapping it up in itself won’t fix it, it will just squidge your abdominal mass in a different direction (think of a tube of toothpaste squeezed in the middle…) You need to correct alignment and re-engage an entire SYSTEM of muscles and fasica to put your tummy back where you want it for the long term.

Before you stress… DON’T! Diastasis recti is a very common occurrence with pregnancy and you can heal it.  Next weeks I am going to run through some steps and exercises that will aid with this. 

…. But remember, be patient with yourself, stay consistent! By prioritizing proper alignment as well as the core and floor connection in all your exercises and in daily life, you’ll go a long way toward healing your diastasis recti and improving your core health.