Mother and Child - Diastasis Recti

What is Diastasis Recti?

Diastasis Recti is commonly known as abdominal separation or DRAM (Diastasis Rectus Abdominus Muscles). It is the separation of the connective tissue that runs down the middle of the abdomen and connects the two bellies of the rectus abdominus muscle. 

What are the causes of Diastasis Recti?

During pregnancy, the abdomen has to make room for the growing baby, which means that the abdominal muscles have to stretch. The pressure of the growing uterus as well as hormonal effects on the tissue can cause the linea alba (connective tissue) between the muscles to separate. 

Diastasis Recti can also happen outside of pregnancy in cases of weight loss after being overweight over a long period of time.

Is Diastasis Recti normal?

A small abdominal separation (2 finger width) is considered a normal change during pregnancy, with 100% of women having some degree of separation during or immediately after pregnancy. 

For some women, the separation will resolve itself without specific work after delivery. 

For other women, a separation means that the muscles of the tummy may be weaker, and can lead to bulging or doming and even pain or discomfort. 

Symptoms associated with Diastasis Recti:

  • Belly bulge or doming appearance in the middle of the tummy
  • The feeling of “core” weakness
  • Low back or pelvic pain
  • Pelvic floor weakness or incontinence

Multiple pregnancies without recovery of abdominal muscles in between increases the risk for developing diastasis due to repeated and prolonged stretch on the abdominal wall. 

How do I know if I have DRAM?

An assessment by a trained Physiotherapist, obstetrician, or midwife can usually determine the presence of abdominal separation after having a baby. 

Preventing diastasis recti

After having a baby, reducing excessive pressure on the abdominal wall can help to reduce the look and feel of DRAM. 

Generally, through pregnancy and early postpartum is best to avoid: 

  • Sit up type motions ie. when getting out of bed. Try rolling to the side and then pushing up as a safer alternative
  • Constipation and straining on the toilet
  • Heavy lifting
  • Crunches or sit-ups 

Gentle abdominal exercises that don’t involve ‘crunching’ can increase the strength and function of the abdomen, and reduce the visual concerns of the abdomen as well as the risk of developing other back or pelvic pains. 

Some women with a severe DRAM may have concerns about the cosmetic change to their abdomen, and surgical repair may be an option in these cases. 

Other tips for healing DRAM in the early period after having a baby include:

  • Wearing compression garments over the abdomen. A Women’s Health Physiotherapist can prescribe and provide abdominal supports or compression garments. 
  • Practice good standing position. You should be upright and tall, with a small curve in your lower back. Try to reduce excessive sway in the lower back and try not to push your hips forward. 
  • Pelvic floor and specific abdominal exercises – such as light pilates or exercises prescribed by your Physiotherapist. 

Diastasis Recti Workout and Pelvic Floor Training

For women with a Diastasis Recti, light rehabilitation exercises for your abdominal wall and pelvic floor muscles are usually prescribed by your healthcare professional. 

As it is important not to ‘bear down’ or strain in the early post-partum (especially with DRAM), it is best to be assessed and ensure you can safely do a correct pelvic floor contraction

Even with DRAM, further pelvic floor muscle exercises (including using pelvic floor trainers) can then commence once you know that you can comfortably ‘brace’ and support your abdominal wall using your deep abdominals and pelvic floor muscles.

Article written by
Laura Justin
Qualified and Registered Australian Physiotherapist
Women's and Children's Health
@thefamilyphysio 

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