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Diastasis Recti Evaluation and Management

What is it?

Diastasis Recti is the occurrence during pregnancy and postpartum women when the rectus abdominis muscle separates beyond normal and the linea alba, connective tissue does not provide sufficient stability and tension.. Diastasis recti however is merely a SYMPTOM. Throughout pregnancy the rectus abdominis muscle must separate at the linea alba to make room for the growing uterus and baby.



This is a physiologically NORMAL process that needs to occur. The rectus abdominis muscle runs along the front of the body from rib cage/sternum to the pubic bone. It is divided into two sides, the right and the left, by a band of connective tissue in the middle called the linea alba. This band of tissue begins to thin and pulls apart as the uterus grows during pregnancy. Oftentimes you will notice this in pregnancy by seeing coning when doing some core exercises or getting up out of bed or leaning backwards.



Diastasis recti occurs after the linea alba is overstretched and flimsy; this does not allow the right and left side of the abdominis to come back together. Usually after baby we begin to see our bodies start to tighten tension in the linea alba and begin to close the separation. This timeline can vary for every women. Usually we see it really start to change by 6 weeks postpartum if it is going to close on its own without intervention. If you are breastfeeding you may notice this timeline is delayed due to increased relaxin still circulating throughout your body. Usually at 6-8 weeks if Diastasis Recti is still present evaluation and management is needed to aid the closure.





There are a few things that can contribute to diastasis recti such as multiple pregnancies, especially if they are consecutive with no time to recover between them or repair prior diastasis recti. Having a baby over the age of 35 can be a contributing factor as well. Someone who is petite in stature and/or having a heavy or big baby. A vaginal birth can sometimes create diastasis recti due to the abdominal pressure used to push the baby out of the womb. Having multiples (ex. twins or triplets) can increase the risk of this condition.

Diagnosis of diastasis recti is usually done by your provider and they will use their fingers to feel the abdominal area. When checking the abdomen, if you have the condition there will be a gap or loss of muscle tone down the middle and right above the belly button. A gap spacing more than 2 centimeters is considered diastasis recti. I like to think of diastsis recti as a symptom because it merely tells the clinician that your core and diaphragm and pelvic floor are not coordinating properly together in order to close down the gap itself. Restoring proper function to the entire core system will help alleviate symptoms and diastasis recti. This must be very individualized per person.


Symptoms

During the postpartum period one of the signs of diastasis recti are a weak abdomen, difficulty picking things up, walking or performing everyday activities. Someone may also feel pain in the pelvis, hip, and low back along with possible pain during sex. Diastasis recti can contribute to poor posture and urination when sneezing or coughing. There are some visual effects that can be noticed mostly around the belly button. When contracting the abdomen a coning or doming look will show through the belly. You may also notice a softness or jelly-like feeling around the belly button.


There is a way of checking yourself for diastasis recti to determine if you want to seek out external help for this condition. You would start by laying on your back with knees bent and feet flat on the floor. To begin you will find your belly button and use two fingers to push down on the abdomen just above that. Then you will lift your head and shoulders slightly off the ground, so that the shoulder blades are off the ground. Use your fingers to press down and feel the space between your abdomen. You may use your fingers to follow up the abdomen to see how high up the abdomen the separation continues. If you feel a separation greater than about two finger widths and/or a deep space that your finger falls into, those are signs of this condition. Please take into consideration how far postpartum you are. As stated above In our office I usually do not even assess until 6-8 weeks postpartum.


Management

Diastasis recti usually resolves itself within 6-8 weeks postpartum depending on variable factors. About 40% of women will have this condition 6 months after giving birth. The best time to begin core strength is before you get pregnant. Build a strong foundation and fix imbalances prior to conception as well as imbalances throughout pregnancy help limit possible postpartum imbalances.


To fix diastasis recti you will need to perform gentle movements of the abdomen. Most of these exercises involve deep breathing and slow, controlled movements.


There are movements that can make diastasis recti worse. You should avoid picking up anything heavier than your baby. When getting up from the laying down position one should roll on their side and use their hands to get themselves up inside of contracting their abdomen to get up. Avoiding activities that push your abdominals outwards, such as sit ups, front planks, and crunches are very important to reduce further worsening this condition. When getting back into fitness postpartum it’s important to monitor imbalances and symptoms like diastasis recti during movements. ANything overhead, any core movements we want to make sure there is not gapping at the linea alba or increase in separation. Working with a trained provider to individualize and modify exercises will ensure the best results.


The amount of time it takes to heal depends on how wide the gap of separation is and how consistent you are with your exercises. Several weeks after postpartum the gap will start to close and you will start to regain your strength back. You should see progress if you are making lifestyle modifications and watching form when performing your exercises. If you have a cesarean you may need about two to three more months to recover before starting the exercises.


You may decide that abdominal separation is something that you can live with, however it is important to correct the separation before the next child. What I do want to reiterate is that the abdominal separation is merely just one symptom you could be experiencing but it could also be contributing to other ailments you might find yourself feeling such as low back pain, hip pain, pelvic pain etc.


It is never too late to start your exercise journey and repair your diastasis recti no matter how far postpartum you are. If you are thinking about conceiving or are already pregnant it is never too late to start building a core foundation with safe and effective exercises. Let us know if we can help!


When it comes to Diastasis Recti management because its so personalized it is always best to work with a specialized provider to make sure specific exercises are being done CORRECTLY with proper activation.


There are exercises and things we can do to make Diastasis Recti worse in the postpartum phase so here are some exercises to avoid.


Exercises to Avoid:

Sit- Ups

Crunches

Planks

Push Ups

Double Leg Lifts

Russian Twists

Bicycle Kicks


Any exercise where you notice hard separation or coning in the linea alba.





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