What is Diastasis Recti? (Its not all about the gap!)
Updated: Jan 15, 2019
When I was asked if I would write about diastasis recti for Rock My Style; helping women better understand and manage their post baby tummy symptoms, I was interested to see what information was already out there. After a few hours sat with the laptop, enjoying the fact that London is now hotter than Miami (where’s the pool view?!) I came across little factually correct information. It’s amazing that over half a million babies were born across England and Wales in the last year, with the majority of women suffering a degree of diastasis recti, yet it is still not widely known about or treated appropriately. My hope is that this blog provides some of the answers to your questions and helps you in the journey back to being you!
What is Diastasis Recti?
Diastasis recti or DRAM/abdominal separation/Mummy Tummy is the widening or stretching of the gap between the right and left parts of the rectus abdominis or six pack muscles. The split occurs at the linea alba, the connective midline where all of the abdominal muscles meet. This can cause less support for your back and organs, giving the pronounced tummy/coning or doming and back pain in some women. 100% of women have a degree of diastasis recti in the third trimester (Diane Lee 2013), after all, your body has grown a baby the size of butternut squash (29 weeks) to a small pumpkin (40 weeks)!
For some women the separation improves over the first 12 weeks but it can take a little bit more time depending on your own body and delivery. Recent research suggests that without the appropriate treatment the separation can remain unchanged from eight weeks postnatal to one year (Coldron et al 2008, Liaw et al 2011). Because the abdominal cavity has many muscles that connect to it, especially your transversus abdominus (deep core) and the pelvic floor muscles, a diastasis recti can also lead to pelvic floor problems such as urinary leakage and vaginal prolapse. These symptoms can be made worse if you return to high impact exercise too soon such as running, high intensity classes and weight lifting. It is always a good idea if you aren’t sure whether your body is ready to return to exercise to see a Pelvic Health Physiotherapist for a post-natal check up. For many women the return to high impact exercises begins at six months post-natal.
How Can You Check For Diastasis Recti?
There are lots of videos online to demonstrate how to check for a separation and it’s something quick and easy you can do yourself. It is not routinely checked at your six week postnatal appointment with your GP but if you have any concerns then ask for a quick check and they can refer you on to a Pelvic Health Physiotherapist for further assessment.
• Lie on your back with your knees bent and feet flat on the floor or bed • Relax your head and shoulders and place your fingers with the palm up towards you just above your belly button • Press down gently but firmly with your fingertips • Slowly bring your shoulders slightly off the floor • You will feel the abdominal muscles close in or tighten around your fingers as you lift your head • Don’t lift your shoulders up too high or hold the position • You want to feel for the edges of the abdominal muscles. You may need to use more than two fingers to do this.
The gap is measured in finger widths with 1-1.5 width gap or less to be expected. If it is bigger don’t worry, that is what the exercises and advice are aimed at helping! I would recommend the MUTU system website who have a great video of how to check your abdominals.
Can You Prevent Diastasis Recti During Pregnancy?
Sadly, abdominal separation is part of your body adapting for your growing baby so although you can’t prevent it you can certainly help minimise the effect. You will generally see a doming of the tummy when going to get out of bed or lifting something up. These signs usually occur in the third trimester during your pregnancy but may occur sooner in further pregnancies. The key things to make sure you exercise are your pelvic floor and deep abdominal muscles throughout pregnancy. I am a big fan of antenatal exercise in general because it keeps you active and physically conditioned for being able to adapt to the increasing load of the baby. It can also help prevent symptoms of pelvic girdle pain (PGP or SPD). Pilates is a common form of exercise that many women enjoy, my only bugbear with this is that it doesn’t take the place of you doing regular pelvic floor exercises.
My 5 starting exercises for Diastasis Recti (Ante and Post Natal)
Remember that it is not all about the gap! You want the abdominal muscles and core system to be working well together so that they can support your pelvis and spine in all the work it does on a day to day basis.
1. Posture A good posture is crucial for allowing your deep core system to work optimally. When sitting down try to make sure that your back is supported and your pelvic is tipped slightly forwards to your weight is through your sitting bones. Try not to slouch! When standing you want to ensure that you don’t let the lower back arch excessively which it may want to do as your centre of gravity shifts forwards with bump. Remember ribs over hips!
2. Pelvic Floor Exercises Your pelvic floor muscles run from your tailbone underneath to your pubic bone at the front a bit like a sling. It is one muscle that works both back and front at the same time to help control your bladder and bowels. My favourite technique is the ‘Back-Front-Lift’. Whilst sitting or lying down (any position) tighten the back passage as if to stop passing wind, at the same time imaging stopping the flow of urine and it all moving in an up and forward direction. Hold for as long as you can, no more than 12 seconds then fully relax. Try to repeat these ten times, three times a day. You can also add in quick ‘snaps’ for ten repetitions three times a day too. Useful tips – make sure you don’t hold your breath, overuse your tummy and bum cheek muscles or raise your eyebrows! Remember your pelvic floor is inside you therefore no one should be able to tell you are working it.
3. Transversus Abdominis This is part of your deep core system. It runs under bump and can be a contributing factor to a low sitting bump during pregnancy if it isn’t working optimally. Lie down on a mat or in bed with knees bent and feet flat on the floor. Take a relaxed breath in, allowing your tummy to gently relax outwards (diaphragmatic breathing) then as you breathe out, gently draw your belly button down towards your spine. Be careful not to use your whole tummy in this movement. You should feel the muscle just inside (quite deep) your pelvic bones at the front of your pelvis tighten in a small movement. Try and hold this for 5-10 second and repeat 10-12 times. If you find lying down too uncomfortable you can always try this exercise on your hands and knees on the bed.
4. Pelvic Tilts Stand up against a wall, with your feet away from the wall so that some of your body weight is supported by the wall. You may feel a gap between your lower back and the wall itself. Try tilting your pelvis so you flatten your lower back against the wall in a gentle movement. Try not to use your whole tummy or push too firmly. Hold for 5-10 seconds and repeat 8-10 times.
5. Deep Core Progression (Post-natal) Lying down with your knees bent and feet flat on the floor. Take a relaxed breath in and on the breath out, engage your transversus abdominis and gently bring one knee up to 90 degrees then slowly return it back down. Repeat this 8-10 times on each side.
Six Daily Lifestyle Tricks To Help Diastasis Recti
There are a few helpful tricks that can prevent a diastasis worsening and aid the recovery process.
1. Getting in/out of bed Make sure you use the right technique for getting out of bed. Try not to throw yourself up! The best way is to roll on to your side, drop your legs off the bed and use your arm to push yourself up. Make sure you keep breathing along the way. If you are struggling to stop any doming, support your tummy with your hand during the movement.
2. Picking things up Whether it be your toddler, the car seat or a kettle bell try to make sure than you bend down through the knees rather than from your back in a split squat position. Breath out and engage your pelvic floor gently as you lift then relax at the end of the movement. Again, use your hand to support your tummy if you need.
3. Good posture I mentioned this above in my starting exercises – same rules apply.
4. General exercise When to start exercising after delivery is very much dependant on you, the type of delivery you had and how you are feeling. It is advisable that you listen to your body and try not to feel pressured in returning to your pre baby exercise routine too soon. The exercises above can be started in the first few days post-delivery and performed within the comfort of your own home. Generally, after 6-8 weeks you may feel ready to start exercising, with post-natal specific classes being the best option to start with. You want to gradually increase your exercises levels and if you encounter any problems with how your lower back, tummy or down below then it’s a good idea to have a check up with a Pelvic Health Physiotherapist. Personal trainers with a speciality in post-natal rehabilitation can also be very helpful either in a 1:1 or group-based exercise setting; just ensure that you feel comfortable with the exercises provided and if not then it’s probably because they are not quite right for your body at that time. Speak up don’t try and carry on regardless!
5. Abdominal belts/splints/taping Abdominal support comes in many forms! If your diastasis is small you don’t need to be thinking about using these, however if you are finding that with day to day tasks you are feeling that you lack that support around your middle then these can be helpful short term. Some of the favourite supports from my clients are the JoJo Mama Bèbè support pants and leggings with the inbuilt tummy support. I also use abdominal taping for bigger separations to help take the constant stretch of the tissues and encourage better recruitment.
6. Nutrition It is important to have a nutrient dense diet and plenty of water to aid your body’s recovery. Your meals should be high in protein, complex carbs, high quality fats (try not to avoid ready meals/processed foods) and plenty of roughage. Avoiding constipation can really help to reduce bloating but also to prevent the need to strain emptying the bowels.
Remember that your post-natal journey is very specific to you. It is difficult in today’s society not to compare your progress or body to those around you, especially on social media but we don’t all recover at the same speed. There are so many factors that can affect this, some which are totally out of our control! If you have tried all the above advice and a few months down the line you still have concerns about your tummy then please seek the advice of a Pelvic Health Physiotherapist through the NHS or privately. We can help provide you with a tailored approach to your recovery and liaise with personal trainers to help you get the most out of your exercise programme whilst ensuring pelvic floor and tummy health. Our aim is to help rehabilitate your abdominal muscles to allow for optimal function and performance long term, the size of the gap is not always the key issue.