Diastasis Recti

So then, what actually is Abdominal Separation?

If you are pregnant or a new mum, then you may haveheard of abdominal separation or diastasis recti. Wondered what it is? Feeling overwhelmed by all the opinions and conflicting advice on social media? Then grab a cuppa and let me quickly introduce you to diastasis recti….

What is the Core? 

When I am talking about the core, I’m referring to the ‘corset of muscles’ surrounding the abdomen that stabilises and supports the spine and pelvis. It includes the diaphragm, the back muscles, the muscles on the abdomen side, its front (‘the six-pack’), the deeperlayers of abdominal muscles and the muscles that form the ‘hammock’ of the pelvic floor. It’s sometimes described as being a reflexive core –essentially it all works together. For everyone, and certainly after pregnancy, it’s helpful to work towards a core that functions correctly with your breath, your movement, and your pelvic floor; and, with training, hopefully one that eventually works optimally and without conscious effort.  After pregnancy, most women need to retrain their core function owing to physical physiological changes resulting from pregnancy and to better support the new repetitive movement habits (lifting, carrying, feeding) of a new mum. And, yes, you can still have a better-functioning and hopefully a reflexive core, sometimes still with separation.

Abdominal Separation

Abdominal separation is fairly common (and normal) after pregnancy as the tummy expands to accommodate baby. It is suggested that around 60% of women have abdominal separation within the first year postpartum and up to 33% of them live with it after that timeframe (Mommer, et. al, 2017)

The ‘rectus abdominus’ (the ‘six-pack’ muscle at the front of your abdomen) runs from your breastbone to your pubic bone and its two sides are joined by a fibrous connective material called the linea alba.(Getting all science-y: The linea alba is essentially made up of all the tiny tendons (aponeuroses) of all the core muscles.)  The linea alba attaches to your sternum and pelvis – so any movement of the ribcage and pelvis puts pressure/forces on your linea alba. (Bowman K, 2016) And, if you think of all the other muscles that attach to the pelvis and abdomen area (think legs, shoulders and arms) even the way you move your feet and arms affects the forces exerting on the linea alba.

‘Diastasis recti is not a tear in the muscle, but a distancing of a muscle from the linea alba’ – Katy Bowman, 2016 

When pregnant the rectus abdominis stretches up and down your tummy to accommodate baby bump. When it can’t stretch any further up and down, it can start to separate horizontally. The linea alba is not particularly flexible in this direction and it’s a bit like a piece of cling film stretching apart.  It can separate around the tummy button, or perhaps above and/or below it. 

What contributes to Diastasis Recti?

During pregnancy your intra-abdominal pressure rises due to your growing baby, which pushes downwards (pelvic floor), out (your abs) and sometimes up into your chest cavity (diaphragm). Relaxin and other hormonal changes from pregnancy may also contribute to abdominal separation. (Thabet, Alshehri, 2019)

If you imagine that your linea alba is a long thin triangle of stretchy toffee running down your stomach, there is a list of things that can push and pull on it and, over time, alter its shape: movements of the ribcage; movements of the pelvis, the obliques (as they connected to the rectus abdominus sheaths), the transversus abdominus muscles, the rectus abdominus, intra-abdominal pressures and babies and intra-abdominal fat. (Bowman, K, 2016)

There have only been a few studies on abdominal separation during pregnancy and in the postpartum period, all reporting varying prevalence of it. Little is known about the risk factors that may contribute to abdominal separation but aside of the physical forces as I listed above, other factors such as age, more than one baby, caesarean section, weight gain, high birth weight, multiple pregnancy (i.e. twins), ethnicity, and a mother’s childcare situation have been suggested. Diastasis recti is often described in relation to pregnancy, but did you know it also occurs both in post-menopausal women and in men? (Sperstad et al, 2016)Ultimately, the factors that contribute to abdominal separation are many and it’s not just pregnancy.

‘The Rec Check’ – How to check for Abdominal Separation:

There is a simple check you can perform on yourself around 6-weeks postnatal to see if you have abdominal separation – for a fabulous how-to video by the Female Fitness Academy please see below. You can also ask your GP/Midwife to check for you at your 6-week appointment. Do remember that the core is flexible andindividual to you: your pre-baby ‘normal’ may have been different to another new mum’s. Generally, a separation is considered to be over 2.4cm or slightly more than 2 fingers width.

What can I do if I am concerned that I have Abdominal Separation? 

As our bodies heal and realign after pregnancy, it is important that we have a core (abs/back and pelvic floor) that is functioning optimally with our breath and movement. Mild separation -as a result of pregnancy -may improve naturally as you heal postnatally. However, severe diastasis can sometimes take much longer to heal, and occasionally worsen if left untreated coupled with less advantageous movement choices.

A more severe diastasis may contribute to pain (sometimes in your back) as your core is not supporting itself optimally. You may be aware of the look of a ‘mummy tummy’, perhaps notice a hernia, or even sometimes visible ‘doming’ or ‘coning’. Abdominal separation can also contribute to longer-term postural changes which may detrimentally affect the lumbar spine and pelvic stability. Research has also shown that around 66% of patients suffering with pelvic floor dysfunction (such as incontinence and prolapse) also had diastasis recti. (Thabet et al, 2019).

There are some breathing and core exercises that are helpful to new mums, and these mainly focus on gently working the deep core, the transversus abdominus, alongside breath. These exercises are more Pilates-based, they avoid sit-ups, and they are also helpful for improving core function and improving abdominal separation. A myriad of other factors may also contribute to its improvement- just as they contributed towards abdominal separation- it’s not just about exercise choices, even how you breathe matters. Other contributory factors may include how (and how often) you move, nutrition, lifestyle factors (such as job-related factors i.e. are you at a desk or on your feet all day)/access to personal support/childcare, stress levels, rest and improving your posture/alignment. 

Sadly, there is no miracle ‘quick-fix’, but with time and effort, it is possible to have improved abdominal separation and a core with improved function. The ‘gap’ may never be back to pre-pregnancy sizing and that’s ok if it’s functioning (with no pain/hernia). By the way, did any of us actually ever check to see what our pre-pregnancy ‘normal’ was? 

If you are concerned that you may have diastasis recti or wish to improve your core function after pregnancy,then consider seeking out professional and individual advice from a Guild of Pregnancy and Postnatal Exercise Instructor’s Fitness Professional and/or a Women’s Health Physio.

It is so valuable for all new mums to book in for a Pelvic Heath check after pregnancy, and most Women’s Health physios will also check for abdominal separation. A pelvic health check and checking for abdominal separation is also super important before you consider a return to gentle, low-impact exercise after pregnancy in accordance with the Guild’s current recommendations on postnatal exercise

Top Tip: Postnatal women would be advised to avoid any ‘crunch’ or sit-up type movements (including backwards movement) – if you are getting up and down to the bed or floor, use your arm and lower yourself up and down on your side. And, always remember to exhale on the exertion.

Remember mama, you are doing great! Sarah x

Disclaimer: This blog post is designed to be informative and is in no way intended to replace the professional guidance of your healthcare provider. If you have any concerns about your health seek medical advice soonest and it is imperative that you speak to your healthcare provider before beginning exercise during pregnancy or returning to exercise post birth.

About the Author:

Sarah Pearce BSc is a Pregnancy and Postnatal Exercise Specialist – a personal trainer, fitness instructor,YourPelvic Matters/BREATHE instructor, YogaFit trainedand current Guild Committee member. Sarah first worked in sport and fitness professionally 15 years ago, and is passionate about providing a safe, kind, realistic and fun environment for women to exercise in. A military veteran of 16-years’ service, Sarah is mom to 2 energetic little boys (4 &1) and also a military spouse – currently posted to East-Coast Canada.  Follow Sarah on Instagram and Facebook @StrollerFiitor www.sarahlouisepearce.com

References/Further Reading:

Mommers, E, Ponten, J, Nienhujis, S, ‘The general surgeons perspective of rectus diastasis. A systematic review of treatment options’, June, 2 2017 available athttps://link.springer.com/article/10.1007%2Fs00464-017-5607-9

Sperstad, Merete Kolberg Tennfjord, Gunvor Hilde, Marie Ellström-Engh and Kari Bø ‘Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain’ BJSM Volume 50-17 2016 available at https://bjsm.bmj.com/content/50/17/1092

Ali A. Thabet and  Mansour A. AlshehriEfficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial’ JMNI, 2019 available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454249/

Bowman, K, ‘Diastasis Recti: The Whole Body Solution to Abdominal Weakness and Separation’ paperback – published February 1 2016

Mockridge, C, ‘Diastasis Detective’ BREATHE approach: CPD Course