Most pregnant women, especially those who are active, have likely heard about diastasis recti or abdominal separation. Toward the end of a pregnancy or postpartum, some women notice either an indentation or a bulge in the middle of their belly which is caused by a thinning and widening of the abdominal muscles that may develop as your stomach expands. Typically women are told to avoid ab exercises so as to avoid the condition, but that isn’t necessarily true. We’ve got the facts you need to know about this postpartum abdominal condition.
What exactly is diastasis recti?
The term diastasis means separation, while recti refers to the abdominal muscles most commonly known as your 6-pack. “These core muscles are held together by connective tissue, diastasis recti (DR) occurs when that connective tissue is stretched thin, usually due to pregnancy, excess weight, genetics or improper core mechanics.” says Joanie Johnson, founder of Strong Mom Society.
DR is hard to diagnose during pregnancy because, technically speaking, every pregnant body will have a diastasis to some degree. “The connective tissue of the linea alba is supposed to stretch during pregnancy in order to accommodate your expanding belly,” says Johnson. “In fact, the linea alba even stretches after we’ve had a big meal! What’s important to be aware of is the difference between a stretch that is safe and naturally occurring versus one that is injury based and won’t return to its original condition once the internal pressure is removed.”
Johnson recommends that pregnant women consistently check for DR throughout their workouts and daily lives. “Diastasis will show up as what looks like a raised cone or dome through the center line of the abdomen. This will be most noticeable when sitting up and flexing the abdominal muscles, raising your head off the ground when on your back, or moving your spine into backwards extension.” It’s important to note that seeing coning or doming, does NOT mean you’ve done any lasting harm to your abdominal wall. Johnson says it simply means you’ve put your body into a position where it can’t maintain neutral pressure within in the core and you simply move out of that position. “It’s the repetition of excessive core pressure over time that many believe will lead to diastasis recti.”
This brings us to the million dollar question: can you prevent diastasis recti?
Some professionals will say absolutely, while others will tell you there is still too little research on DR to guarantee success with any methods of prevention. However, according to Johnson, it’s widely accepted that focusing on exercises which incorporate diaphragmatic breathing and activating your deep inner core unit are integral to DR prevention and recovery.
“This practice strengthens your core by coordinating the muscles of your diaphragm, pelvic floor, transverse abdominis and multifidus muscles,” says Johnson. “Diaphragmatic breathing also improves your posture, brings ease back to your everyday movement mechanics and helps neutralize pressure in your core. Breathing correctly is so important, especially post birth, to ensure you’re not increasing tension on your already stretched linea alba.”
If you notice coning or doming in the abdomen when you’re working out or moving throughout your day, Johnson suggests moving into another position or practice engaging your core (hugging the muscles in vs. pushing and engaging them out) to neutralize the abdominal pressure.
As a general rule, laying straight back and sitting straight up from a back-lying position isn’t recommended. “It requires a great deal of deep core strength that for most people is too challenging to maintain proper core engagement with,” says Sheryl Wilson, founder of Fitnotic. “Instead, pregnant women should get into and out of a back-lying position by going to their side and using their arms to push themselves up and lower themselves down.” This holds true for everything from getting in and out of bed to doing crunches and sit-ups, which are not exercises that are recommended, particularly in the later stages of pregnancy.
Other than avoiding crunches and sit-ups, how are women supposed to know which exercises are safe for them? “If while doing an exercise or holding a position, a woman can breathe normally and keep her upper, middle and lower abs drawn up and in towards her spine with her torso wrapped to cinch her waist, the exercise should be safe for her,” says Wilson. For this reason, planks could be safe for one women, but not safe for another. “If a plank on elbows and toes causes a woman’s belly to hang down and she’s unable to keep her core engaged to prevent that from happening, she will need to modify the exercise to make it safe and appropriately challenging for her. This could be a plank on her knees, a plank leaning on a couch or even a plank against the wall. ”
A number of specialist can help deal with DR including pre- and post-natal corrective exercise specialists and diastasis and core consultants, women’s health physical therapists, pelvic floor physical therapists or an occupational therapists. For those who don’t have access to a specialist, Megan Roup has number of diaphragmatic breathing videos designed especially with DR in mind on her Sculpt Society app (there’s a 2-week free trial). The videos are designed to be part of a pre-natal workout routine as it will be most helpful to address DR sooner rather than later. Every Mother also offers videos “to recruit and engage the transverse abdominis while coordinating that muscle engagement with breathing and appropriate pelvic floor activation.”
What about diastasis recti postpartum?
Postpartum it’s considered normal to feel separation through the connective tissue for up to 12 weeks after birth. “It takes approximately that length of time for your body to start drawing the connective tissue and muscles of the rectus back together,” says Johnson. “It’s outdated science to have a list of forbidden exercises or movements that activate the rectus abdominis or obliques during the healing process. Today’s research makes clear that when it comes to DR recovery, it’s not what you’re doing, but how you are doing it. Our entire body is covered in fascia and the linea alba (where DR occurs) is part of that fascial system. Because of that, your recovery has to focus on the entire body, not just isolated movements within the deep inner core. This is why I recommend working with a specialist that truly understands DR and can create an effective program specific to your body.”
While some women are lucky to have DR and never know it, others, will have their DR causing a pooch or bulge in the stomach, lower back pain, incontinence, excessive fatigue, poor posture, constipation, bloating, etc. if left untreated. “In some cases, diastasis can also be a precursor to developing hernias. Because it’s a sign of improper core function the longer you put off treating it, the worse it’s likely to become as you continue to adopt compensatory movement patterns in your body.”
Does sever diastasis recti in one pregnancy make it more likely in a future one?
There are many factors that contribute to how much, if at all, a separation will close following a pregnancy. “One thing we know is that once a separation exists, it’s not likely going to close completely,” says Wilson. “For that reason, with subsequent pregnancies, the diastasis will still exist, but that doesn’t necessarily mean it will be larger or more problematic than it was before.” To the contrary, Wilson says that a diastasis during a second or third pregnancy can actually be smaller than it was during an earlier pregnancy and also can cause fewer problems for the mother. “It all depends on how successful the woman is in avoiding damaging movements and keeping her core properly engaged during strenuous activities and how much effort she puts into proper core strengthening during and following her pregnancies.”