The body undergoes many different changes during pregnancy. In the final weeks of pregnancy, the connective tissue (linea alba) widens between the "six-pack" (rectus abdominis), allowing the stomach to expand with the growing baby. Instead of a tightly knit "six-pack" configuration, the muscles begin to shift to each side, forming two separate groups. This is known as diastasis recti, which can be shortened to diastasis or DRA.
While this happens in almost 100% of women during their third trimester, the connective tissue can regain it's tension and return the rectus abdominis back to it's original configuration. However, studies show that 50-60% of women are still experiencing a diastasis recti six weeks after delivery.
Common, but Not Normal
Many new mothers are either told that a diastasis is common and nothing to worry about, while many others never even hear about what a diastasis is at all. At most women's 6 week checkup, they are not evaluated for diastasis recti, and are told to return back to regular activity and exercise. However, we cannot expect the diastasis to always heal on it's own -- especially when moms are not even aware that they have it to begin with. Studies show that more than 75% of those with an initial diastasis will still have it after six months, and even after a full year it hasn’t resolved for more than half of mothers.
Often, women are surprised when their stomach appears distended or flabby despite rigorous workouts. They might even notice "doming" or "coning" especially when doing things like sit-ups or even picking up their children. These are all common signs of a diastasis recti. Unfortunately these signs can be frustrating especially due to the prevalence of social media fitness gurus and celebrities posting their secrets on how they "got their body back."
Diastasis recti isn’t just a cosmetic issue. The abdominal muscles are an important part of your entire core. When one area is not functioning optimally, other areas have to compensate, which may lead to other issues. Diastasis recti has been correlated with other conditions like low back pain, incontinence, and pelvic organ prolapse. In fact, 2 in 3 women with a diastasis also reported either incontinence or prolapse.
Don't Believe the Media
If you search the Internet for information on how to "close" your diastasis recti, you will likely come across a lot of confusing and conflicting instruction. That is because resolving a diastasis is not a simple case of following a few key exercises to "close the gap". It is about retraining and rehabilitating the body to use all of the "core" muscles efficiently.
Not every exercise is inherently bad or good, it depends on the person! Each individual varies in how flexible or strong they are, how they move, and even how they breathe. Our bodies are amazing, unique, and adaptable. With all of the changes that occur to the abdomen during pregnancy, our bodies have to learn new ways of moving. After delivery, our bodies can sometimes need a helping hand to relearn how to function the most efficiently, without over-pressuring any one area.
So Who Should I Believe?
Although not every online diastasis guideline is perfect, research indicates that some activities can put quite a lot of pressure on the diastasis. These activities include exercises such as sit-ups or any "crunch" movement, jumping, running, and planking, along with other "normal" daily activities like sitting up to get out of bed, lifting and carrying heavy objects such as your baby! Some of these activities are unavoidable, but a pelvic floor physical therapist can help you learn to perform or modify these exercises or activities during and after pregnancy.
Pelvic floor physical therapists are trained to assess each individual and create personalized rehabilitation programs to address your specific needs. They can help you train your body to function without experiencing a loss of tension through any one part of the abdomen (or pelvic floor!). For some people, this new use of their core can allow the linea alba to regain much or all of it's previous shape, essentially getting rid of the diastasis. For others where the rectus abdominis may continue to be divided, they can still teach their body to manage the internal pressures without doming, gapping, or coning.
How Can I Tell if I Have a Diastasis Recti?
It’s relatively easy to determine whether you may have a diastasis with a simple home test. Lying flat on your back, let your fingertips find the middle of the abdomen, an inch or so above the navel. Lift your head up and move into a mini-crunch, feel the inner edges of both sets of abdominals. These should be pressed closely together in the midline of your abdomen. If you feel a gap of two finger-widths or more, it is a sign of a diastasis recti.
Recommendation
The majority of new mothers will experience a diastasis recti after childbirth but every mother experiences it during her third trimester. It is beneficial to see a pelvic floor physical therapist before or during your pregnancy to begin optimizing your core functionality, which could greatly improve your recovery time and ease after delivery. It is equally important to see a qualified pelvic floor physical therapist 4-6 weeks after delivery to assess whether or not you have a diastasis or other common post-partum conditions. Your physical therapist can help you safely return to doing the things you love, like taking care of the new addition to your family! The earlier you catch a diastasis, the better, but they can be improved or resolved years - even decades - after childbirth.
Additional Resources
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.
Dr. Sharon Thompson is a physical therapist at PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. Sharon combines a strong orthopedic background with her skill as a pelvic floor physical therapist. She is vocal advocate for those who suffer from pelvic floor dysfunction or pain, and is especially passionate about spreading hope and awareness about these conditions.