Diastasis recti would have to be one of the most commonly asked about conditions or concerns from pre and postnatal women. If you’re not familiar with what diastasis recti is it is defined as a the separation of the 2 muscle bellies of the rectus abdominis muscles (the six-pack muscles). Joining the two muscles is connective tissue (the linea alba) which runs from the bottom of your sternum to your pubic bone and connects the left and right side of the six-pack muscles. As your belly begins to expand during pregnancy the connective tissue that joins the abdominal muscles begin to stretch and thin causing the abdominals to separate to accommodate the growth of your baby.
The above definition of muscle separation can be misleading and confusing to some women as many think the muscles tear when they separate but in fact, they are still joined by the connective tissue. This tissue thins and stretches to allow for the growth of your baby and is a NORMAL part of pregnancy. It’s important to note that some studies report that diastasis occurs in 100% of pregnancies by the third trimester and that athletes, menopausal women and even men can get diastasis.
For most women, within 12 months after birth (more on birth recovery here) the abdominal muscles and connective tissue will return to a normal state. However, from some women, a diastasis (gap) and increased laxity of the linea alba remains which can lead to decreased function of the core and weakness in the abdominal wall. These changes cause the belly to fall forward from the weight of the abdominal and pelvic organs and often women complain of still looking 6 months pregnant even years postpartum. The great news is if you suffer diastasis recti with the right management and adjusted training strategies and movement you can manage and improve your function!
Can diastasis recti be avoided?
There is no definitive answer!!! It is not known what causes diastasis recti and we can only guess the risk factors. What we do know is diastasis isn’t caused by ONE specific exercise it’s much more multifactorial and complex than that. A range of factors may contribute such as genetics, inactivity prior to and during pregnancy, the effect of hormones like relaxin on the joints and tissues, posture, breathing and exercises that cause a build-up of intra-abdominal pressure. Diastasis recti is a very hot topic and I see many women concerned about their degree of separation (example I have a 4 finger gap) but it’s important to note that it’s not just about the gap!!! The gap width is just one part of the puzzle. We also need to consider the tension and function of the linea alba and the person’s ability to control intra- abdominal pressure. Intra abdominal pressure is the steady-state of pressure concealed within the abdominal cavity and this pressure if affected by moving our body through daily tasks like moving from sitting to standing, breathing, coughing, sneezing or exercise. When the pressure increases in some cases this causes weakness as it pushes on the abdomen or pelvic floor.
Loss of control of pressure on the abdomen results in doming or bulging of the abdomen and loss of control from pressure on the pelvic floor often results in bladder leakage or exacerbated symptoms of prolapse. The loss of control can be caused by factors such as form, movement pattern, posture, impacts on the body, muscle recruitment or pressure such as breath-holding and doesn’t necessarily mean the abdominal wall or pelvic floor is weak (although sometimes this is the cause) more so that the entire system is out of balance and uncoordinated which causes the pelvic floor or abdominal wall to not function as “normal”.
How do you heal diastasis recti?
I would first challenge you by asking what does healing mean to you? does it mean closing the gap? being pain-free? looking a certain way? being able to do a certain movement? feeling stronger?
You can still have a “healed” diastasis with a gap. If you are assessing yourself you might want to note how the connective tissue is feeling because its the quality, tension and density of the connective tissues that important. Is the tissue feeling taut? strong? when you press into your belly, exhale and lift your head is the tissue doming or bulging out?
It’s ideal to try and balance the pressures with their available structure or muscular work so when you do a daily task or exercise you don’t get bulging of the abdomen (loss of control of pressure) or incontinence or other symptoms.
Should I avoid certain exercises if i have diastasis recti?
Until research identifies the cause it may be best to modify or omit exercises that cause discomfort or increase symptoms like leaking, downward pressure on the pelvic floor or doming or coning of the abdominal wall. We know that exercises like front planks, sit-ups or other high impact activities increase intra-abdominal pressure but just going from a seated to a standing position increases your abdominal pressure MORE than any of those exercises and we are not over here telling pregnant women not to stand up!
Each of us are individuals, no woman or woman’s body is the same so a blanket restriction and flat out NO you can’t do these things or to claim that by doing them you will get diastasis recti or pelvic floor dysfunction doesn’t make sense! This attitude is why many Women end up BLAMING THEMSELVES for their condition or symptoms. Some women can plank in pregnancy or postpartum with diastasis without creating a loss of control of the intra- abdominal pressure or experiencing symptoms so why tell the woman who can that she should stop?
What to can i do if i experience doming, bulging, other symptoms of loss of control in pressure?
If you experience bulging in the middle of the abdomen, pelvic pain, incontinence, back pain during or after exercising then the exercise you are doing may require modification. It may be as simple as changing your posture, position, breathing, reducing the load, impacts or finding a strategy that works for you. This is why working with a pre and postnatal coach can be so beneficial because your coach will help you identify these issues and help you adopt a strategy so you can improve your function, reduce or eliminate symptoms or help you do the things you love! For further assessment and diagnosis it may be beneficial to see a women’s health physiotherapist to help get further information to assist in your recovery.