A growing belly is one of the most apparent – and adorable – signs of pregnancy. Less obvious, though, is the potential damage caused by the expanding abdomen.
What is diastasis recti?
Diastasis recti is an excessive separation of structures of the anterior (front) abdominal wall. To accommodate for a developing baby, pregnancy hormones soften the muscles and connective tissue of the abdominal wall to make them more pliable. Stretching causes these structures to widen and thin, weakening them. As pressure from the uterus increases, the vulnerable structures can separate and create a diastasis.
The linea alba is a midline, fibrous band of connective tissue that holds the two halves of the rectus abdominis (or the six-pack muscle) together. Since it is the central connection, it is the primary structure involved in diastasis recti. When suffering from diastasis, the linea alba fails to become tense with contraction and becomes wider than what is considered to be anatomically appropriate.
While diastasis can occur in premature babies and those with excess abdominal fat, pregnancy is the most common cause and some degree of abdominal separation occurs in every pregnancy. However, women over age 35, women carrying a high birth weight or multiple babies, and women who have had multiple pregnancies are more susceptible to problematic separation.
What are the symptoms of diastasis recti?
The most apparent symptom cause by diastasis recti is a bulge in the middle of the abdomen where the muscles have separated. Even with weight loss, a bulge caused by diastasis will persist. This bulge may only be noticeable when the rectus muscles are tightened and contracted. Other symptoms include low back pain, difficulty lifting, and urinary incontinence (the ability to control bladder function).
How do I know if I have diastasis recti?
A healthcare provider can perform an easy exam to determine if diastasis is present and to what degree.
To test at home, lie face up with knees bent and feet flat on the floor. While slowly lifting the head and shoulders off of the ground (a “crunch” motion), place the fingers just above the bellybutton and feel for a gap. Measure the amount of fingertips that fit into this gap. Failure of the tissue to tense and/or more than 2.5 fingertips width is indicative of diastasis.
*Women should wait until the 4th day postpartum to perform this test.
**Contact a healthcare provider if there is any painful bulging.
What can I do if I have diastasis recti?
The separation caused by diastasis recti usually lessens within a few months after childbirth. However, this may not be the case for excessively wide gaps and/or chronically weak core muscles.
The best way to reverse diastasis recti is to strengthen the entire core. There are two key exercises for abdominal separation:
1) Transversus Abdominis Tightening: while this is a simple exercise, it can be tricky to do properly. The most common mistake is to suck in the abdomen without ever engaging the core. To properly tighten, pretend that the bellybutton is being vacuumed toward the spine. Or, think of how the core would tighten if it were about to be punched. The shoulders, chest, and pelvis should be stationary and breathing, talking, and smiling should all be easy to do during this exercise. Think of it like the core muscles giving the abdominal cavity a warm hug. This can and should be done with movement, especially twisting, lifting, pushing, or pulling.
2) Side Bridge: this exercise will help to strengthen the core (and the shoulders, arms, and gluteals!) without increasing midline abdominal pressure. It is important to avoid exercises that increase pressure on the linea alba and rectus abdominis, as they can worsen the separation. This means avoiding crunches, planks, straight leg lifts, and certain yoga and Pilates poses.
Abdominal binding can add some external support and create awareness of the lower abdomen, but it should not be a substitute to core exercises.
While the linea alba may occasionally be too stretched to return to so-called normal, the core can always benefit from strengthening and stability exercises. Proper alignment through chiropractic adjustments also ensures that the muscles are in the best possible position for strengthening. For any questions, please contact Dr. Sarah at firstname.lastname@example.org.