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The Pilates PT Blog

Diastasis Rectus Abdominis – What it is & How to Identify it

Diastasis Rectus Abdominis (DRA) refers to thinning and widening of the connective tissue between the two rectus abdominal muscles (linea alba) and the associated laxity of the anterior abdominal wall. It is also referred to as “Diastasis”, “Diastasis Recti”, “abdominal separation” and “mummy tummy”. It is mostly associated with pregnancy however it can also occur in women who have not had children and even men.

 

Slight separation towards the end of pregnancy should be considered absolutely normal and a necessary adaptation of your body to accommodate the growing baby. This separation generally resolves naturally in the weeks after childbirth. For reasons unknown, it may not naturally resolve in approximately 1/3 of postnatal mums. This is where evidence informed information and rehabilitation is important.

 

 

Risk factors for non-resolving DRA

 

As it is a normal and necessary process of pregnancy we do not fully understand why a small number of women do not have natural resolution. We think the following factors may have some influence:

 

  • Pregnancy, especially multiples (twins, triplets)
  • Genetics – some people may be more at risk due to their
  • connective tissue composition.
  • IVF (due to potential prolonged hormonal influence)
  • Exercise that excessively and repeatedly overloads the abdominal wall
  • Prolonged exposure to heavy lifting

 

Are there signs of DRA that I should be aware of and monitor during my pregnancy?

 

A common sign of DRA is doming or bulging of the midline abdominal wall. This may look like the bump is pointing or bulging specifically down the centre. It often happens in activities such as sitting up from lying but it can occur during any exercise or activity, even when upright. Do not worry if this happens, it is likely the normal widening that needs to occur during pregnancy.

 

What should I do if I notice doming?

 

It is a good idea to modify movements and activities to prevent excessive doming. This may mean scaling back the difficultly of some of your exercises targeting the abdominal area, rolling onto your side to get out of bed or using your hands to help push yourself up from the floor in an exercise class.

 

Abdominal exercises are still important and beneficial, however it is important to implement strategies which do not result in doming. Something you can try if you notice doming during an exercise or activity is to ensure you are recruiting your pelvic floor and/or transverse abdominis. You’ll notice Hollie cues this a lot in your workouts. This may reduce or alleviate the doming enabling you to continue. Or it may not change the doming and indicate that modifying the exercise is sensible.

 

Another important tip is to try and avoid constipation and straining where possible. Straining requires a lot of abdominal effort and can result in extra intra-abdominal pressure against the midline abdominal wall. Constipation can be common for women during pregnancy due to the higher levels of iron that we ingest. Try to eat a balanced diet and incorporate adequate water intake to help avoid unnecessary constipation.

Using a footstool while on the toilet can help make opening your bowels much easier. This position may not be as easy in the later stages of pregnancy depending on your bump and general mobility.

 

Breathing

 

There is a unique relationship between the diaphragm, abdominal wall and pelvic floor. This can become altered during pregnancy as the body learns to navigate new ways of functioning around all the normal bodily changes.

 

These may include:

 

  • taking shallower breaths
  • breath holding during strenuous tasks or exercise leading to increased intra-abdominal pressure and excessive strain on the midline connective tissue.
  • increased expansion of the ribs to accommodate the growing bump

 

It can be helpful to consider breathing during your pregnancy and bring awareness to how you are breathing during everyday tasks and exercise so that you maintain the natural synergy between the diaphragm, abdominal wall and pelvic floor. Ensuring you are not breath holding during exertion will also lessen the load against the abdominal wall.

 

You can also practice “letting go” and relaxing the tummy muscles as you breathe – with the belly rising on a breath in and falling on a breath out. For anyone who tends to “grip” or “overuse” their upper abdominal muscles this is also a great way to let them go and relax.

 

Key messages

 

  • DRA is nothing to fear, some degree of separation towards the end of pregnancy is expected and normal.
  • It normally resolves itself after childbirth.
  • You can modify activities and exercises during pregnancy to minimise doming or bulging at the midline.
  • You can use breathing to lessen the pressure against the abdominal wall during exertion
  • Avoid constipation and straining if possible
  • If by 8 weeks following childbirth you think there has been no improvement or resolution you may benefit from getting evaluated for further rehabilitation.

 

Helpful Resources

 

  • At Your Cervix Podcast – listen here
  • Read the Diastasis Patient Handbook here
  • Diastasis Revolution online course for health and fitness professionals – check it out here
  • Gráinne’s website – click here
  • Follow Gráinne on Instagram here
  • Follow Gráinne on Facebook here
  • Follow Gráinne on Twitter here

 

If you enjoyed reading this article on Diastasis by Gráinne Donnelly and would like to discover more about prenatal fitness and your changing body I would love you to check out and try my pre & postnatal plan ‘The Bump Plan’ out for FREE today – simply click here to get started

 

 

Gráinne Donnelly

Gráinne Donnelly (Bsc Hons Pg Cert HCPC MCSP Current MSc Student) is an Advanced Physiotherapist and Team Lead for pelvic health physiotherapy, researcher and teacher in pelvic health physiotherapy. She is on the Specialist Advisory Board for the Active Pregnancy Foundation and an associate member of Canterbury Christchurch University’s Perinatal Physical Activity Research Group (PPARG).

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