What you need to know and how physical therapy can help
Diastatis recti literally translated means separated abdomen. But what does this mean? Who gets one? How does this happen and how do I know if I have one? Is it bad? Can it be treated? Better yet, can it be prevented? We will go through all of these questions and more giving you the knowledge to ask appropriate questions to your healthcare provider and when to get screened and/or treated.
Background: What is Diastasis Recti?
As we stated already, diastasis recti is the splitting of the abdominal muscles. In the picture above, you will see the rectus abdominis (the six-pack muscle) and the linea alba (the white, connective tissue). Diastasis recti occurs when the rectus abdominal muscles get stretched, pulling on the linea alba. In these structures, tension is important, it helps give us flatter, defined abdomens. The more stretch/pull on the rectus abdominis, the further stretched the linea alba becomes and the less tension that these structures can generate. The lower the tension, the more the intestines push on the abdomen, which creates a bulge or "pooch."
Why Does it Happen?
Diastasis occurs anytime too much pressure is placed on the abdomen. Pregnancy is one of the most common reasons for developing a diastasis recti. As the baby grows, the uterus expands, putting pressure on the organs and abdominal tissue. Research shows that diastasis recti occurs in 60-100% of women in their third trimester and up to 60% of women 6 months post-partum! This begs the question is diastasis recti pathological or normal? (We'll go over this more in a later section).A common misconception is that diastasis only occurs in women. False! Men can have diastasis recti as well! Remember, diastasis recti occurs when there is excess pressure placed on the abdominal tissues. Other reasons for diastasis recti include excess abdominal fat, poor form with weight lifting or abdominal exercises putting excess pressure on the abdominal muscles, or swelling in the abdomen.
How Do I Know if I Have a Diastasis Recti?
There are some more obvious signs of diastasis recti such as a bulge in the abdomen (pictured above), or you feel like you still look pregnant even several months after giving birth. Some people report feeling like their organs are going to fall out. In a physical therapy evaluation, the PT will have you lie down and then lift your head and/or shoulders off the table to see how well your abdomen contracts. If there is a visible bulge, then you have a diastasis recti. The PT may palpate in the middle of your abdomen above and below your belly button to see if there is separation between your rectus abdominis tissues. Specific measurements of the separation can be taken using calipers, ultrasound or a tape measure.
How is Diastasis Recti Treated?
Once you and the PT have established that you have a diastasis recti, individualized treatment begins. The most important aspects of treatment is regaining the ability to create tension in the abdomen as well as re-establishing a coordinated contraction between the abdomen, diaphragm, pelvic floor and deep core muscles of the spine. Typically this treatment begins lying on your back, learning how to engage the correct muscles and starting with simple exercises to improve the strength and coordination of these muscles. As your strength and coordination improves, your exercises will get more difficult and functional so that you can sit, stand, squat, lift and carry with proper form and tension in the abdomen. If you are having trouble generating tension, sometimes bracing/wrapping or the use of tape can help in the short term while you work on developing these muscles and coordination again. Again, your treatment should be individualized to your body and progress so that you achieve your best possible outcome!
Can I Prevent Diastais Recti?
The short answer is we are not sure - more research needs to be done in this area. As we briefly discussed above, the majority of women have a diastasis recti during and after pregnancy which makes us question what is normal? Your belly needs to expand for your growing baby, so an abdominal separation makes sense. However, if you are post-partum and do not feel like you are regaining your strength or losing the "pooch," this is where you need additional help.Ideally, treatment begins during pregnancy! A physical therapist can help you determine what positions you should avoid that place excess pressure on your abdominal muscles, as well as the best exercises for you to maintain strength and tension in your abdomen. Each woman is different which is why an evaluation is essential. This is important not only for post-delivery, but also for labor/delivery. You want to avoid positions that place too much pressure on your abdomen which could worsen your diastasis recti, and find positions that allow you to create efficient strength for pushing.
This is Not Something You "Just Have to Deal With"
If you are struggling with diastasis recti, difficulty gaining abdominal strength, do not like the way your belly looks etc, talk to your doctor, mid-wife, doula, physical therapist etc. Go see a physical therapist to see what can be done to improve your strength and function and ultimately, how you feel in your own body. Every person, regardless of the reason for having a diastasis recti, has the right to be able to perform their daily activities and exercises without issue AND feel good about how they look.
