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What is Diastasis recti?

Diastasis Recti, also known as abdominal separation or the tummy gap is very common during and after pregnancy. During pregnancy, the rectus abdominus (six-pack) muscles and the fascia (the linea alba) between them stretches to allow room for the baby to grow. Diastasis recti is characterised when there is widening and thinning of this fascia between the abdominal muscles to the point that a gap appears in the midline between these muscles. Note this is stretching, not tearing of the linea alba. Not everyone is aware that they have separation during pregnancy, but some studies have suggested that most women have some degree of separation by the end of the third trimester. However, is also worth noting that the prevalence decreased to 52.4% at 4-6 weeks postpartum and continued to decrease to 39% at 6 months.

What causes Diastasis recti during pregnancy?

  • Hormonal changes and increased mechanical stretch leads to softening of the linea alba.
  • Increased occurrence with twins
  • Other contributing factors
    • Multiple pregnancies
    • Obesity
    • Hypermobility 

Is it normal?

Yes. It is considered a normal part of pregnancy and should decrease in the weeks after birth as the uterus shrinks.

When is it abnormal?

It is considered abnormal to have greater than 2cm separation at 6-weeks post-partum.

What can you do?

We recommend having a 6 week check up with one of our Women’s Health specialist osteopaths who will assess your abdominal separation and the integrity of your pelvic floor (an more!) . Following this, your osteopath will be able to develop an individualised management and treatment plan and safely prescribe a postnatal exercise program for you to begin.

Our Approach at Meadowside Osteopathy

Due to the complexity of diastasis recti, the diagnosis, treatment, and management requires a thorough understanding and multifactorial approach. 

Firstly, a detailed case history that will cover:

  • Pre-pregnancy, pregnancy, birth, post-partum health
  • Pelvic floor function such as bowel, bladder dysfunction or uncomfortable intercourse
  • Other symptoms such as lower back or hip pain

 The osteopath with examine and assess the function of key anatomical areas such as:

  • The abdominal muscles – they play an important role in postural control, truck and pelvis stability, trunk movement and respiration. 
  • The pelvis and pelvic floor -pregnancy and birth will also have an impact on the pelvic floor’s structure and function as it plays a significant role in supporting the baby and pelvic organs. 
  • Respiratory diaphragm -there is a significant connection and correlation between the respiratory and pelvic diaphragms. During normal respiration such as coughing, laughing, or sneezing, the pelvic floor diaphragm will exhibit a symmetric change to match that of the respiratory diaphragm. Imbalance or dysfunction between the diaphragm and pelvic floor can lead to instability of the trunk, back pain, and incontinence. 

After we have made a full assessment the osteopath will discuss their findings and treatment plan which may include:

  • Hands-on treatment to the muscles and joints by an osteopath who specialises in women’s health. 
  • Advice on do’s and don’ts regarding movements that could aggravate the rectus diastasis. 
  • Individualised exercise plan that will help stabilize and strengthen your abdominal (not just rectus abdominals) and pelvic floor muscles to improve your balance and posture and make your trunk and spine more stable.

Useful links

Canadian physiotherapist @Phit Physiotherapy has done a great video on Diastasis rectus abdominus: Being (banana) split up the middle, a fresh (produce) perspective.

References

Benjamin DR, Van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar 1;100(1):1-8.

Hills NF, Graham RB, McLean L. Comparison of trunk muscle function betwen women with and without diastasis recti abdominis at 1 year postpartum. Physical therapy. 2018 Oct 1;98(10):891-901.

Phit Physiotherapy. DRA: Being (banana) split up the middle, a fresh (produce) perspective. Available from: https://www.youtube.com/watch?v=rVxAUOkb3M4 [last accessed 18/01/2021]

Michalska A, Rokita W, Wolder D, Pogorzelska J, Kaczmarczyk K. Diastasis recti abdominis — a review of treatment methods. Ginekologia Polska. 2018;89(2):97–101.

Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy. 2015 Feb 1;20(1):200-5.

Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Jun 20:bjsports-2016.