Diastasis Recti is a condition in which the rectus abdominus muscles separate but with no fascia defect during pregnancy. A protruding midline is a characteristic of Diastasis Recti, which is caused by an increase in intra-abdominal pressure.
The hormonal activity of hormones (relaxin, progesterone, and estrogen) during pregnancy, affects ligaments and joints in the body. Joints and ligaments become more flexible, and unstable. As the pregnancy advances, the uterus and the baby grow in size and weight, and stress is placed on the muscles and tissues of the abdominal wall. Because of the laxity of the linea alba (connective tissues), the expanding uterus stretches these muscles, allowing the abdominis rectus to separate more easily. Hence, because of these biomechanical and hormonal changes, females experience diastasis recti.
This separation between the muscles may range from a tiny vertical gap of 2 or 3 centimeters wide and 12 to 15 centimeters long, to a distance reaching 12 to 20 centimeters wide and extending practically the whole length of the rectus muscle. There is no consensus on the magnitude of the separation of DRA that is considered pathological. It doesn’t pain and occurs in 100% of females during pregnancy. Most common amongst females having multiple births, twin babies, or having a small pelvis as the baby will be placed more anteriorly during pregnancy. It regresses gradually after delivery in most females, although it can last beyond childbearing years in some females.
DRA is not limited to females and pregnancy, it can occur to newborn babies and males as well.
What are the Risk Factors?
Body mass index (BMI), weight growth during pregnancy, infant weight, and maternal age were once assumed to be risk factors. However, a 2015 study showed no link between these characteristics and the likelihood of developing the condition in pregnant women.
When it is a problem?
- A gap of over 2 fingers anywhere along the midline.
- In case, the midline is squishy and deep
- In case of any pelvic, hip, or lower back pain
- If you have any bulging, doming, or sinking of the abdomen during any exercise ****
DRA test at home
- Lie down on the back with both knees bent.
- Place the index and middle finger directly above the belly button.
- Raise the head and shoulders off the supporting surface just like you are about to perform crunches, and feel for any gap or dip under the fingers. Note the width and depth of separation.
- Lower the head and shoulders back to starting position
- Repeat this test 1-2 inches below the belly button, and about 3-4 inches above the belly button. ****
Diastasis Recti Postpartum Management
The gap tends to shrink in most women in the days following birth, but it may not go away for some unless a treatment regimen is followed.
- The truth is that there is no consistent, high-quality research to back up any exercise program or binder. In the first 6-8 weeks, natural healing is most likely.
- Prenatal exercise can help to maintain abdominal muscle strength and control, which can serve to reduce linea alba stress.
- Focus on the strengthening of back, pelvic and deep core muscles at least 3 times a week with the help of a physiotherapist.
- Include pelvic floor contractions , plank, isometric abdominal contractions, and conventional abdominal movements to gain the lost functionality. Avoid jumping, crunching, and twisting movements that can aggravate the gap.
- Avoid doing repetitive workouts or activities that cause the belly to 'dome.'
- Learn how to load the region without doming or straining by using the pelvic floor and abdominal muscles.
- Wear support around the abdomen in the first few weeks after giving birth, especially in case of pendulous abdomen or separation of more than 2-3 finger widths.
- It is important to educate females about DRA during prenatal visits in order to manage expectations, and limit their fears and worry about the birth-related changes.
Diastasis Recti is a normal part of pregnancy. The female body tries to create space for the growing baby and there is nothing they can do to avoid it. However, physiotherapists may use a variety of approaches and techniques to assist their pregnant and postpartum female patients maintain and improving strength and function. Pelvic floor physiotherapists are trained to create exercise and mobility plans that are safe and effective for promoting optimal physical function throughout pregnancy, preventing functional impairment, and preparing for childbirth.
