Diastasis Recti Abdominus – What is it?
The Recti Abdominus are two connected muscles that run parallel down the front of your stomach; from halfway down the ribcage to the pubic bone. As your baby grows during your pregnancy, the connective tissue between these muscles can separate.
When this happens it is called Diastasis Recti Abdominus (DRA). It occurs most often near the umbilicus (or belly button) in the third trimester of pregnancy.
This change of tummy muscle during pregnancy may alter the usual line of action of these muscles, making it harder to produce enough force to do certain activities. This change in biomechanics can also put more pressure on the lower back and pelvic regions which may cause pain and discomfort.
Will I develop Diastasis Recti Abdominus during pregnancy?
It is important to note that all women will have a separation of their abdominal muscles during pregnancy, however, DRA is a significant widening of the linea alba or connective tissue which can be assessed by a Women’s Health Physiotherapist.
Factors that may increase the risk of developing a DRA are:
- Lack of exercise during pregnancy can contribute to:
- Having poor muscle tone
- Having a swayback posture
- Pelvic instability
- Multiple pregnancies or multiples pregnancy (twins, triplets etc)
- A history of DRA in previous pregnancies
- History of an umbilical and ventral hernia
- Excessively using the incorrect technique when doing abdominal exercises after the first trimester
What are the symptoms of DRA?
You may notice a bulge in the midline of your abdomen with movements that require ab strength such as getting up from bed or sit-ups. Other symptoms include:
- Lower back pain
- Pelvic pain
- Difficulty engaging your core muscles (abdominals)
- Cramps within the abdominal muscles
Why can you get lower back pain and pelvic pain with DRA?
The separation of the connective tissue can cause your abdominal muscle function to decrease. To compensate, your lower back and pelvic muscles will work harder, which can cause pain in the lumbo-pelvic region.
What does the research say about DRA?
From the research that has been done in this area, we know what up to 48% of women can suffer from lumbo-pelvic pain following the birth of a child. It is also known that increased separation of the tummy muscles can contribute to weaker abdominal muscles, an increase of lower back pain and pelvic floor dysfunction.
Therefore, it is important when assessing rectus abdominus separation, we also discuss any lower back and/or pelvic pain. We also use real-time ultrasound or an internal examination to assess your pelvic floor muscles for any dysfunction.
What not to do if you have a Diastasis Recti Abdominus
If you have noticed any increased abdominal separation since delivery, then you should avoid anything that worsens the bulging. Activities like lifting heavy objects, or lifting where you have to hold your breath and going straight from a lying position to sitting straight up in bed (like a sit-up).
Many of these activities can be safely done and modified if you are using the lower abdominal muscles (such as transverse abdominis) correctly and that is something a qualified physiotherapist can teach you.
How can Diastasis Recti Abdominus be treated?
Normally, the separation will lessen on its own within the first 6-8 weeks post-partum, but it is common for it to continue beyond this time.
The aim is to close the connective tissue, to avoid the abdominal bulging with increased tension and to restore normal movement.
It is important to keep in mind that everyone will heal at a different rate.
Exercise is often the first treatment option to repair DRA and at Wisdom Physiotherapy, we incorporate Clinical Pilates into our Clinical Movement Therapy classes.
The purpose of these classes is to:
- promote correct activation of your abdominal muscles
- get your abdominal muscles moving after being in a suboptimal position for a number of months
- increase blood flow to the area, and
- avoid increased intra-abdominal forces.
Exercises that are done without a professional supervising can worsen the condition. Often women will do core exercises such as crunches and twists with poor technique, which, unfortunately, can worsen the condition.
Postnatal Clinical Movement Therapy at Wisdom Physiotherapy in Nedlands is a safe and targeted way to help you get on top of this condition.
We have a team of experienced physiotherapists and a women’s health physiotherapist that can help you with your healing process and can tailor a specific program for you. The focus is to activate the deep stabilising muscles around your pelvis and core, with a gentle, yet progressive approach. Bring along your socks and gym gear, it’s time for you to take back your body!!!!
What else should I check?
Come to Wisdom Physiotherapy for your 6-week postnatal check-up with a women’s health physiotherapist and we will do the following:
- Thorough assessment (current and past history) to see if you have any symptoms or risks of abdominal or pelvic floor problems
- Use real-time ultrasound to see your lower abdominals and pelvic floor lift and check your technique. If required an internal examination can be completed.
- Education on what specific exercises you may require and how to incorporate these into your current exercise and daily routine.
- Discuss any pelvic floor, bladder or bowel symptoms and give you advice on how to manage these issues.