Diastasis recti is a condition where the rectus abdominis muscles (the "six-pack" muscles) separate along the midline of the abdomen at the linea alba. This separation can cause a bulge in the middle of the abdominal wall and is particularly common in postpartum women. Diastasis recti can lead to various issues, including an abdominal “pooch,” low back pain, pelvic floor muscle dysfunction (diastasis and urinary incontinence commonly occur together), and impaired posture. At 6 weeks post partum 60% of women will present with a diastasis recti, this number drops to 39% at 12 months. Diastasis recti is significantly under diagnosed and undertreated in women > 1 year post partum. Fortunately, there are effective ways to manage and treat diastasis recti.
What Causes Diastasis Recti?
Diastasis recti occurs when the connective tissue, the linea alba, that holds the rectus abdominis muscles together thins out and stretches. During pregnancy, the growing uterus puts pressure on the abdominal wall, and the hormone relaxin softens connective tissue, making it more susceptible to separation. By the end of pregnancy, 100% of women will present with diastasis recti. Other contributing factors include:
- Multiple pregnancies
- Carrying large babies or multiples
- History of cesarean section delivery
- Genetic predisposition
- Rapid weight changes postpartum
Common Signs of Diastasis Recti
- A visible bulge or "pooch" in the abdomen, especially when straining or contracting the muscles.
- A gap or a soft area along the midline of the belly.
- Lower back pain or pelvic pain.
- Poor posture or difficulty lifting objects.
Diagnosis
A pelvic health / women’s health physical therapist (PT) can diagnose diastasis recti through a physical examination. They may measure the gap between the rectus abdominis muscles while the patient lies flat and performs a slight crunch. In some cases, imaging tests like diagnostic ultrasound or MRI may be used to assess the severity.
Treatment Options:
The good news is that diastasis recti can often be treated with non-surgical methods, especially when addressed early. Here are some effective treatments:
1. Physical Therapy
A physical therapist specialized in pelvic floor health can develop a customized exercise program, including:
Core Stabilization Exercises: Gentle movements that target the transverse abdominis, the deep core muscles, to help reduce diastasis and effectively load the abdominal wall.
Pelvic Floor Exercises: Training the pelvic floor muscles can provide better support to the abdomen. The muscles of the pelvic floor and deep abdomen coordinate, improving pelvic floor muscle function can reduce diastasis.
Posture Training: Improving posture can reduce strain on the abdominal muscles and aid in the healing process.
Manual Therapy: C-section scar management, rib dysfunction correction, and manual treatment of trigger points in the abdominal muscle wall can improve abdominal wall activation and reduce diastasis.
2. Safe Exercise Practices:
Postpartum mothers with diastasis often ask if they should avoid certain exercises like planks, sit-ups, V-sits, and heavy weight lifting. The answer is “it depends.” Previously, women with diastasis recti were uniformly advised to avoid exercises that heavily loaded the rectus abdominis. Now, it's well understood that women with diastasis can return to any form of exercise once they have learned to effectively engage and use their transversus abdominis muscle and properly load through their rectus abdominis. A women’s health PT will consider each patient individually to advise them when they can to return to exercises that specifically challenge the rectus abdominis.
3. Wearing Supportive Garments
Postpartum mothers with diastasis recti often inquire about abdominal binders. Generally, abdominal binders and heavy supports should be avoided postpartum as they create increased intra-abdominal pressure, which puts downward force on the pelvic floor, potentially causing pelvic floor dysfunction. Diastasis recti is best managed with daily activity and specific exercises. In severe cases, the temporary use of an abdominal support may be advised by your women’s health physical therapist.
4. Nutrition and Weight Management:
Maintaining a healthy weight through balanced nutrition can help reduce excess pressure on the abdominal wall. A diet rich in lean proteins, healthy fats, whole grains, and plenty of fruits and vegetables can support overall health and muscle repair.
5. Surgery:
In severe cases, where exercise-based treatment has not been successful, surgical intervention may be considered. Abdominoplasty, or "tummy tuck," is a procedure that can repair the muscle separation. This option is typically considered when diastasis recti is present with abdominal hernia or when it is causing significant bothersome cosmetic changes.
Preventing Diastasis Recti
While it may not always be possible to prevent diastasis recti, certain strategies can minimize the risk. Working with a women’s health physical therapist can be very effective.
- Engage in safe, core-strengthening exercises before and during pregnancy.
- Avoid excessive weight gain during pregnancy.
- Practice good posture and body mechanics.
Diastasis recti is a common and manageable condition. With the right approach, most women can significantly improve their symptoms and restore their abdominal strength and appearance. If you suspect you have diastasis recti, consult with a certified pelvic health/women’s health physical therapist who can guide you through a personalized treatment plan. Remember, patience and consistency are key to recovery. With the right guidance and exercises, you can reclaim your core health and overall well-being.
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