The stretching out and thinning of the abdominal muscles and connective tissue allows a woman’s belly to grow into the beautiful, round shape of pregnancy. An understandable concern for a woman is how pregnancy will change the function and appearance of her abdomen postpartum.

Pregnancy affects the abdominal wall muscles, often causing them to weaken in a process known “Diastasis Recti”

The most superficial muscle on the abdomen is called the rectus abdominus. This is the ‘six pack’ muscle that can be seen on some people. There is a ligament that runs in between the right and left sides of this muscle (called the linea alba). When the amount of distance between the right and left abdominal muscles (rectus abdominus muscles) expands, women can develop a noticable abdominal separation known as diastasis Recti (aka “DR”).

Diastasis Recti is a normal part of pregnancy and approximately 100% of women will have it in their last weeks of pregnancy.

In the days, weeks and months postpartum, one of the priorities for the body is to close that separation. By 6 months postpartum, approximately 60% of women will no longer have DR, but 40% still will.

What are the symptoms of Diastasis Recti? There are two considerations when discussing symptoms of postpartum DR. One is function and support of the abdomen / trunk, and the other is appearance.

Because the role of the muscular and connective tissue of the abdomen is to contain the abdominal contents, support the trunk, and move the body around.

In some forms of DR (aka functional DR) women do no struggle with symptoms such as muscle weakness, pain, or abdominal hernias. Instead, the functional DR causes a separation of the muscles that may be aesthetically unpleasing. From an appearance stand point, a DR can cause the look of a larger abdomen that sits forward more than it did before pregnancy.

Women can also develop what is called a dysfunctional DR. In this form, you may be at higher risk of experiencing back and/or pelvic pain, weakness, or hernias. There also may be a link between dysfunctional DR and pelvic floor dysfunction such as urinary incontinence, but the research on this topic is not very clear and is still on-going.

Imagine the abdominal muscles and connective tissue like saran wrap. Pregnancy stretches out the saran wrap so after baby is born, the abdominal contents can sit farther forward than it did before pregnancy.

Having said that, not all excess abdominal tissue/fat is caused by DR. Especially in breastfeeding women, the body may store extra subcutaneous fat on the abdomen.

How do you know if you have Diastasis Recti? You can check by lying on your back with your knees bent, place 2 fingers in your belly button.

Very slowly, begin lifting your head off the floor. The very moment you bring your head up, feel for a muscular edge on either side of your fingers. This measurement gives you the width of your DR at rest. If you continue to the top of your curl up, you’ll feel the gap narrow. This measurement gives you the width during a contraction.

If you are able to place 2+ fingers between your muscles at rest or during a contraction, consider making an appointment with a Pelvic Physiotherapist who can more thoroughly assess your abdominal wall. They will consider not only how wide the diastasis separation is, but how much tension there is in the linea alba, how well it contains intra-abdominal pressure, and how well it’s able to transfer load from one side of the body to the other.

So how can I strengthen my abdominal muscles and help to improve my Diastasis Recti?

During pregnancy, although 100% of women will get DR, there are some alignment and exercise considerations to make sure it doesn’t become bigger than it must.

1. If you habitually find yourself thrusting the bottom of your ribs forward, try to bring them back in line with the rest of your body. Think “ribs over hips.” This repetitive exercise will help strengthen the muscles.
2. Stay active. Exercise during pregnancy has been shown to be protective to prevent developing Diastasis Recti.
3. There might be movements or exercises you do where you see a doming or tenting effect on your midline, A common movement that causes this doming is sitting straight up from lying on your back. This could mean that you are over stretching the linea alba – try to modify these movements or avoid them so that you don’t weaken the ligaments.

After your baby is born, give your body several weeks of true rest so that it can close up the abdominal wall and pelvic floor after birth. This is a tough one for some women who are keen to get back at the gym.

If a DR is still present beyond 6 months postpartum, the first thing to figure out is whether there is anything keeping the DR open and/or worsening it. An assessment by a Pelvic Physiotherapist will provide this information.

Next, there are certain exercises, and more importantly, certain strategies for movement that can help a diastasis to recover and heal over time.

Being able to coordinate breath, deep abdominal muscle contraction, and movement during exercise is the starting point for DR rehab. For example, try this exercise:

1. Kneeling on hands and knees, allow the belly to be very soft but don’t collapse through your low back.
2. Take a deep inhale by expanding your rib cage without letting the chest move.
3. On the exhale, draw the area below your belly button slightly inwards. Continue by “zipping up” your abdominal muscles until you reach the bottom of your rib cage.
4. Your spine should not move and you should not be holding your breath.
5. If this is easy for you, perform 10 times and repeat 3 times per day.

Remember – the goal for some people may not be to entirely close the DR gap, but rather to strengthen it and help it function better. After-all, your body did go through a miraculous transformation to create some pretty fantastic humans.

This post was authored by Jillian Palmer is a Pelvic Physiotherapist and a Mom of four wonderful children. She is passionate about improving the quality of care for women in pregnancy and postpartum. Her Pelvic Physiotherapy practice in Edmonton, Alberta, serves women throughout the lifespan struggling with pelvic dysfunction. You can find her @yeg_pelvicphysio and @pine_health_yeg

References:

Mota P, Pascoala A, Bo K (2015) Diastasis Recti Abdominis in Pregnancy and Post Partum period. Risk Factors, Functional Implications and Resoltion. Current Women’s Health Reviews 11,59-67.