Understanding Diastasis Recti In Pregnancy & Postpartum 

Diastasis Recti (DRA), often referred to as abdominal separation, is a condition common in pregnant women and can also occur in men and infants. It’s characterized by the stretching or thinning of the connective tissue between the rectus abdominis muscles, causing the abdomen to protrude or even sink in towards the center. While it is prevalent in pregnancy and postpartum, many women remain unaware that it is a natural adaptation in response to pregnancy and are given little to no guidance on how to navigate DRA.

Understanding Diastasis Recti:  Diastasis Recti occurs when the linea alba, the connective tissue running down the midline of the abdomen, becomes weakened or stretched, causing a gap between the left and right rectus abdominis muscles. This separation leads to the characteristic bulging or caving in of the midline at the belly. It can be more noticeable when the individual engages in activities that increase intra-abdominal pressure, such as coughing, sneezing, straining, or performing certain movements. 

The most common cause of diastasis recti is pregnancy, particularly in the third trimester when the uterus expands, exerting pressure on the abdominal muscles and stretching the connective tissue. A study in 2014 indicated that 100% of women in their third trimester of pregnancy exhibited some form of diastasis recti. With numbers like this, it is safe for pregnant women to assume that they should expect some degree of DRA to still be present after having a baby.

The severity and degree of DRA can depend on additional factors including pregnancy with multiples, speed and extent of weight gain, and genetics. Even outside of the pregnancy population, individuals who experience rapid weight gain are at risk for DRA. When it comes to weight gain during pregnancy, we advise that you speak with your physician about what a healthy weight gain amount and timing looks like for you and your pregnancy. Some women will gain more weight than others, and they should not look to compare themselves to other women. Instead, they should embrace that their pregnancy journey is unique to them.

Genetics is another factor that can contribute to DRA, and this is something that is out of our control. Simply due to genetics, some women will have more laxity in response to the hormonal and body changes and their tissues may remain more elongated long-term. All women will have changes that occur and these changes likely will not go completely back to the pre-pregnancy state. It is a known that the uterus does not return to the original size after undergoing expansion in response to a growing baby.

Symptoms of Diastasis Recti:

The primary symptom of diastasis recti is a noticeable bulge, ridge, or caving-in at the midline of the abdomen, particularly when the individual engages the muscles in the abdominal region. Other symptoms may include:

1. Lower back pain
2. Poor posture
3. Urinary incontinence
4. Digestive issues
5. Pelvic floor dysfunction

When does DRA become a problem?

First, let us state that if you are recently postpartum and noticing DRA do not become discouraged or immediately start to believe that you are doomed. A lot of women are told after just being a few weeks postpartum that they have DRA. Although this may be true, diagnosing too early in the postpartum phase could be problematic and cause unnecessary fear for many women. 

For women who are breastfeeding, it is known that they may have a higher presence of laxity compared to those who are not breastfeeding. Breastfeeding has many benefits for both mom and baby, and we encourage women to continue breastfeeding. As they continue breastfeeding, it is important to educate that this can temporarily impact their recovery relating to the laxity of various tissues throughout the body. This should be taken into consideration when diagnosing and treating DRA.

During the postpartum phase, there will be some women who have a significant increase in the gap between their abdominal muscles and also increased depth when testing. For women with larger changes, they may experience a slower recovery and have some aesthetic concerns as well. In some cases, DRA can contribute or be related to pelvic floor dysfunction, low back pain, difficulty with performing daily tasks, and digestive issues. In the cases where DRA are impacting the postpartum woman, it is important that we consider the needs of the woman and address her concerns. Addressing her concerns should include education on a realistic timeline for healing, which can take months to years for some women. This education could also be providing assistance with addressing the postpartum changes and self-perception. 

Many women respond positively to physical therapy in the postpartum period to re-learn proper activation of these muscles and to assist with recovery. Even women who experience more severe DRA have been shown to benefit from physical therapy to improve their overall function, and aesthetics. Yet, there are some women who decide to have surgery to treat DRA. Some may choose to have the surgery to address their aesthetic needs and desires, and others to improve their overall function due to undesired symptoms. Nonetheless, it should be standard of care for all to undergo physical therapy prior to surgery to see how they respond to conservative based care. When surgery is chosen, physical therapy is ideal both prior and after the surgery to help women prepare and recover respectively.

Take Home Message:  Finally, it is critical to address that postpartum recovery takes time and oftentimes many falsely believe that once they deliver the baby their body should immediately go back to the pre-pregnancy phase. This leads to ridiculous recovery timelines and many disappointed women who feel as if they have failed. DRA  is a common yet often overlooked condition that can have significant implications for an individual’s physical health and self-esteem. By understanding its causes, symptoms, and treatment options, individuals can take proactive steps towards managing and treating DRA effectively. Whether through targeted exercises, physical therapy, or surgical intervention, addressing DRA can lead to improved core strength, posture, and overall well-being.

What to learn a self-assessment? Watch this video

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References:

Fernandes da 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. Man Ther. 2015 Feb;20(1):200-5. 

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