Diastasis Recti: the Hidden Enemy of Postpartum Fitness
The postpartum period can bring numerous physical challenges, one of which is diastasis rectus abdominis (often referred to as DR or DRA). DRA is a condition that affects the abdominal muscles, and can have a significant impact on postpartum fitness. In this article, we will explore what DRA is, what causes it, how to recognize it, and how to overcome it.
Understanding Diastasis Recti
Diastasis recti is a common, painless condition that usually begins in pregnancy, affecting the rectus abdominis muscles. These muscles, also known as the "six-pack muscles", run vertically along the front of the abdomen.
During pregnancy, as the uterus expands to accommodate the growing baby, the abdominal muscles stretch to make room. This stretching can lead to thinning of the connective tissue (linea alba) that holds the abdominal muscles together, resulting in diastasis recti.
It is important to recognize that the majority of women will develop DRA by the end of their third trimester, and this itself is not something to be concerned about. While we cannot prevent this stretch from happening, women can learn now to manage abdominal pressure during their pregnancy to reduce excess stress to the connective tissue.
After delivery, the abdominal muscles and connective tissue begin returning to their pre-pregnancy length. We see the fastest change in the first 8 weeks postpartum. However, around one third of women still experience some degree of DRA at one year postpartum.
Causes of Diastasis Recti
While pregnancy is the primary cause of diastasis recti, there are other contributing factors as well. Multiple pregnancies, carrying a large baby or multiples, or having a weak abdominal wall before pregnancy can increase the likelihood of developing diastasis recti. Additionally, improper lifting techniques/excessive stress on the abdominals, obesity, and genetic factors can play a role in the development of this condition.
Recognizing Diastasis Recti
Some women might be screened by their provider for DRA during a 6-week postpartum check-up. Other women might notice it themselves, often when they see a gap or bulge (sometimes referred to as coning or doming) in their abdomen.
Left: abdomen at rest, Right: coning present when raising head
If you are unsure if you have DRA, you can try performing a quick self-test
Lie on your back with your knees bent and feet flat on the floor.
Place your fingertips just above your belly button and perform a gentle abdominal crunch, lifting your head and shoulders slightly off the ground. If you feel a gap or a soft, squishy sensation along the midline of your abdomen, it may indicate the presence of diastasis recti.
Repeat above and below the belly button at midline as DRA can occur at any point along the linea alba.
A physical therapist specialized in pregnancy and postpartum can thoroughly assess for separation, as well as test your mobility, strength, and muscle coordination. If you suspect that you have DRA, consult with a physical therapist who can provide an accurate diagnosis and build a personalized rehab program.
The Impact on Postpartum Fitness
DRA can have a significant impact on postpartum fitness. The separation of the abdominal muscles weakens the core, affecting overall body strength. It can contribute to issues such as lower back pain, poor posture, pelvic floor dysfunction, and difficulties with activities that require core strength. Many women with DRA find it challenging to regain their pre-pregnancy abdominal strength and tone, which can be discouraging on their fitness journey.
Overcoming Diastasis Recti
While DRA may seem like an obstacle, it is possible to overcome it with the right approach and consistent effort. Here are some steps to help you on your journey to recovery:
Safe Exercises for Diastasis Recti
Engaging in appropriate exercises is helpful when recovering from diastasis recti. Avoid exercises that cause the abdomen to bulge out further. Opt for exercises that focus on strengthening the deep core muscles and are able to be done without abdominal coning or breath holding. The abdominal muscles have undergone a significant change through pregnancy and postpartum, so early exercises that help you reconnect with your core and breath are often beneficial before progressing to more advanced exercises.Seek Professional Help
It can be beneficial to seek professional guidance when dealing with DRA. Consult with a physical therapist or a specialized postpartum fitness expert who can assess your condition and provide a tailored exercise program. They can also guide you in using techniques like abdominal bracing and proper body mechanics to protect your core during daily activities.Proper Nutrition for Healing
A well-balanced diet plays a vital role in the healing process. Ensure you consume a variety of nutrient-dense foods, including protein, fruits, vegetables, whole grains, and healthy fats. Adequate protein intake supports muscle repair, while vitamins and minerals aid in tissue healing and overall recovery. Consider consulting a registered dietitian for personalized postpartum guidance.Staying Consistent and Patient
Overcoming DRA takes time and consistency. Be patient with yourself and celebrate small milestones along the way. Remember that everyone's journey is unique, and progress may vary. Stay committed to your exercise program and trust in the healing process.
Reducing Risk of Diastasis Recti in Future Pregnancies
If you're planning future pregnancies, there are steps you can take to reduce the risk of developing DRA. Engaging in safe exercises during pregnancy and practicing proper lifting techniques can help minimize the strain on your abdominal muscles. Additionally, consulting with a healthcare professional before and during pregnancy can provide guidance on managing DRA.
Do I need surgery?
The majority of women with postpartum DRA are able to manage it and recover with time and consistency. A small percentage of women may not see enough recovery with exercise and lifestyle management alone, and choose to seek a surgical solution.
A DRA repair is an extensive surgery that involves bringing the rectus abdominis back together alone the abdominal midline. This is done once a woman is done having children and the abdominals will no longer be stretched to pregnancy levels again.
There are a fair amount of restrictions for the first few months of recovery such as no heavy lifting or exercise that puts stress on the abdominal wall. Before someone considers surgery, I usually recommend sticking with a consistent exercise program for at least a year postpartum as there is often significant change that happens naturally with time and healing.
Conclusion
Diastasis recti may pose challenges on the postpartum fitness journey, but with the right approach, it is possible to overcome this condition. By incorporating safe exercises, adopting a nutritious diet, seeking professional guidance, creating a supportive environment, and staying consistent and patient, you can rebuild your core strength and function. Remember to consult with healthcare professionals for personalized advice and support throughout your recovery process.
Work with Remedy!
Erin Rahter is a doctor of physical therapy and is board certified in women’s health through the American Board of Physical Therapy Specialties (ABPTS). She is the owner and founder of Remedy Pelvic Health and provides physical therapy services in the San Diego area. Virtual services are also available throughout California. She specializes in women’s health, prenatal, and postpartum care.
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