Understanding Diastasis Recti
What is Diastasis Recti (DR)?
Diastasis recti is a condition found, surprisingly, in both women and men. For women, it can be more commonly found during and after pregnancy. Weak core muscles or those muscles subjected to excessive strain can also be seen in other populations such as men, older/geriatric adults, and even younger athletic women. It is also sometimes found in those who have undergone “minimally invasive” laparoscopic surgery. During surgery, the linea alba is punctured through the umbilicus (belly button) in order to gain access to the gut. The surgical intervention creates a mild piercing to the linea alba which creates a diastasis. Other causes include a chronic cough such as in those with severe seasonal allergies, emphysema or chronic obstructive pulmonary disease (COPD). Individuals who are overweight with most of their adipose in the front of their abdomen and physically deconditioned are also some examples of those who may have diastasis recti.
DR is the thinning or abrupt separation of the linea alba. The linea alba is comprised of thick connective tissue that connects the two ends of the rectus abdominis and forms the middle of the “six pack”. This separation can normally increase with age as found by Taft in 1997 when he used real-time ultrasound measurements to determine “normal values” of those younger and older than age 45. When DR happens to someone in their younger years, the separation has been shown to cause many long-term problems. So how much dysfunction does the linea alba have to be to cause lifelong problems? Research states acceptable levels of dysfunction are less than 2 centimeters. Measurements of 2 to 3 finger widths is considered to be problematic, which is greater than 2 centimeters.
Complications related with diastasis recti include weakening of the support system of abdominal organs, low back pain, stress urinary incontinence, chronic low back pain, and pelvic organ prolapse, where the organs will descend.
Pregnancy hormones soften and physically stretch connective tissue between your muscles as your body is trying to make room for the baby. During this process your rectus abdominis muscle moves farther apart which can lead to an overstretch or separation. This gap can occur from 14 weeks of gestation and may increase until delivery. Diastasis recti can be located anywhere from below your sternum (chest bone) to your pubic bone, but the tendency is to be around your belly button area (umbilicus). It may also leave you with a bulge in the front as the muscle is being separated.
Diastasis recti commonly occurs during pregnancy. The research done by Biossonnault and Bleschak shows that 66% of women in their 3rd trimester have DR and 53% in immediate postpartum period. (Boissonnault & Bleschak, 1998). A study done by Coldron also found that the first 8 weeks postpartum are critical healing time for DR (Coldron et al., 2008).
So how do I know if I have it?
Luckily, it is pretty easy to check for diastasis recti. A physical therapist can easily check for diastasis, but checking on your own may help you decide that you need some professional help.
After the delivery of your baby, you can administer a self-check to see how wide the gap is between your muscle.
(1) Lay down on your back with your both knees bent (hooklying position)
(2) Relax your abdominal muscles completely
(3) Lift your head forward gently (lifting it off a pillow). This slight head lift in this hook-lying position will require a rectus abdominis contraction and allow you to assess diastasis recti. If you see some doming (pouching up and out that wasn’t there before pregnancy, that could be a good indicator)
(4) Put your finger in at your belly button, check separation width with your fingers by applying gentle pressure.
(5) Small separation of midline at the rectus abdominis (approximately 1-2 finger width) is normal after pregnancies. However, if the gap in midline is wider than 2 fingers, does not shrink as you tighten your abdominals, or if you see small bulge, you may need to seek treatment by a physical therapist for your diastasis recti.
Real-time ultrasound is also used by physical therapist in a women’s health physical therapy clinic to assess for DR. It is non-thermal ultrasound, similar to what is used for checking babies that produces a picture. At New Dimensions, we have a real-time ultrasound that can give you a small picture of the gapping between the heads of the rectus abdominis.
What can I do to treat diastasis recti?
If you have not seen qualified physical therapist before, you should start from there. In treating diastasis recti, conservative management provided by a physical therapist is usually the first line of intervention. Pelvic health physical therapists are specialists within physical therapy that focus on this type of treatment. At your initial evaluation, the physical therapist will assess your functional limitations and biomechanical/structural impairments to a get the big picture of what has contributed to your symptoms (particularly if you are not a post-partum patient). The physical therapists at New Dimensions Physical Therapy will be able to provide treatments including:
(1) Postnatal assessment/education and biomechanical assessment/treatment
(2) Correct faulty body mechanics and postures
(3) Correct any orthopedic or bony alignment contributing factors
(4) Prescribe appropriate exercises to activate the abdominal musculature without increasing intra-abdominal pressure
(5) Manual treatments to release myofascial restrictions
(6) Advise on usage of passive support including belt or garment, if necessary
(7) Use of real-time ultrasound in order to view the width and depth of the diastasis which aids in neuromuscular re-education of the muscle
Poorly performed abdominal exercises can cause excessive intra-abdominal pressure, straining, or may isolate the wrong muscle which can cause further diastasis recti separation and accompanying bulge to worsen. Thus, it is important to monitor the diastasis recti and get accurate exercise prescription for abdominal exercises. Inappropriate exercises include crunches, sit ups, or planks which can strain your abdominal muscle excessively. Building strength in your core will protect your back and provide sufficient support to the sacroiliac joint. This will decrease or diminish any low back or hip pain. At New Dimensions PT, we will help to identify any functional impairments and will build a plan to help you to return to optimal and enhanced function.
Boissonnault J.S. & Blaschak M.J. Incidence of Diastasis Recti Abdominis During the Childbearing Year. Physical Therapy July 1988vol. 68 (7), p 1082-1086
Benjamin D.R, van de Water A.T.M. [Effects of exercise on diastasis of the rectus abdominus muscle in the antenatal and postnatal periods: a systematic review.] Elsevier 2014. Physiotherapy 100 (2014) 1–8. http://dx.doi.org/10.1016/j.physio.2013.08.005
Chiarello, C. M.Research Study: The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women’s Health Physical Therapy: 2005:29(1), p 11–16.
Chiarello C.M, Falzone L.A, McCaslin K.E, Patel M.N, Ulery K.R. [The effects of an exercise program on diastasis recti abdominis in pregnant women]. Journal Women’s Health Physical Therapy 2005; 29:11-6.
Coldron, Y., Stokes, M.J., Newham, D.J., Cook, K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008 May;13:112–121.
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How does the diastasis recti happen during pregnancy?
Diastasis rectus separation occurs due to a number of reasons:
Release of the hormone relaxin
Stress of weight gain and tension on the linea alba
Chronic increased intra-abdominal pressure due to cough, pressures during excessive bowel movement straining and pregnancy, for example
Weakness of abdominal muscles