Diastasis Recti and the Do’s and Don’ts of Ab Separation
What is Diastasis Recti?
Diastasis Recti Abdominis, or DTA, or “Split abs”, is one of those medical terms you start hearing when you are pregnant. But what does it mean, and should you be concerned?
The quick answer is that it is a fancy term that refers to a separation of abdominal muscles. This can happen during or following pregnancy.
It means the uterus under the abdominal muscles is growing larger with the baby or babies. And in order to make room, the muscles separate as the uterus pushes outward. Kind of like a curtain separating to let someone come through it.
Sadly, the product of this separation is usually a stubborn bulge of the belly where the muscles have separated. And this becomes the famous “Postpartum Pooch” that you were probably told about.
Is it dangerous?
Having muscles separate definitely sounds like a scary thing, right? But in reality, about one third of pregnant women have this separation. Many of them aren't even aware they have it. For many women, diastasis recti is simply a fact of pregnancy. Havin said that, it’s not necessarily painful. Or should we say, not more painful than anything else that’s going on when you’re pregnant!
It’s the body’s natural way of accommodating the growing uterus and baby. It’s not dangerous to the mother or the fetus. Of course, having your abdominals disrupted in this way is sure to have some effect on the body. It disrupts the integrity and strength of the abdominals and hinders their ability to hold us upright. This means other muscles have to work overtime in order to make up for this weakness. These muscles happen to be in your back. So very often, back pain is a major symptom of diastasis recti.
How do I know if I have diastasis recti?
So now that you know what diastasis recti is, the next question you’re asking is definitely if you have it. There are some self-examination tests you can do to determine if your abs have split. But generally, it is best to check with your obstetrician or midwife, if you are concerned.
Here is how you can check yourself if it’s likely that you have diastasis recti:
1. Lay on your back with your knees bent, feet flat on the floor
2. Place your hand just above your bellybutton, with your fingertips touching your belly and your palm facing you
3. Start to do a partial sit-up so that your abs start to engage and your ribcage moves closer to your pelvis
4. Press your fingertips gently into your abdomen
5. See if they sink in, and how far. How many fingers wide is the gap?
6. Repeat this test just under your belly button and even as high as your solar plexus
If your fingers sink in at all, you may have some level of separation. The number of fingers wide the gap is, tells you the severity of the separation. There is no set distance that determines if you have it. Although it is generally accepted that any gap about 2 fingers wide is considered diastasis recti.
Can diastasis recti be fixed?
If you have diastasis recti, your next question might be what to do about it. Not to fear. Many of the separations heal all on their own in the 4 to 6 weeks after birth. The body can often repair this separation as part of the general adjustments it makes after birth.
Unfortunately, for some women, the body isn’t quite able to repair the gap on its own. The gap may be painful after birth and certain physical tasks cannot be performed without hurting. Specific physical exercises or even surgical intervention may be necessary.
What can you do?
There are definitely things you can do to increase your chances of a smaller gap, or a gap that heals. Here are some do’s and don’ts if you find yourself with diastasis recti:
- Take extra caution during pregnancy not to over-strain your back muscles. They are doing the majority of your posture work. Sit up without scrunching your belly by rolling to the side and using your hands to help get you upright.
- Practice gentle transverse abdominal training and oblique training once your doctor or obstetrician clears you for postpartum exercise (usually around 6 weeks post partum)
- Start with gentle exercises like pelvic tilts, heel slides, and toe taps
- Don’t do ab exercises. This might seem counter-intuitive, but ab exercises like sit up’s actually target the wrong muscles and can even make the problem worse.
- Don’t do any back-bends or other spinal extensions. This strains the abdominals further and could also make the problem worse
- Don’t inhale while you strain during exercise or just in daily life. Try to consciously exhale whenever you’re in a movement that requires effort, to decrease compression on the abdominal cavity
First steps to healing diastasis recti
The first option at treatment should normally always be exercise. It has a great rate of success. You need to make sure to give yourself enough time though. Many women get impatient and without doubt, it will take a lot of time. Since diastasis recti is usually more cosmetic problem than a functional one, do not rush yourself. The healing process is different for every woman and can take years.
Seeing a physiotherapist who specializes in pelvic health can be helpful after birth for many reasons. Plan a visit if you have the time and means. A physiotherapist can design an exercise program tailored to your situation. This way you can be sure the exercises you are doing are not harming you any further.
Some doctors suggest that women with separated abs should wear an abdominal binder. This has been quite controversial because it’s only a temporary solution. The muscles will need to be strengthened again eventually, not just artificially supported.
When to seek professional help
You should consult with your doctor, OB, or midwife anytime during your pregnancy or after birth if you’re concerned. It’s much more urgent if you are more than 8 weeks postpartum and still feel a significant gap. Your doctor will assess your unique situation and may even recommend abdominoplasty, if necessary. This is a surgery that would repair the abdominal wall, if the separation is severe and nothing else has helped.
It is important to weigh the pros and cons of surgery very carefully. You might not have the desired results, even after surgery. You will have scarring and the recovery time is lengthy. There are, of course, situations where surgery is necessary. But give exercise and physiotherapy a chance first, if possible. It will greatly help in most cases.
So, if you discover that you have diastasis recti, don’t panic. Exercise and physiotherapy usually have solid success in helping with ab separation. Give yourself time to heal and don’t rush the process. Anticipate that it will take time. The best thing is prevention. Taking care of your body during and after pregnancy will go a long way.
Be sure to avoid heavy lifting while you are pregnant, as it can make the ab separation worse. Keep your core strong during pregnancy and inform yourself about which ab exercises you can do safely while pregnant. If you choose the wrong ones, you might worsen the condition. So, to be safe, avoid crunches and planks.
It is normal for your body to change during pregnancy. After all, you are getting ready to birth a human. Be gentle with yourself, understand your limits, and give yourself a lot of time to heal after birth.
Physical Therapy, Volume 67, Issue 7, 1 July 1987, Pages 1077–1079,https://doi.org/10.1093/ptj/67.7.1077
Rectus abdominis diastasis, Javed Akram &Steen Henrik Matzen, Pages 163-169 | Accepted 21 Oct 2013, Published online: 21 Nov 2013
Journal of Women's Health Physical Therapy: September/December 2012 - Volume 36 - Issue 3 - p 131–142