Diastasis Recti and Abdominal Separation
Condition Overview
Diastasis Recti Abdominis (DRA) is a widening or separation of the connective tissue (the linea alba) in the middle of the large superficial abdominal muscles known as the rectus abdominis (6 pack abs). The rectus abdominis runs from the sternum (chest) to the pubic bone, so a DRA can occur at any point along this connective tissue path.
DRA is more common in pregnant and postpartum patients due to the hormonal fluctuations causing softening and stretching of the linea alba. Muscles are also elongating from increased pressure on the abdominal wall to accommodate a growing fetus.
It is more common in the third trimester since this is when most growth takes place, but can be seen at any point throughout pregnancy and may last into postpartum. For instance, without intervention 80% of women have DRA at 8 weeks postpartum and 40% women continue with DRA at 6 months postpartum.
DRA can also be exacerbated by poor body mechanics, decreased core strength, and chronic straining with pooping or urinating and/or holding breath with activities.
Symptoms:
DRA symptoms include:
A visible bulge that protrudes above or below the belly button
An invagination (hole or valley) around the belly button
Coning or doming when you contract your belly (getting out of a deep chair or bed and bending/leaning backwards)
Feelings of unsteadiness and weakness through your core causing difficulty doing everyday tasks such as lifting, carrying, and walking or running
Low back, pelvic, or hip pain
Stress urinary incontinence (leaking urine with coughing, sneezing, laughing, jumping)
How Can Physical Therapy Help?
In a nutshell, our core system is made up of the pelvic floor muscles (PFM), the deeper abdominal muscles known as the transverse abdominis (TA), the diaphragm, and the low back multifidus muscles. When we have a lengthening abdominal wall and pelvic floor system due to a growing fetus, our core and pressure system may require extra attention and training to perform functions appropriately and support ourselves as it did prior to pregnancy. If any of these muscles are weak or overactive (too tight) this can inhibit function and result in a DRA. Therefore, in physical therapy we will train these systems to prevent or reduce DRA and maintain function throughout pregnancy and postpartum.
At Nola Pelvic Health, we offer a 4 session package of childbirth preparation - this typically works best for those who are not having many symptoms. However, if you are having symptoms this may be a good place to start and we can add sessions as necessary to make sure you feel your best throughout your pregnancy and onward.
In physical therapy, we will discuss all pelvic health related symptoms including bladder, bowel, sexual health, and gynecological history (including previous births and pregnancies). We will then do a thorough muscle assessment of the abdominals, the glutes, inner thighs, and pelvic floor. In your second and third trimester and/or 6 weeks postpartum we may perform an internal pelvic floor muscle assessment with your consent. Testing these muscles helps us determine their muscle tone, tenderness, strength, endurance, and coordination. A true DRA is a separation of 2 cm or more, so even if you attempt to test this at home it is a good idea to speak with a health care provider to get properly diagnosed.
Whether you have a DRA or not, we will teach you appropriate pressure management strategies, body mechanics to get in and out of bed/chair, lifting/carrying of kiddos or groceries, and begin strengthening deep core muscles as appropriate to improve tolerance to daily activities. From here, we will continue reassessing and progressing strength training as well as balancing with improved tissue mobility and tone to prepare for labor and delivery into postpartum. If you are coming to us postpartum, we will progress core strengthening to ensure you can return to prior level of function such as running, pilates, yoga, and strength training!
Reach out and schedule an appointment if you are looking for guidance through the process of pregnancy, labor, delivery, and postpartum!