Diastasis of rectus abdominis muscle, Diastasis recti, Rectus abdominis diastasis = WTF?

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All of these terms mean the same thing: abdominal muscle separation. This is really common during and after pregnancy! Your belly may look like one of the above pictures, or you may feel like you still look pregnant, or you may notice a change in the way your tummy looks.

What is it?

Quick anatomy lesson: You have four layers of abdominals. Starting from outermost to deepest layer:

  • Your rectus abdominis muscle – the two strips of muscle that run down the front of your tummy, commonly known as your ‘6 pack’ (more like a 6 pack of beersies for me!). These 2 strips are connected by the linea alba – a line of connective tissue down the middle of your tummy
  • Underneath that you have 2 layers of obliques, or your side abdominals
  • Your deepest layer of abdominals (welcome to your ‘core’ ladies, along with your pelvic floor and breathing muscles) is kind of like a corset, running all the way around the upper rim of your pelvis, up your vertebrae in your lower back, and around the lower part of the rib cage

When you are pregnant, the hormones, particularly relaxin, cause a softening of the connective tissues, i.e. the linea alba, to allow for stretch around the baby. As the baby grows, all 4 layers of abdominals stretch and grow, and the top layer of rectus abdominis starts to separate outwards. 

Image credit: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03

Image credit: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03

You are more likely to have a diastasis if you:

  • have a huge-mongous baby
  • have multiple babies in 1 pregnancy i.e. twins
  • are an older mother
  • have stretch marks (thought to be due to the genetic type of your connective tissues)
  • have more than one pregnancy (you are often ‘pre stretched’ from your previous pregnancy, hence why a lot of women tend to ‘show’ earlier in their second or third pregnancy than with their first)
  • and it probably has something to do with your torso length, whether you are carrying high or low etc… but there really is not that much research on diastasis!

How do I know if I have a diastasis?

You may have some of the following signs:

  • a ‘pouch’ for a tummy or a doming shape (kind of like a Toblerone chocolate bar running down the centre of your tummy when you do a crunch movement)
  • feel like you have nooooo abdominal strength
  • low or mid back pain
  • pelvic floor problems such as prolapse or leakage of urine

The best way to check is to seek help from your women’s health physio. We measure the gap width (we measure in finger-widths i.e. more that 4 finger-widths apart after birth needs expert attention), but we also measure the depth of the separation, and the integrity of the tissue underneath our fingers. 

What can I do to improve it?

Most of the healing happens in the early days (like the first 6-8 weeks after delivery) so the most important thing to do? Seek expert advice from a women’s health physio early. They will probably suggest:

  • abdominal support like a tubigrip, or post natal support shorts/undies. No, not those terrifying corset things that the Kardashians promote – they may push the abdominal contents down and cause a prolapse. Eeeeek!
  • Exercises for the deep abdominals and pelvic floor muscles
  • tips on how to lift, carry and hold your baby, along with postural advice
  • Avoid constipation
  • Avoid lifting anything heavier than your baby
  • Avoiding anything that involves using your rectus abdominus too much in the first 6-12 weeks ie sit ups, planks, crunches. So that means rolling in and out of bed like you are still pregnant for a couple of months after delivery
  • there is limited research on the types of exercises that improve diastasis, but there is new research coming out suggesting that some women actually close down their gap with crunch like movements, where as other women would make their diastasis worse with crunches.
  • if you get pregnant again after having a diastasis, you may like to wear a support garment during pregnancy and get a pregnancy exercise programme from your physio

So, in conclusion, every post natal body is different. If you suspect you have diastasis, go see a physio that has lots of experience in women’s health, and avoid doing the ‘cookie cutter/everyone do the same thing’ type exercise programmes online, as us physios have seen many women worse off from doing these. 

– the vagina physio

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