Diastasis Rectus Abdominus in the pregnant and post partum woman

Commonly referred to as DRA, this is a separation of the rectus abdominus muscle or “6-pack muscle” of the abdomen. Although it can occur in men and children (for varying reasons) it is commonly seen in women in the 3rd trimester of pregnancy and the post-partum period. Some reports state that at least 75% of women in the 3rd trimester have a diastasis, which is not surprising considering that the connective tissue has to stretch to accommodate for the growing fetus. Post-partum however it remains common in approximately 35% of women and this is where it can be concerning.

For some, they are concerned with the aesthetics. However, for pelvic health therapists, we are concerned with not only function but the associated issues that may be common in a persistent DRA such as, but not limited to, back pain, incontinence, prolapse, abdominal doming, abdominal hernias and failure to return to prior level of activity as a result of any or all of the above.

Again, this post is not to scare but to offer information. While some persons may have a DRA that resolves without intervention during the post partum period, there are others who may have a greater separation and as such greater compromise to the strength and integrity of the tissues and would need to be evaluated and treated for that.

How do we test for DRA?

A diastasis is determined at the level of the belly button, slightly above and also slightly below if the separation is greater than 2 finger widths or approximately 16mm.

To test, you lie on your back with the knees bent (feet flat). Relax your body and place your fingers, palm facing towards your abdomen slightly above the belly button.

Lift your head and neck slightly from the floor- no need to lift your shoulders- as if doing a slight curl up.

If you feel a gapping or separation, then that is a diastasis. Repeat at the level of your belly button and slightly below.

You may also note bulging or doming through the separation.

Why do we need therapy to help?

Often times when there is a DRA, women use strategies that can make it worse, including over-using other muscles and holding their breath. Since this can increase the pressure within the abdomen, it can also negatively impact the DRA.

A women’s health therapist can assess your DRA, not only in the position described above, but in other functional positions and would therefore be able to customize a program to address this and any other concurrent issues with the focus of returning you to prior function and activities without pain, leaking, to fitness related activities and not adding further insult to the region.

It should be noted that in some instances, the diastasis will not fully close. The key here is to remember that the integrity of the tissue is what is important with the goal of improving tensile strength and ability to transfer loads t/o the muscles thereby promoting improved function.

 

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