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Diastasis Recti in the Pregnant and Postpartum Birthing Person

Updated: Jul 15, 2021

Diastasis, or DRA or abdominal separation, develops due to 2 issues: forces pulling OUT and abdominal forces pulling IN. Almost all programs only focus on 1 of these aspects resulting in reoccurance, difficulty healing or other issues like prolapse and back pain.


Diastasis is defined as greater than 2 cm width of the rectus abdominis or 6-pack muscles, roughly the width of your two fingers. It occurs when the linea alba (or connection between the 6-pack muscles) is stretched due to pressure. The pressure of carrying a baby (or babies!) puts a lot of strain and stretch through that connective tissue, which is why diastasis occurs at the end of most pregnancies. In fact, diastasis occurs in 66-100% of women in the 3rd trimester (Chiarello), 68% of women in the early postpartum period (Keshwani) and 32.6% at 12 months postpartum (Gluppe).


While having a DRA can cause body image concerns for some, there is literature supporting back and pelvic area pain if a DRA is not addressed. DRA can cause an increase in abdominal pain in the early postpartum period, (Keshwani), increase in low back pain and pelvic girdle pain and be related to incontinence and prolapse. You can check if YOU have a diastasis by following the video at the end of this blog post. Other clues that you have a diastasis are that you have "doming" or "coning" visible when you lift your head while laying on your back.



A common question fielded from pregnant and postpartum birthing people is how to prevent diastasis or prevent it from getting worse. Answering this question revolves around controllable and uncontrollable factors. Uncontrollable factors include: older age, having more than 1 baby, cesarean section, gestational weight gain, high birth weight of your baby and childcare (Gluppe). Our approach at RVA Holistic PT is to “control the controllables!” So, let’s chat about some things you can influence for the positive!



The "ABCs" of diastasis are


A is for alignment

B is for proper breathing

C is for core


Alignment:

There is much concern about the “pulling in” forces with exercises, but what about the “pulling out” forces? Our body is connected by fascia, or cotton-candy like networks. When you lift your arm overhead, there IS a pulling in your mid-section because of the fascial connections. When you walk, one leg is drawn back. Tightness in that hip causes pulling at your belly button. In our modern society (ahem, this applies to me, too!) we sit too much! We are not walking 5 miles a day or squatting to pee/ poo. As a result, we have lost alignment mobility! Tight shoulders, hips and mid-back joints and muscles, a stiff and wide postpartum ribcage-- create a pulling out force that the abdominals may not be strong enough to counteract in the pregnancy and postpartum period! In order to compensate for the stiffness in the mid back and ribs, we often see womxn "rib thrust," which creates even more pressure going out the front belly. Manual therapy can be incredibly useful for healing diastasis: we work to restore the ribcage position, unstick any fascial stiffness, gently restore your organ position and release tension in the shoulders and hip sthat create those "pulling out" forces.


Proper alignment, from the feet to the head, allows the forces to be spread throughout the body (rather than forced all to the front abdominal wall).