The Starter Guide to Diastasis Recti (DR) aka. ab separation during pregnancy and postpartum recovery.
All you need to know about ab separation aka. 'the gap'.
I have been working with pregnant, new and seasoned mamas on safely staying active during all phases of motherhood for many years now. One of the most talked about subjects is Diastasis Recti and Pelvic Floor health! Firstly because most Mamas will experience DR in some degree and secondly because it can alters the way the core functions which may lead to physical discomfort or pain, especially when it stays untreated. The function of the core ties into all movements and daily activities from breathing, to raising your arm and all compound movements. You see the core is one of the most important systems in the body. Knowledge is power - knowing what these changes can look like in the body and how to adjust daily life to accommodate them will support the body in the transition through motherhood. Pregnancy, birth and the recovery phase is tough as it is. Let's prevent additional injuries, discomforts or pain.
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What is DR?
How is diastasis recti identified?
Diastasis Recti during pregnancy and postpartum
Did you know that ab separation is the natural way of the body to create more space for the growing baby (or babies)? It is most commonly found in pregnant and postpartum women, but can also occur in infants and men. Since most Mama's will have to deal with it, knowing how it can effect your body during pregnancy and after birth, how to prevent worsening of the gap and how to accelerate it's healing can make a big difference in your quality of life.
Small changes in your everyday life, posture and breathing can make a huge difference in your DR. Let's dive into it.
What is Diastasis Recti?
It is the separation of the abdominal muscles (rectus abdominis or 'six pack muscle') that runs vertically along the midline of your body along the belly button. The connective tissue between the two halves of the rectus abdominis muscle, called the linea alba, thins out, stretches sideways and therefore is weakened. The core is a pressure system and works as a unit and as one part is weakened, the whole system is weakened. After delivery it will usually take 6-8 weeks for the tissue to recover and the gap to close up. The healing time may vary dependent on the severity of the gap, the integrity of the tissue and many other factors unique to each birth parent. Around the 6-8 week mark tests are most commonly conducted to measure the width of the gap. If the gap is smaller than two finger width, it is not considered DR. A gap wider then two fingers width is considered DR. (Keep reading for more in-depth information on testing options and details on what other variables need to be taken into consideration when testing for DR.)
You may see other articles referring to ab separation as DR or DRA (Diastasis Recti Abdominis)
Why does diastasis recti occur?
As the baby (babies) grows during pregnancy, the body needs to create more space to accommodate and DR is one way of how the body does so. To do so, the body releases pregnancy hormones (relaxin) to allow tissues to stretch more easily to prepare the body for pregnancy and birth.
Will I get DR?
Most likely. DR is detected in most pregnant women around the third trimester into the postpartum period. While DR is extremly common in pregnant and postpartum women, it can also be seen in infants and men. The increased outward pressure against the abdominal wall combined with the pregnancy hormone relaxin will allow for the expansion of the tissue. Diastasis recti itself is not painful. Discomfort or pain may be associated with some of the side effects of diastasis.
What are those side effects or symptoms?
Common symptoms or side effects for DR can be: lower back pain, pelvic pain, painful sex, a visible bulge or "pooch" that protrudes around the belly button area, leaking of any kind when lifting, sneezing or coughing, constipation, feeling weak in your abdominals, coning or doming when contracting the abdominal muscles.
How do I know if I have diastasis recti?
There are some common signs that can signal you have diastasis recti. One of the most common signs of diastasis recti is a bulge in your midsection that doesn't go away, even after exercising or losing weight gained during pregnancy. Another sign is that your belly cones or domes during any 'high pressure position' for the core, like a plank hold or crunches. You can check for diastasis recti on your own, but it is always a good idea to speak with your healthcare provider about your symptoms.
When and how can DR be diagnosed?
Check with your healthcare provider, OBGYN or pelvic floor specialist to get a medical opinion. Most OBGYNs will test at the 6-8 week postpartum check up. There is no benefit in testing earlier as it can be expected that some softness, separation or both are still present. In the early postpartum periods taking all precautions to allow the core to heal and recover without adding additional stress, is a good idea.
To test on yourself, here are the instructions for a simple self test.
To perform a self check:
Lie flat on your back with knees bent, hip width distance.
Place the fingers of your left hand, fingertips facing down, just above your belly button.
Inhale. As you exhale, lift your head 1 inch off the floor (Only 1 inch to avoid wrong reading). Use your fingers to feel for the width of the gap and the depth of the gap (integrity of the tissue). Meaning: how many fingers can you fit in the gap next to each other. And how deep do your fingers push into the gap. Do your fingertips disappear? Your full finger nail? Or can you push your fingers into the gap to the first or second knuckle?
< 2 fingers wide (2.5 cm): No Diastasis is present.
> 2 to 3 fingers wide: Diastasis is present.
It is important to note the integrity of the tissue as well as the widths of the gap. While the definition of DR is mainly based around the width of the gap, the strength and elasticity of the tissue play an important role in the control of your intra abdominal pressure and overall core strength.
While opinions and recommendations differ between Physitians and pelvic floor experts what conservatively supports the healing of ab separation, studies have shown that supporting the functionality of the core is key. Closing the gap is a secondary goal, as it is not always necessary in order to regain the ability to create tension. Connecting to the deep core using breathing exercises and tactile feedback will support your functionality.
What does it mean to have a 'functional DR'
Functional DR means that your core can still perform its main functions even with gap or weakened tissue. For example a sign that you might have functioning DR is that you can still create tension across the linea alba and manage the intra abdominal pressure to stabilize your core.
How long does DR take to heal?
While many mothers get 'medical clearance' from their doctor around the 6-8 week mark after birth, DR may not fully be healed. DR and its severity is influenced by many factors, such as:
DNA
Elasticity and integrity of the tissue before pregnancy
Size of the baby
Size of the mother
Number of pregnancy
Number of babies
etc.
DR can be effected by above mentioned factors, but also seems to be very dependent on many individual factors and outcomes. A petite mama carrying a baby to full term, can cause more DR, but is not a safe situation to expect it. Mothers who make adjustments to their daily life, according to DR recommendations to prevent worsening of the gap, focusing on proper alignment and strengthening the deep core are more likely to see progress in their recovery. Overall, the recovery can take anywhere from a few weeks after birth to many months or years. Resources like 'New Mama Fitness Programs' to recover the core and restrengthen the tissue have been shown to support a healthy recover. In rare cases mother may need additional or medical support to recover your DR. It is also never too late to recover your ab separation. Even if you gave birth years ago - you can still strengthen your core now and work on eliminating any symptoms.
5 signs that your DR is improving
Your gap is getting smaller (fingers width size of the gap)
The depth and tension of the tissue is improving
Overall core strength is improving
Physical changes may include: flatter lower belly, less pouch
Less coning and doming of the abdominal wall during exercises and daily activities
Simple tips to support the healing of your DR
Roll onto your side and push up onto your arms when transitioning from laying down to sitting or standing up
Avoid high core pressure activities (plank holds, crunches, etc.)
Initiate full body or loaded movements on the exhale to brace your core first
Learn to engage the deep core
Check your posture and align yourself optimally during your daily activities
What are the best exercises for diastasis recti?
To support your core in the healing process, it is recommended to start with deep breathing, followed by stabilization exercises and low impact movements. Once you can engage the deep core and know how to manage the intra abdominal pressure when stabilizing your body, you can add light resistance and load to keep restoring the core. The New Mama Fitness Program is a program designed to walk you through all steps considered important in rebuilding your core:
Posture and alignemnt
Core anatomy
Deep core engagement:
Diaphragmatic breah
Connection breath
Core compression
low impact, low resistance movemement
progressive and controlled exercises including check ins, modifications and guidance
What movements are not recommended with DR?
Can DR be prevented?
As mentioned earlier, DR is the natural way of the body to create more space for the growing baby. While research about DR is limited, the ab separation seems to be present in most pregnant women by the third trimester and into the forth trimester and beyond. The following precautions may reduce the risk of worsening 'the gap':
modifying daily activities according to the phase of pregnancy or postpartum recovery.
looking out for signs and symptoms that may indicate that a specific movement is not optimally supported by the core and modifying accordingly.
focusing on optimal alignment in exercises and during daily tasks.
practicing deep core engagement to manage the intra abdominal pressure properly during daily movements.
initiating movements on the out breath to create optimal deep core engagement.
healing of any kind is best supported with sufficient hydration, nutrition and rest.
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