Abdominal Separation aka Diastasis Recti

WHAT IS IT AND HOW DO WE TREAT IT?

Abdominal separation or Diastasis of the Rectus Abdominis (DRA) is a common condition seen in pregnancy with some studies reporting as high as 100% at full term. This number drops around 50% at 6 weeks and 39% at 6 months postpartum.

WHAT IS DRA?
DRA is a normal and necessary process in pregnancy to allow room for the expanding uterus. It is a process that effects abdominal muscles and the Linea alba, the connective tissue that bridges the gap between the two rectus abdominal muscles (the 6 pack muscles). Stretching of the Linea alba leads to the separation of abdominal muscles during pregnancy and can be influenced by hormonal changes, your body size and shape, weight gain and the size of your baby. You may have noticed a raised line called ‘doming’ down the length of your stomach; this can be a sign of Diastasis Recti.

HOW DOES DRA AFFECT YOUR AND WHY IS IT IMPORTANT THAT YOU’RE ASSESSED?
As physiotherapists we’re not too concerned about the degree of separation of the muscles from causes out of our control such as the size of you baby, but more of the risk of a hernia due to over-stretching the Linea alba. We can help reduce the risk by avoiding actions that can place stress on the Linea alba such as excessive abdominal muscle use in exercise and straining when opening the bowels.

Studies have shown that mothers with DRA may have:

• Decreased abdominal strength, for example difficulties with doing a sit up at 12-14 months postpartum
• Decreased trunk stability
• Poor image perception

(Some of these studies were small and may not apply to everyone).
Emerging evidence from 2017 has found that there is no correlation between DRA and urinary incontinence or lower back pain. That’s not to say, you can’t have back pain or urinary incontinence as well as DRA.

WHAT DO WE LOOK FOR AS PHYSIOTHERAPISTS?
As physiotherapists we assess for DRA either in hospital in the days after you deliver or at your recommended 1-2 week post-partum follow up appointment. Here we look to see the distance between both of your rectus abdominal muscles. You will lay on your back and your therapist will feel along the middle of your stomach as you lift your head from the bed. To be considered as having DRA there must be more than 2 finger widths between your abdominals.

PHYSIOTHERAPIST MANAGEMENT OF DRA:
If identified your physiotherapist will give you activity modification in your pregnancy to limit the strain on the lines alba. After delivery treatment consists of education, progressive abdominal strengthening exercises and are able to fit you for a compressive garment such as a 3-in-1 Belly Band to help the body’s natural healing process. We again assess you at your recommended 6-8 week postpartum follow up appointment to track the progress of the DRA healing and progress of your physiotherapist lead abdominal exercise program based on your individual needs.

THE IMPORTANCE OF AN ABDOMINAL EXERCISE PROGRAM:
Around 4-6 months postpartum improvements to the connective tissues and musculature can occur, however after 4-6 months improvement to your DRA are reduced. So, the sooner we can address this separation the better!

WHAT IF I HAVE DRA?
At Bump Fitness we have physiotherapists who are trained in assessment and treatment of DRA. We can provide you with current evidence-based practice education surrounding DRA and tailor and individualised program specific to your needs.
To book a telehealth or face to face appointment contact us a info@bumpfitness.com.au or 0422 988 033.

Disclaimer: This is intended for general advice only; we recommend you seek individualised advice from your health care provider.

References:

1. Beamish N, Green N, Nieuwold E, McLean L. Differences in linea alba stiffness and linea alba distortion between women with and without diastasis recti abdominis: The impact of measurement site and task. J Orthop Sports Phys Ther. 2019 Sep;49(9):656-65.
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