Diastasis recti abdominis (abdominal separation)
What is diastasis recti abdominis?
Diastasis recti abdominis (DRA) is a commonly discussed topic throughout pregnancy and postpartum. Many women want to avoid and prevent DRA, and dislike the aesthetic appearance it can create over the abdomen. The purpose of this guide is to empower you to understand the cause of DRA and how you can rehabilitate correctly after birth.
Diastasis is referring to the midline separation of the abdominals during pregnancy, to allow room for your baby to grow. The rectus adominus is made up of two walls of muscle that are connected together by the linea alba. During pregnancy the linea alba will become thinner and stretch as the abdominals separate, but it doesn ’t tear. DRA is determined by a separation of at least 2cm at one or more points of the linea alba. DRA occurs in 100% of pregnancies from 35 weeks gestation and is still prevalent in 39% at 6 months postpartum.
Symptoms of diastasis recti
Common signs that may help you recognise if you have DRA;
Doming/coning/bulging along the midline of the abdominals at rest
Doming/coning/bulging that pops up with abdominal activation
Visible dip/sinking along the midline
Lower back pain
Bloating
Pelvic floor dysfunction (leaking, urgency, painful intercourse)
Types of DRA
During pregnancy the gap created due to DRA will vary amongst women. There are many factors that play into this including: genetics, size and position of the baby and previous pregnancy.
DRA occurs most commonly around the umbilicus, with the second most common area being above. DRA very rarely occurs below the umbilicus alone, it is often seen alongside separation at or above the umbilicus.
DRA during pregnancy
Although DRA is highly likely during pregnancy, it is not something that should be feared and stop you from exercising or doing the things you enjoy.
Research has shown that in pregnant women with DRA, abdominal and pelvic floor exercises during pregnancy do not increase DRA during or immediately after pregnancy. (Theodorsen et al 2024). DRA during pregnancy.
Lengthening and separation of the rectus abdominus during pregnancy can lead to changes in posture and impair pelvic stability, this makes the lower back and pelvis more vulnerable to injury.
Postpartum DRA
Many women will have a DRA after they have given birth and this is considered quite normal.
Research has shown that significant reductions in DRA and an improvement in quality of life can be achieved with a prescribed deep core stability exercise programme (Thabet et al, 2019). Using abdominal bracing, such as a tubigrip, in the early postpartum period, alongside an exercise programme, will also enhance the likelihood of reducing DRA.
A direct correlation between DRA and pelvic floor weakness has been shown to cause issues such as; incontinence, urgency and pelvic organ prolapse. This means it is imperative that DRA should be identified and treated in the early postpartum stages to prevent future development of pelvic floor dysfunction, at any point in life.
See a Women’s Health Specialist
Although it is not mandatory in the UK to see a women ’ s health specialist - it should be!
Once you have reached 6 weeks postpartum, even if you have a 6 week check with your GP, you should also book in with a women ’ s health specialist. During the assessment they will not only be able to tell you if you have DRA but they will also be able to assess your posture and breathing patterns, functional movement, core and pelvic stability, and pelvic floor activation.
Achieving good tension across your abdominals when you are postpartum is imperative to optimal function. If you are not in control of your core and pelvic floor you are likely to place too much pressure onto these areas which can lead to longer term problems such as: lower back pain, hip pain, incontinence issues and pelvic organ prolapse.
Many people think losing control of their bladder postpartum is just what happens, yes it is common, but it is not normal! Postpartum is forever and changes can be made at any point!
Treatment stratgies
Kinesiology tape can be applied across the abdominal wall to bring the two walls of muscle closer together and manually reduce the gap. This technique may reduce symptoms such as lower back pain, by enhancing abdominal muscle contraction and improve core stability. This is particularly useful in earlier postpartum weeks whilst muscle strength is being regained.
Abdominal binding is another technique that can be used to provide additional support to the abdominal wall. Belly binders are straps that are placed around the abdomen and held in place with velcro.
Exercises for postpartum DRA
A postpartum exercise programme for DRA should include gentle exercises for the abdominals, deeper core stabilising muscles and the pelvic floor. A postpartum exercise specialist will be able to assess: posture, breathing patterns, degree and location of DRA and provide specific exercises to enhance your DRA recovery.
Diaphragm breathing is a great exercise to start managing pressure through the abdominal area, this is key when you begin to increase your training as you need to avoid bracing!
Place one hand on your stomach, and your other hand on your chest. Take a deep breath in, and push your belly outwards. Try and keep the movement of your chest to a minimum, so you concentrate on deep breathing. Perform for 8-10 breaths.
Disclaimer
The information in this guide is intended for your general knowledge and should not replace any personalised professional medical advice. Consult your healthcare provider with any questions or concerns you may have regarding your health.