Diastasis recti after pregnancy is a prevalent condition.
Every pregnant woman will experience physiological laxity of the fibres of linea alba (LA, connective tissue between the two rectus muscles) which will manifest as widening and weakening of the structure.
What do studies say?
Studies show: 100% prevalence at 35-week gestation and 39% still at 6 months
Normally this natural widening resolves itself in the weeks following delivery, however, in approximately 1/3 of postnatal women, for unknown reasons, the separation can persist. Rectus abdominis muscle wasting (atrophy) is also present.
While diastasis is not life threatening condition, it can have a negative impact on a woman’s life. Studies have found that diastasis rectus abdominis (DRA) correlates with negative body image and decreased quality of life. Furthermore, some women with diastasis also report:
- lumbo-pelvic pain
- pelvic floor dysfunction ( prolapse, incontinence)
Increased social media focus has helped to highlight DRA as an important issue, but caused also a lot of uncertainty around it leaving women scared of movement and exercise.
It is important to look at the post partum period beyond the 6-week mark and remember that it takes several weeks for the tissues to return to their original tension and length. Factors such as poor sleep, prolonged sitting, poor diet and excessive loading (too heavy lifting), inadequate physical activity (impact exercises introduced too soon) can also influence woman`s recovery.
What is Diastasis Recti?
Diastasis recti abdominis (DRA) is a functional and a structural dysfunction of the rectus abdominal muscle.
DRA, also known as tummy separation, is commonly defined as a gap between the two sides of the rectus abdominis muscle. The distance between the right and left rectus abdominis muscles is created by a thinning and widening of the LA and increased laxity of the anterior (front) abdominal wall. It can occur at different points of the tummy: at the belly button, below or above.
What is considered ‘’normal’’?
There is currently no consensus as to the definition and classification of DRA.
Beer’s classification system for patients with rectus abdominis diastasis proposes that the Linea alba can be considered “normal” up to a width of:
15mm at xyphoid
22mm at 3cm above the belly button
16mm at 2cm below the belly button
How is DRA assessed?
- The gold standard is RTUS (real-time ultrasound)
- Palpation (most practiced and sufficient for clinical assessment)
Check out my video about a Curl-Up Test (self-check for diastasis recti) here: https://www.instagram.com/p/CWD8RB_grNE/
What are we looking at?
- Inter-recti distance- distance between the two rectus abdominal muscles
- Depth
- Doming
Physiotherapist will:
- Assess LA at rest through palpation to determine its integrity
- Assess pelvic floor function—internal examination (per rectum/per vaginam) or via ultrasound
- Assess generation of tension in LA with pelvic floor muscle contraction
Clinical assessment will also include:
- Postural assessment
- Breathing pattern and thoracic mobility
- Cluster of loading test to assess the integrity of the abdominal wall
Women with DRA are also at risk of hernias. If the is a suspicion of a hernia, you will be referred on to your doctor for further examination.
Physiotherapy treatment
Rehabilitation for diastasis needs to be individualised, informed and active. It may include:
- Exercise therapy
- Postural re-education
- Breathing retraining
- Pelvic floor retraining
- Manual therapy
- Kinesio Taping
- Advice on lifestyle modifications
Find a therapist who understand the condition to help you reach your rehab goals.
To book an appointment click: Contact – mnaphysiotherapy.com
Want to know what to expect on your first visit? Click: What happens at the first women’s health physiotherapy appointment? – mnaphysiotherapy.com
References:
Donnelly, G. (2019) Diastasis rectus abdominis: physiotherapy management. Journal of Pelvic, Obstetric and Gynaecological Physiotherapy Spring (124) Pp.15-19.
Mota, P., Pascoal, A., Carita, A. and Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), pp.200-205.
BØ, K, Hilde G, Tennifjord M K, Sperstad JB, Engh ME (2016) Pelvic Floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourology and Urodynamics, March 2016
Rozejście mięśnia prostego brzucha Daniela Milka, Małgorzata Jachacz-Łopata, rok wydania 2019, wydawnictwo: Medpharm