Diastasis Rectus:

What is it? How can it be treated?

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What is it?

A diastasis rectus occurs when the muscles of the rectus abdominus split at the linea alba, their connection down the middle of the abdomen. The most common cause of a diastasis rectus is pregnancy, with studies showing that 98-100% of women will show a gap in the muscles by week 35 of pregnancy.

Why does it happen?

As a pregnancy progresses, a women’s abdomen must expand to accommodate growth of the baby. The increased pressure on the abdominal wall will cause the muscles of the rectus abdominus, or “6-pack muscles”, to stretch at their attachments sites, leaving a gap between left and right muscles.

Will it go away?

Most women will see complete recovery by one year after giving birth. However, some women will see persistent symptoms after one year.

What does it look like?

In post-partum women, a diastasis rectus may look like a ridge of tissue that pooches out at, above, or below the level of the belly button, which often worsens in standing and with activities that increase abdominal pressure such as coughing, straining, lifting, or curling the trunk. The tissue may sink when lying down, creating a valley around the level of the belly button.

Is there anything I can do to prevent it?

Probably not. Studies have found that none of the following factors correlated with presence of diastasis rectus after delivery: pre or post-pregnancy body mass index, weight gain during pregnancy, baby’s weight at birth, abdominal circumference, and generalized hypermobility.

What are the problems associated with a diastasis rectus?

Presence of a diastasis rectus often indicates functional loss of the core muscles, which play an important role in stabilizing the low back and trunk. This can become problematic if it contributes to low back pain, pelvic girdle pain, pelvic organ prolapse, and urinary incontinence. Additionally, the cosmetic appearance of a diastasis recuts can make some women feel uncomfortable in their post-partem body.

Can I fix it by myself?

Activation of the transversus abdominus muscle, which is the deepest layer of abdominal muscles, can assist with reducing the diastasis. Finding and firing these muscles without assistance from a physical therapist or qualified post-partem trainer can be challenging. Here are some instructions to master the activation on your own:

  1. Lie on your back with your knees bent
  2. Find the muscle: place your fingers on your hip bones, and then roll them an inch toward your belly button on either side
  3. Cough to feel the muscle become firm under your fingers
  4. Take a deep breath in, and let it out slowly
  5. As you reach the end of your exhale, pull your belly button a little closer to your spine
  6. As you draw the belly button in, you should feel the same tightening of the muscles under your fingers as you did when you coughed
  7. Hold the contraction for 10 seconds while you continue to breathe normally
  8. Relax the muscle and then repeat the breath and contraction
  9. Repeat 3 sets of 10 repetitions, with about 2 minutes rest between sets
  10. Do 2-3 rounds of this exercise throughout the day

Follow this link for a video if you’re having trouble with the muscle activation:

https://www.youtube.com/watch?v=g5pJ_Os_5S8

While this may manage the diastasis for some women, others may have multiple factors contributing to the persistent symptoms, indicating an appointment with a physical therapist. Still other women won’t be able to manage the diastasis conservatively, and may require surgical correction.

How can physical therapy help?

A physical therapist will perform a comprehensive evaluation including the severity of the separation, as well as movement patterns, muscle stiffness, and muscle firing patterns which may be contributing to persistent symptoms. Your physical therapist will treat and design a home program based on your individual needs.

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