Diastasi Recti Abdominis (DRA)
What is it?
Diastasis recti abdominis (DRA) is the occurrence when the rectus abdominis muscles separate beyond normal and the linea alba, the connective tissue does not provide sufficient stability and tension. This is almost guaranteed for the pregnant body to make room for the growing baby. It is physiologically normal to occur during pregnancy. All pregnant women will have some form of diastasis recti by week 35 in pregnancy.
Symptoms
During pregnancy, as the uterus grows the muscles of the abdomen expand and stretch which causes a separation of the muscles. Where these muscles separate you may feel a gap in the abdomen or a bulge poking through. The patient will most likely notice this most when tensing the muscles, for example when trying to sit up or get up out of bed. The patient may notice coning or doming right above the belly button. There is no reason to stress about this condition because it will not affect the pregnancy. It is important to remember that this is a normal process as the pregnancy is nearing its end stages.
Diastasis recti is a symptom of core dysfunction. So it is common if you have DRA to also experience weakened muscles within the abdomen. This can lead to low back pain. They may see difficulty picking up objects or doing other daily activities that require core engagement. Other symptoms include poor posture, constipation, and bloating. Diastasis recti can lead to a pelvic floor dysfunction as well.
There are a few different contributing factors to diastasis recti which include weight gain, baby size, number of pregnancies, and genetics. Another factor can be expecting more than one child. Women who are considered obese or petite are at risk as well.
The abdomen muscles are important for a few functions of the body which include posture support, movement, and breathing. Following a pregnancy a patient may notice that they are not as strong when it comes to normal postural control. They also may notice a change in appearance with the stomach muscles.
Assessment
We first assess for DRA in the supine position with the patient going into a slight crunch or deadbug. Depth and width is usually assessed above and below the belly button. We also like to assess it in a side plank position as this is a more functional core move. According to standards anything less than 2 fingers is considered fairly normal. The connective tissue closest to the belly button can be the last bit approximate and can often have the most depth.
Treatment
DRA is a symptom, not the cause of core dysfunction. For patients with DRA it is important to bring awareness to the breath and intra abdominal pressure during movement.
If DRA is going to approximate on its own it will do so around 6-12 weeks. Breastfeeding could delay or be a reason it approximates closer to the 12 week mark due to relaxin continuing to be present.
It is important to rebuild your core strength postpartum and improve the abdominal muscles with a gentle, but progressive exercise routine. Babies are born with diastasis recti and approximate or heal by progressing through natural movement patterns. We often like to go back to the foundations postpartum of breathing and movement to recalibrate the system and restart the building of the core again. Because it is a symptom its important that you find where the weakness and dysfunction lies within the core. It could be different for each person so individualized care is important.
Once you confirm that you have diastasis recti after giving birth, you’ll want to avoid the following these types of moves, which cause your abs to bulge out and put extra strain on your rectus abdominis including crunches, sit ups, and stretches where your abdominals are splayed.
Prevention
A patient can prevent diastasis recti by building core strength before pregnancy and during. Other ways to prevent diastasis recti during pregnancy is to refrain from contracting the core muscles, for example getting into a crunched position. When getting out of bed, roll to one side and use your upper body to push you up versus use your core.
During pregnancy there is not much prevention that can be done due to the physiological adaptation that is necessary to occur. We can however offer tools like breathing and basic core movement patterns to mitigate the symptoms of DRA and start to retrain your body.