What is Diastasis Recti?

If you are postpartum, you might be familiar with the term “ab separation” or “mommy pooch.” But there is an actual term for this: Diastasis Recti. 

What is Diastasis Recti?

Diastasis Recti (DR) is the thinning of the linea alba, which is the connective tissue that connects the two sides of your abdominal wall. You have four abdominal muscles in the center of your body. These muscles include the rectus abdominis (the 6 pack abs), transverse abdominis (the deepest layer), internal obliques and external obliques (the lateral abs). 

The abdominal muscles work with the pelvic floor muscles to maintain intra abdominal pressure. Intra abdominal pressure is the amount of pressure in the abdominal cavity at any given time. The diaphragm (breathing muscle under your rib cage), pelvic floor and transverse abdominis work together as a canister to maintain this pressure. A diastasis recti can form when this pressure is not managed properly or on heavy exertion. 

Diastasis recti is normal and necessary during pregnancy to accommodate the growing baby. By 35 weeks, it is present in 100% of pregnant women. It can take 6-8 weeks postpartum to heal, but can still be present at 6 months to one year postpartum. 

There are many factors that influence diastasis recti, some of which we can control, and some we cannot. These include the size and positioning of the baby, genetics, exercise tendencies, pressure management strategies and posture, to name a few. 

How Can You Tell If You Have a Diastasis? 

Ever notice coning or doming in the middle of your abdomen when doing a sit up? That may be indicative of a diastasis recti. A pelvic floor physical therapist can perform an assessment to see how wide and how deep the abdominal separation is. Width is not as important as depth is. A deep diastasis recti tells us that you are not managing your intra abdominal pressure well. 

How is Diastasis Recti Treated? 

Diastasis recti can be treated by a pelvic floor physical therapist. 

Diastasis recti requires a whole body approach for treatment. This includes evaluating posture, breathing patterns, pressure management when exerting yourself such as lifting heavy objects, and how you activate your core. Let’s take a look at each of these in depth: 

Posture: 

Where is your ribcage in relation to your pelvis? Many pregnant and postpartum women tend to stand with their ribcage behind their pelvis which can increase stretch on the abdominal muscles and send pressure out towards the abdomen. We tend to do this when holding the baby. This is not ideal, especially postpartum when your abdominal muscles have been stretched for the last 9 months. By stacking your ribcage over your pelvis, your abdominal muscles are not in a lengthened position and are able to contract more efficiently. This also allows the abdominal muscles to coordinate with the pelvic floor muscles, which is necessary for regulating intra abdominal pressure. 

Breathing Patterns:  

Are you a chest breather or a belly breather? An ideal way to think about breathing to help regulate pressure is what’s called an umbrella or 360 breath. To accomplish this, when you inhale, your belly should expand, but you should also feel expansion laterally into your ribs and into your back. This allows for more uniform pressure management and does not put excessive pressure on the abdomen. 

Managing Pressure on Exertion:

Do you hold your breath when you pick up your baby or pick up the car seat? When you lift something heavy, do you feel pressure out into your belly or down into your pelvic floor? Can you coordinate an abdominal contraction with a pelvic floor contraction when lifting something heavy? Sometimes, weakness in the pelvic floor can be a contributing factor to diastasis recti. If you are working with a pelvic floor physical therapist, pressure management can also be evaluated through an internal pelvic floor examination. 

Core Activation:

When someone asks you to activate your core, what does that look like? Do you suck in which causes your upper abs to grip and your ribs to flare? Does your lower abdomen bulge out? Or do you have a nice uniform contraction that starts from the pelvic floor and acts like a zipper from your lower abs to upper abs? Learning how to properly activate the core is key to rehabilitating a diastasis recti. Once you have mastered this correct activation, you can apply it to your favorite abdominal exercises. This coordination can take weeks or even months to master, but it is a crucial component of diastasis healing. Loading the abdominal wall through core exercises has been shown to improve diastasis recti, but it’s important to receive a thorough assessment to find out which exercises are best for you. 

Yes, you can do crunches if you have a diastasis recti, BUT first you need to learn how to manage your abdominal pressure correctly.

Reach Out

If you would like to be assessed, do not be afraid to reach out to a pelvic floor physical therapist. They can perform an assessment to see how wide and help you. Feel free to reach out to me if you have any questions or want to schedule an assessment.