Do you have Diastasis Recti?

Rectus abdominal separation (diastasis recti) is a completely normal and necessary part of pregnancy where the connective tissue (linea alba) between the two sides of the rectus abdominal muscles (your six pack muscles) thin and stretch to accommodate the growing uterus. Each individual is different, depending on the size & position of baby, number or babies, maternal age and shape, and nutrition.

The separation often closes gradually in its own time, however the tension and function of the tissues often remain altered. A two-finger gap is considered normal after 8 weeks. Some women have a two-finger gap for years after pregnancy, while others have up to 5 finger gaps that close up within 9-12 months

Having Diastasis (or “mummy tummy”) will increase lower back pain and hernias and a study of women with abdominal separation found that 66% also presented with pelvic floor dysfunction (i.e. incontinence both urethra & bowel) and pelvic organ prolapse, and back pain (british journal of sports medicine).  Keeping the connection to the the ever lengthening Transverse Abs and Pelvic floor during pregnancy is the best key to avoiding the conditions that are associated with DR and in reducing the severity of DR itself. You can’t prevent DR during pregnancy  – as mentioned earlier, it is a necessary phsyiological adapation of late pregnancy and is present in 100% of women at full term.

There are many exercises both during and after pregnancy that can strain the linea alba, making DR worse, delay the healing process and prolong the look of what is also known as the “mummy tummy”.

How to test if you have it:

• Lie on your back, with your knees bent and your feet flat on the floor
• Place your fingertips just below your sternum, walk your fingers slowly down the centre of your abdominals in the gap – all the way past your belly button and down to your pubic bone
• Record width, where the widest part is, length, depth and how the tissue in that gap feels.
• (The deeper the separation and softer the tissue the longer it can take to heal)
• Repeat steps in a curl up position and note any changes in how the tissue feels or how wide the gap is
• 1 finger is considered normal for anyone who has had a baby.  3 or more fingers is considered “severe”
• Now, contract your PFM and TVA, try the steps again with these muscles engaged and notice the changes. Do you feel the linea alba tension when you engage your PFM/TVA? If you do, and you can also do this during a push up, a plank, a sit up, your DR is considered functional.

If you are in the later stages of pregnancy, 25 weeks onwards, the easiest way to test if you have separation is to get a qualified trainer or therapist to check for you. I test all my clients!

Learning how to properly engage your deep abdominal (core) muscles and your pelvic floor will help reduce Diastases during pregnancy. Post pregnancy activating these muscles will encourage the rectus to close. Exercises that can be begun immediately after birth to help with the healing process are gentle pelvic floor and transverse abdominus activation. It took me at least one year of Pilates (post baby) 1-2 x per week to notice a close in my separation and it prevented my back pain from around 3 weeks of regular classes. Just like developing a baby in your womb, the healing process takes time.

Facts about Diastasis Recti/Abdominal Separation:

• Diastasis is a normal symptom of pregnancy. It is nothing to be afraid of!
• Diastasis recti does not have to cause permanent damage, nor is it the muscles tearing
• Diastasis recti does not require surgical repair
• Diastasis recti does not cause pain, there are no nerves in the linea alba
• Your core can be stronger after pregnancy
• Diastasis recti is linked closely with umbilical hernia and back pain
• Stress, poor gut health, a poor diet, medications, dehydration, and sleep debt can contribute to Diastasis Recti
• Diastais recti requires a whole body approach to heal, not simply focussed core exercises
• Diastasis recti can be a problem if you suffer any of the above issues, if you’re doing  the wrong type of exercise or if you want to get back into sport/crossfit/gym training. “The wrong type of exercise” can vary from person to person. This is why you need an individual assessment with a women’s health physiotherapist
• In the long run, you can have Diastasis recti and still be pain-free and functional – even with a considerable gap as long as the load of movement and everyday tasks can be transferred well.

If you have less than a 2finger gap, ask yourself- Do I leak? Do I have back pain? Does my stomach feel flat? Do I have good posture and good core activation? If you answered no to leaking, back pain, and yes to a flat stomach, good posture and good core activation, you will most likely be safe to do the above exercises and continue on your path to more intense forms of exercise, especially abdominal work. However, it is always worthwhile consulting a Physiotherapist who specialises in women’s health first, at some time soon after birth.

xx ali