Diastasis Recti: What is it, Why Does it Happen, and How Can it Be Improved?

To begin, a quick anatomy lesson:

The outermost layer of one’s abdominal wall is made up of two halves of the rectus abdominis muscle that are attached in the middle by a band of connective tissue called the linea alba.  For women who have not been pregnant, a typical distance between the two halves of the abdominals is about 2 centimeters.

It’s no surprise that, during pregnancy, a woman’s body needs to expand to make room for her growing baby (or babies!).  One area where this takes place is in this space between the abdominal muscles.  When this space widens beyond 2 centimeters, it is referred to as Diastasis Rectus Abdominus, DRA, or Diastasis Recti.

Often pregnant women will notice their DRA when engaging their abdominal wall and notice a doming or indentation down the center (often above the belly button).   Does this mean something is wrong, or they haven’t been exercising their core enough?

Not at all!  By the 3rd trimester of pregnancy, between 66% and 100% of women will experience DRA, leading researchers to believe that this stretching is “functional” to provide essential room for growth.

There are certainly safe ways for pregnant women to engage their deep core muscles while pregnant, however because DRA is potentially necessary for uterine growth, the distance of the DRA is not likely to decrease until after giving birth.

How should DRA be treated postpartum?

While DRA during pregnancy is normal, the distance and depth of the separation should improve gradually in the first 8 weeks postpartum.  Research shows that, without intervention, if DRA remains past 8 weeks it’s likely to still be there at 1 year.  In other words, if a woman is still experiencing abdominal separation 8 weeks after she gives birth, that’s when she should seek specialized physical therapy.*

Although returning one’s abdomen to its pre-baby state is a goal of many postpartum women, function and stability (rather than appearance) is the primary goal in physical therapy.

Here are a few research-based, reasons to address DRA:

DRA correlates with decreased function

DRA correlates with increased urinary incontinence

DRA correlates with increased low back pain

In physical therapy to address DRA, we work to educate clients about several key topics including:

1.     How to avoid over-straining the deep core tissues (a quick hint: avoid Valsalva/ breath holds while completing daily activities or using the bathroom!)

2.     Working to safely generate tension through the linea alba.  Once we are able to appropriately engage the deep core muscles without compensations, we work to engage these muscles in various positions.

3.     Lastly, skilled physical therapy will work towards completing advanced movements that correlate with a woman’s goals.  If a woman needs to get back to walking, her needs and rehab will look different than that of a woman who is working towards return to running.

 In summary DRA during and just after pregnancy is likely a normal adaptation, but if it remains after 8 weeks- give us a call!

 *An 8 week timeframe to begin specialized pelvic floor postpartum physical therapy is specifically recommended for a woman with DRA that has not resolved on its own.  In an ideal world, ALL women would begin postpartum physical therapy 30 days after birth to prevent and address many other common concerns (like wound healing, preventing incontinence, and beginning gentle return to pre-birth activities).