What Is Diastasis Recti?
One of the most common concerns during pregnancy is Diastasis Recti Abdominus (DRA), with 70% of women reporting concerns about it during pregnancy and the implications for it postpartum as found in recent studies .
How common is Diastasis Recti and what is it?
It happens naturally to 70-100% of woman during pregnancy as a result of the body creating space for a growing baby. It is considered the stretching of the space between the 2 rectus muscles and the thinning of the connective tissue called the lines albea.
It is important to know—
For some people, tt can resolve on its own after childbirth
33% of woman have it at 12 month postpartum and for most women it is considered a mild level of space
Some studies show it can persists for up to 52% of women in menopause
Not all space is the same— What technically counts as a diastasis?
It depends!
Keep in mind some people have a little bit of space between your 2 six pack muscles prior to pregnancy.
Measuring postpartum is most accurate with using ultrasound imaging which is not accessible to most physical therapists.
Next most accurate is using calipers and quite commonly “2 fingers” is what is considered a diasistasis but it is important to consider by whose fingers?
Where to measure—
Quite often women will check at the umbilicus however the increased width has the potential to occur along the length along the rectus abdomens from the pubic bone to bottom of the xypohid process where the muscle connect for a through assessment information.
Recently, researchers in the hernia society have proposed classifying DRA by
Mild 2-3cm,
Moderate 3-5cm, or
Severe 5cm
Increased distance between the recti abdomens has not been show to cause back pain, pelvic organ prolapse, or urinary incontinence however women with diastasis may concurrently experience those symptoms.
Associated factors with diastasis recti postpartum has been found by contemporary research to be associated with-
Fear of movement & movement restriction
Body dissatisfaction
Abdominal pain and bloating.
What are the treatment options For Diastasis Recti?
To date, current research tells us that closing the gap is only really possible by surgery and considering the costs, risks and benefits is not accessible to most people.
Furthermore, abdominal exercises has been shown to improve abdominal strength and muscle size postpartum as well as has been found to NOT make it worse when performed in pregnancy. This is important considering that women avoid abdominal exercises due to fear of worsening diastasis during pregnancy and postpartum resulting in muscles that get deconditioned in addition strong implications on body dissatisfaction as noted by these researchers.
Exercise has been studied at length for the management of Diastasis Recti and is considered the gold standard of treatment with the goal of improving function and quality of life as full closure may not complete happen from exercise alone. It is important to note, given the vast changes that occur in childbirth and the stretching of the abdominal wall, connective tissue it would be unrealistic to expect a postpartum body revert to one that has not given birth.
What are the Best Exercises for Diastasis REcti?
Common concerns about diastasis include back pain, hernia, or appearance this concerns are addressed by comprehensive by retraining programs that include the whole postural and trunk stability system.
Using well proven principals of exercise science and gradual progressive overload the opportunity to improve daily and athletic performance by gaining strength, coordination, power and endurance of not only the rectus abdominals but the support lateral and posterior musculature. of the spine.
It is important to recognize research is evolving in the conservative treatment options to help women experiencing decreased quality of life from diastasis recti. This study and this study are among the many that support training the whole abdominal wall with individualized approach for each person. As well as retraining the deep abdominal muscles, pelvic floor, and improving the integrity of the lines alba for optimizing core support.
At Radiance PT in Durham, you will receive a whole person approach to help you designed for your unique needs. Working together we help you—
Regain your function and improve your abdominal strength
Alleviate your back pain and heal your bladder leakage
Discover enjoying your body again so you can fully be present with your growing family
References:
Gluppe S, Ellström Engh M, Bø K. Primiparous women's knowledge of diastasis recti abdominis, concerns about abdominal appearance, treatments, and perceived abdominal muscle strength 6-8 months postpartum. A cross sectional comparison study. BMC Womens Health. 2022 Nov 2;22(1):428. doi: 10.1186/s12905-022-02009-0.
Eriksson Crommert M, Petrov Fieril K, Gustavsson C. Women's experiences of living with increased inter-recti distance after childbirth: an interview study. BMC Womens Health. 2020 Nov 23;20(1):260. doi: 10.1186/s12905-020-01123-1.
Gluppe SB, Ellström Engh M, Bø K. Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial. J Physiother. 2023 Jul;69(3):160-167. doi: 10.1016/j.jphys.2023.05.017.
Theodorsen NM, Bø K, Fersum KV, Haukenes I, Moe-Nilssen R. Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. J Physiother. 2024 Apr;70(2):142-148. doi: 10.1016/j.jphys.2024.02.002. Epub 2024 Mar 11. PMID: 38472049.
Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, Ross D, Montgomery A. European Hernia Society guidelines on management of rectus diastasis. Br J Surg. 2021 Oct 23;108(10):1189-1191. doi: 10.1093/bjs/znab128. PMID: 34595502; PMCID: PMC10364860.
Deering, et al. Exercise Program Reduces Inter-Recti Distance in Female Runners Up to 2 Years Postpartum, Journal of Women's Health Physical Therapy 44(1):p 9-18, January/March 2020. | DOI: 10.1097/JWH.0000000000000157
Fuentes Aparicio L, Rejano-Campo M, Donnelly GM, Vicente-Campos V. Self-reported symptoms in women with diastasis rectus abdominis: A systematic review. J Gynecol Obstet Hum Reprod. 2021 Sep;50(7):101995. doi: 10.1016/j.jogoh.2020.101995.