Diastasis Recti
Diastasis Recti is the abdominal separation that occurs in pregnancy as the abdominal wall expands to make room for your growing baby.
Your abdomen has connective tissue that runs along the midline, from your sternum to pubic bone, called the linea alba. Did you notice a dark line appearing on your belly during pregnancy? The linea alba softens during pregnancy, which allows the rectus abdominus muscles (or six pack muscles) to move apart, as show in the diagram below.
100% of pregnant women will have diastasis on their due date. Diastasis will be prevalent for 60% of women 6 weeks postpartum, 39% of women 6 months postpartum and 32% a year postpartum. Highlighting that there is natural healing that does occur, we should be careful to not disrupt this process but aide it.
The goal during pregnancy is to minimize the severity of separation by avoiding certain movements, ie a plank. For instance, after birth we recommend continuing to roll on to your side to sit up until your core is activating correctly. Pre & postpartum we recommend learning how to engage your core and pelvic floor with breathing to perform exercises with better efficiency to reach your goals.
Separation is commonly discussed in terms of finger widths, for instance you may have heard women discuss a two or three fingers gap. However, it is important to note that diastasis recti is not just about the width of the gap but more importantly its depth, how far down the gap can you push. If your connective tissue, the gap in the abdominal wall, is firm and can gain good tension when you engage your core muscles correctly during exercise, then you are likely to be fine. If your deep core muscles are weaker, the connective tissue will feel soft, squishy and you’ll be able to press down easily into your belly.
When to check postpartum?
We recommend that at your 6 weeks doctor check up to have your abdominal separation assessed. Your doctor can help guide you to what you should be looking for and recommend you to a women’s health physio if required. That being said we do recommend for you to be able to assess yourself, especially to help track your progress.
How to self-check
Lie down with your back on the floor and your knees bent. Lift your shirt up to your bra line and pull down your pant to 4 inches below your belly button. We will be assessing DR in three different places along the linea alba.
1. Walk your hand along the linea alba to get a sense of the tension in the connective tissue separating your rectus muscles
2. Place your index and middle finger half way between your belly button and your ribcage. Find the gap between the rectus muscles. Tuck in your chin towards your chest and pick up your head a little bit, be wary not to come up into a crunch. Do you feel a tension in your linea alba, does it feel like a trampoline or do your fingers sink in? Can you feel a gap between your rectus muscles, if so how many fingers wide is the gap? Gently release and bring your head down.
3. Repeat step 1 just above your belly button
4. Repeat step 1 halfway between the pubic bone and your belly button
We will now repeat the exercise with added awareness on breath, core and pelvic floor connection:
5. Inhale to prepare. As you exhale contract and lift your pelvic floor and lower abdominal muscles while keeping your ribs down. Try to keep your glutes relaxed, and lift your head. Check in the three same sites again and compare.
Do you feel more tension in your line alba? If you felt a gap the first time around, is the gap now narrowing? If so, this means you are engaging correctly and safely. If not we suggest incorporating on a daily basis breathing and pelvic floor exercises outlined to help your reconnect with your core. You’ll be there before you know it!
If you are unsure on how to do a full contraction of your pelvic floor we will provide a post on this soon!
Signs of Diastasis Recti
· A gap a width of 2 fingers or more before engagement (see step 1)
· The gap does not shrink as you contract your abdominal wall.
· You can see coning or doming along the length your linea alba.
Disclaimer: Please consult with your doctor if at any time you see a round, hard or painful bulge protruding from your belly button area, or along your mid line, this may indicate a possible hernia.
References
Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain, Jorun Bakken Sperstad, Merete Kolberg Tennfjord, Gunvor Hilde, Marie Ellström-Engh, and Kari Bø. Br J Sports Med. 2016 Sep; 50(17): 1092–1096.
Sperstad JB, Tennfjord MK. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Sep;50(17):1092-6.
PatrÃcia Gonçalves Fernandes, Augusto Gil Brites Andrade. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy. Volume 20, Issue 1, February 2015. 200-205.