Abdominal Diastasis

What is Diastasis Recti?
Your rectus abdominis (the “six-pack muscles”) is a pair of long, flat muscles that run vertically down each side of your abdomen. The two sides are connected by a band of connective tissue called the linea alba.
While you are pregnant, the linea alba thins out and widens in response to your changing hormone levels to accommodate the enlarging uterus. This, along with the increased laxity of the rectus abdominis muscle, causes the two sides to separate vertically down the midline.

After delivery when your hormone levels return to pre-pregnancy levels, the thinning of the linea alba generally improves and the muscles come back together. This usually happens by the time your baby is 8 weeks old. However, sometimes the tissues become so stretched during pregnancy that they lose some of their elasticity and ability to retract back into position. Studies show that about 40 percent of women have a diastasis at six months postpartum.
This gap in between your right and left rectus abdominis muscles can result in a rounded, protruding belly “pooch
After pregnancy, a diastasis recti results in a rounded, protruding belly ‘pooch’ when standing. Women often report still looking pregnant months after delivery. When you are straining- trying to sit up for example, it looks more like a ridge down your midline. The ridge may disappear or cave in when you lie down or relax your abdominal muscles.
A diastasis recti can lead to other problems including lower back pain, urinary incontinence, constipation, and pelvic or hip pain if not treated due to the lose of ‘core’ support.
You are more likely to develop a diastasis recti if:
• You have carried twins
• Had multiple pregnancies
• Had diastasis recti after a previous pregnancy
• Have a previous history of abdominal hernias
• Suffer with chronic constipation
• Have hypermobility syndrome
How can I tell if I have diastasis rectus?
Lie on your back with your knees bent and feet on the floor. Have your top rolled up so you can see your tummy. Tuck your chin in towards your chest and gently lift your head of the floor. If you have Diastasis Rectus, you will see doming or a ridge down the middle of your tummy. If you place your fingers by your belly button and apply a gentle pressure as you lift your head off the floor you will be able to measure the gap between the edges of the muscles. You can also check if there is a gap a few inches above and below the belly button on the midline. If this gap appears to be greater than two fingers wide or is deep with a soft base you should seek advice from a women’s health physiotherapist.
How do you treat a Diastasis Recti?
A women’s health physiotherapist can help you to improve the tension of the linea alba between the muscles to restore the ‘core’ strength and prevent the doming or ridging during activity. They will asses your posture, the length, width and depth of the separation and check for weakness or tightness in any other supporting muscles.
Treatment will involve posture correction– advice, exercises/stretches, joint mobilisations or massage, correction of any dysfunction of supporting muscles such as strengthening the pelvic floor muscles and gluteals and a clinical Pilates programme to restore the tension of the linea alba and strengthen the deeper tummy muscle, the Transversus Abdominis.
Is it ever too late to correct a diastasis?
No. With a thorough assessment and appropriate management, you can improve a diastasis recti even many years after you delivered your last baby. How long it takes to improve depends on the severity of your as well as your commitment to performing the exercises and correcting your posture.

Some useful tips!
• Avoid heavy lifting, pushing or pulling. If you do have to lift, push or pull try to activate your deep tummy muscles and pelvic floor first to support you.
• Avoid straining on the toilet. Sit with your feet on a step and lean forward to have your elbows resting on your knees.
• Avoid challenging abdominal exercises that would put strain on the midline of the abdominals such as full sit ups or double leg raises from lying.
• When getting out of bed, roll on to your side first before pushing up with your hand, avoiding the sit up motion.
• Avoid carrying your baby on one hip.
•If possible, try to get someone with lifting the buggy and car seat in and out of the car.

Remember if you are doing an exercise or movement and you see the midline doming or ridging you should stop the activity as you are currently unable to generate enough abdominal tension to perform it safely.