Closing the Gap After Pregnancy – Managing Your Diastasis Recti

by Robert Grech B.Sc. (Hons) Phys.; B.Sc. (Hons.) Ost. (UK) 

One of the most common problems after pregnancy is the gradual separation of the abdominal muscles. Clinically, this problem is better known as diastasis recti. For some, a gap in this region can lead to further health complications. However, others might begin to experience self-esteem issues. Regardless, there are ways to prevent and manage diastasis recti. The following article will incorporate our clinician’s extensive experience and the latest research to help you close the gap after pregnancy.

What is Diastasis Recti?

Diastasis of the Rectus Abdominis or Diastasis Recti is defined as an increased gap between the abdominal muscles (also known as rectus abdominis). Overall, this is a staggeringly common condition. Staggeringly,  33-75% of women who have had children may end up with it [1]. Generally,  puerperium women (e.g. >6 weeks after birth) will seek assistance with their diastasis recti. It’s important to note that diastasis recti can also affect women during pregnancy, non-pregnant women, and even men. [8]

Anatomy of the Core and Abdominal Muscles

The core is formed by the diaphragm (as the top wall), pelvic floor (as the bottom floor), abdominal muscles (as the front wall), and lumbar spine (as the back wall). All these structures work synergistically to ensure efficient movement and protect the spine and organs [9]. The function of the abdominal muscles is essential in every single aspect of life, including:

• Posture
• Trunk and pelvic stability
• Breathing
• Trunk movement
• Housing the organs
• Controlling the pressure in the abdomen (i.e. intra-abdominal pressure)
• Increasing tension in the thoracolumbar fascia. 

Any disruption to the core and abdominal muscles can place these functions at risk [8][9]. For pregnant women, diastasis recti is a frequently related phenomenon leading to problems in these areas.

Diastasis Recti Causes

Causes of diastasis recti during and after pregnancy can be attributed to certain behaviors or lifestyles. Examples of prevalent factors, including:

• The overstretching of the abdominal wall from the pregnant belly
• Incorrect breathing patterns during exercise
• Having a sedentary lifestyle or not moving enough. 
• Especially during effortful exercises, those with this sleep apnea will especially experience increased pressure in the abdomen and pelvic floor. Sleep apnea can also lead to additional dysfunction, such as urinary/fecal incontinence and lower of pelvic organs [1]
• Too much intense abdominal exercise (e.g., crunches, etc.)

Risk Factors of Diastasis Recti

Major risk factors that can lead to diastasis recti, include abnormal BMI ranges and giving birth via C-sections compared to natural vaginal delivery [4]. 

Additionally, mothers with greater than one child also seem to have a high likelihood of this condition. There is some speculation that this is due to the improper lifting technique of the previous child(ren). Forcefully inhaling and bracing (i.e., Valsalva maneuver) when lifting increases tension in the front abdominal wall, which can lead to overstretching and consequently ab separation [2].

Diastasis Recti Symptoms

Those with diastasis recti will often complain about overlapping symptoms. According to researchers Gszczyńska and Rekowski (2021), these symptoms (and prevalence rates) of postpartum women (i.e., after giving birth) include:

• Lower back and pelvic girdle pain in 64.5%
• Forms of incontinence in 69%
• Sexual dysfunction in 57.5%
• Bowel disorders in 61-69% (e.g., problems with peristaltic movements, prolapse, etc.)

How to Tell You Have Diastasis Recti – Test and Techniques

There are different ways to assess whether you have diastasis recti. Several techniques can be performed to determine both the presence and severity of the abdominal separation.

• The ‘finger width’-method. This technique is widely used by many healthcare professionals but can also be performed by yourself.
• Calipers are also widely used by clinicians.
• Ultrasound and MRI are generally more reliable but are not always necessary [3]

How to Fix Diastasis Recti

The treatment can be conservative or surgical, depending on the severity of the abdominal separation. Experienced osteopaths and/or physiotherapists will use treatment techniques, including core exercises, pelvic floor treatment/exercises, electrical stimulation, home and lifestyle advice, among others (5,6). 

However, our bodies are complex. Improving the overall interaction between the musculoskeletal, nervous, and immune systems is often required for better health outcomes. Generally, a holistic and tailored approach may be necessary to speed up recovery [6]. 

Breathing

In the early postpartum period, the focus will be on reducing intra-abdominal pressure. During the earlier phases of rehabilitation, avoiding excessive abdominal muscular activation will be the priority. You can start by working on restoring normal breathing patterns through simple breathing exercises and low-impact exercises. Over time, as the ability to perform exercises increases, more complex exercises can be introduced, including pelvic girdle and thoracic activation [6].

Exercises for Diastasis Recti

Specialized exercises for diastasis are one of the most effective treatments recommended by physiotherapists and osteopaths. One example is the gradually loaded plank activity which has been shown to effectively reduce the distance between the abdominal tear [7]. 

Although there is still no consensus for the treatment of diastasis recti, training a region called the transverse abdominals has a myriad of relevant benefits, including:

• Enhancing lumbopelvic stability. 
• Improving the ability to tolerate weight and positional changes. 
• Bridging the gap between the abdominal muscles.

Hypopressive exercises or low-pressure fitness exercises are one of the most proven and best exercises for diastasis recti. The purpose of these movements is to strengthen the transverse abdominal muscles reflexively [8]. From a scientific point of view, low-pressure fitness exercises help restore the ability of the diaphragm to contract and facilitate normal abdominal pressure. Proper activity in the diaphragm helps increase blood flow into the pelvic region, decrease compression onto the pelvic floor and improve organ positioning [9]. These are all benefits that are relevant for mending diastasis recti. 

What the Research Says

Research conducted by diastasis recti experts Cuña-Carrera I and Soto-González M (2019) showed that the size of the abdominal separation could be decreased by regularly performing hypopressive exercises. Specifically, this involved strengthening the transverse abdominals, rectus abdominis, and posteriorly along the oblique muscles over 3 months. Promisingly, results were seen as early as 6 and 9 weeks into the program [9].

These exciting new findings give us a better perspective on how we can help our patients overcome diastasis recti. Currently, low-pressure fitness exercises and strengthening specific structures are proven treatment approaches that should be considered by anyone suffering from this condition. 

Not only does having a significant gap between the abdominal walls cause further health complications but can also lead to self-esteem issues. At Osteopathy Malta, we understand the frustrations that diastasis recti can bring. By using modern and proven techniques, we pride ourselves on helping you achieve the best outcomes and closing your gap.

Book your appointment here. 

References

1. Gszczyńska D, Dąbek A, Rekowski W. Diastasis recti abdominis – what may cause it in postpartum women? Adv Rehab. (2021), https://doi.org/10.5114/areh.2021.103996
2. Candido G, Lo T, Janssen PA. Risk factors for diastasis of the Recti Abdominis. J Assoc Chart PhysiotherWomens Health. (2005) 97:49-54
3. Water A and Benjamin D. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalization. Manual Therapy (2015)
4. Wang Q, Yu X, Chen G, Sun X, Wang J. Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Intl Urogyne J (2019); 4(2): 1-7
5. Iqbal MH et al. Diastasis recti abdominis and its associated risk factors in postpartum women. Pak Armed Forces Med J (2020); 70 (5): 1535-38
6. Dufour S et al. Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study. Journal of Women’s Health Physical Therapy (2019) 73-81.
7. Awad E et al. Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: A randomized controlled trial. Journal of human sport & exercise (2021) Vol16 Proc2 S395-S403.
8. Cuña-Carrera I and Soto-González M. Effects of an Exercise Program on Diastasis Recti in Women. International Journal of Health Sciences & Research (2019). Vol.9(10) 90-99.
9. Rial T and Pinsach P. Rehabilitation for Pelvic Floor and Core Muscles Through Low-Pressure Fitness. Sports Medicine: research and practice (2016) T6 nº2 68-72.