Diastasis Recti - What It Is and How to Treat It
Diastasis recti is a condition of the abdominal muscles that affects both men and women and even babies. The causes can vary, such as lifting heavy weights, lifting with poor technique or being overweight.
However, it is most common in pregnant women as the abdomen stretches to accommodate the growing baby. This stretching during pregnancy is normal and necessary, but when it fails to go back to normal after birth, then intervention is needed to help the muscles and tissue to heal properly. A women's health physiotherapist will be able to help resolve this condition with appropriate treatment or, in severe cases, surgery will be an option.
We'll look at what causes diastasis recti, how to tell if you have it and what you can do to treat it, even long after you have given birth.
What is Diastasis Recti?
In the simplest terms, diastasis recti is a separation of the abdominal wall muscles. You might have heard it called ab separation, tummy gap, baby tummy or mummy tummy. The full medical term is rectus abdominis diastasis.
The abdominal muscles, or rectus abdominis, are the ridge of stomach muscles also known as the six-pack muscles. Along with the lower back and pelvis, they work together to help us move and transfer weight. During pregnancy, these muscles naturally stretch and thin to accommodate the swelling uterus and fetus, and this makes them more prone to separation.
The process of the abdominal muscles stretching away from each other is normal during pregnancy, and should not be considered abnormal or cause for concern.
It becomes a problem when diastasis recti occurs and the muscles stretch apart and separate from the midline of your abdomen, where they are normally joined. The connective tissue, called linea alba, can be damaged, creating the possibility of a host of problems. Without the supportive structure of the abdominal wall in place, the internal organs can put pressure on the stretched linea alba. These organs can protrude and even result in a hernia in the worst case.
Diastasis recti is a common condition that often resolves itself 6-12 weeks after giving birth, but seeing a women's health physio can help to encourage quick healing. If left untreated, diastasis recti can lead to range of unpleasant problems such as
- pelvic floor problems
- back pain
- urinary incontinence
- painful sex
- pelvic or hip pain
How To Know If You Have Diastasis Recti
The most common cause of diastasis recti is pregnancy. It is normal for the stomach muscles to stretch in pregnancy, as your body makes space for the developing baby. As the fetus grows, the uterus expands and increases pressure against the abdominal wall. As a result of this pressure, the connective tissue stretches to accommodate the baby, increasing the space between the right and left sides of the muscle. Typically, this stretching develops during the second or third trimester when the fetus grows most rapidly.
A diastasis is a gap in the ab muscles of more than 2.5 cm or any visible bulging in the muscle on exertion. It most commonly occurs around your belly button, but it can happen anywhere along the midline of the stomach muscles, or even along the entire length of your abdominal wall midline.
Here are some ways you can tell if you have diastasis recti during pregnancy:
• In the early part of pregnancy, extra skin and soft tissue on the belly might be the only signs of diastasis recti.
• Feel your abdomen. Press your fingers firmly but gently on your tummy, just above your belly button. Feel for any bulging along the midline up your torso, particularly when you are participating in an activity such as exercise.
• Look at your abdomen. In some people you can see the outline of the abdominal muscles, and if there is a bulge in them, it will be obvious. For many women, it will appear as a ridge running vertically down the midline of your abdomen.
• Look for bulging when you are exercising, when you roll over in bed or when you get out of a chair or the car.
Sometimes you only realise you have diastasis recti when you develop pelvic or back pain.
However, it's worth noting that research has shown that there is no more lower back or pelvic pain in women with diastasis recti than other pregnant women.
Although pain in the pelvis or lower back are symptoms of diastasis recti, having pain does not automatically mean that you have diastasis recti. An examination by a pelvic floor physiotherapist will be able to put your mind at rest and determine whether your abdominals are stretching normally. At the same time, your women's health physio will also be able to diagnose the causes of any pain or other problems you are experiencing and to help treat them.
Postpartum Diastasis Recti
If your ab separation is not resolving after you give birth, you will need intervention with a trained post natal physiotherapist. The best time to test for diastasis recti is about two weeks after giving birth.
In order to self-check for postnatal diastasis recti, follow these simple steps:
Lie on your back, with your knees bent and your feet flat on the floor.
See if you can press your fingers right down into your stomach in any of the areas between your sternum and your pubic bone.
Then, press down above your belly button with your three middle fingers, place your chin towards your chest, and lift your head off the floor.
If you can feel a gap that’s the same size as your finger spread, you have diastasis recti, and you should seek help from a women's health physiotherapy specialist.
The most noticeable symptom of diastasis recti after giving birth is usually a bulge or "pouch" in your belly that becomes more pronounced when you contract your stomach muscles. You might have poor posture and have problems breathing or moving as you normally would. You might also have any or all of these symptoms:
- Pain in the lower back, hip or pelvis
- Weakened pelvic alignment
- Pain during sexual intercourse
Your women's health physio will also examine your abdomen as part of your Mummy MOT to ensure your tummy muscles are healing properly. If they find that you have diastasis recti, they will give you a personalised physiotherapy treatment plan.
How Do You Fix Diastasis Recti?
In many cases, the abdominal muscle separation that leads to diastasis recti will heal on its own over the weeks following birth. However, perhaps your symptoms are not resolving. Or maybe you just want a postnatal check up for your peace of mind to ensure everything is healing as it should. Maybe you gave birth several months ago - or even several years ago! - but you are having unpleasant symptoms.
In any of these cases, you should consult with a women's health physiotherapy practitioner who will assess your own personal situation and devise a bespoke treatment plan of exercises and movements to work on closing your tummy gap and resolve or reduce any problematic symptoms you are having.
They will even tell you exactly what you should NOT be doing in order to help heal your diastasis recti.
PelviCare Women's Health Physiotherapy is located in Greenwich, London, serving women across South London, East London, Essex, Kent and beyond.