The rectus abdominus is the most superficial muscle in the abdominal wall. You probably know this muscle as the “6-pack muscle”. There is a right and left side of this muscle with connective tissue between the two sides. Diastasis Rectus Abdominus is the separation of fibers in the Linea Alba (the tissue that connects the right and left side of the rectus abdominus). This separation usually occurs during pregnancy; however, you can also experience this if you’ve never had children as well.
When there is a separation within this connective tissue it can create suboptimal function of the “core”. When I say core throughout this blog, I am referring to the coordination of the:
- Diaphragm: primary breathing muscle located inside the bottom portion of our ribcage
- Pelvic floor: the bowl-shaped group of muscles on the inside of the bony pelvis
- Transverse abdominus: the deepest abdominal muscle
- Multifidi: the deep back muscles that create the backside border of the core
A separation in the linea alba can result in any of the following:
- Bowel & bladder changes (incontinence, straining, urge, etc.)
- Pain in pelvis, abdomen or low back
- Pain with intercourse
- Bulging of abdominal wall with activity or a deepening of the separation (both can be felt and/or seen)
- Feeling unable to “connect” to or use the abdominal muscles for support
During pregnancy, the uterus grows, and our tissue stretches to accommodate. This is not a bad thing, rather it is one of the reasons our body is so amazing. The 2nd and
3rd trimester is when the stretching happens most rapidly. The 2nd & 3rd trimester is also when you will probably start to notice changes to the front of the abdominal wall. While pregnant, you are more likely (although not always) to notice a bulging on the front of the abdomen when performing activities that challenge the abdominal muscles versus a deepening of the separation. A challenge to the abdominal muscles can come from exercise but can also come from typical daily activities. Moving from a lying down position to sitting, moving from a slouched position on the couch to sitting up straight or carrying heavy loads are examples of daily activities that commonly challenge core support. If there is a bulge, it simply means that this movement is no longer serving your body in a positive way. To check for this, place a hand on the front of your stomach (the area to either side of your belly button) as you move and feel for bulging; you can also usually see the bulge happen. Rolling to your side first and then sitting up is one way to help decrease the extra force and protect the abdominal wall.
After having a baby, you may still notice a bulging of the abdominal wall however you can also start to feel a deepening of the separation. One of the easiest ways to check for separation is to lay on your back and lift your head. If you feel a bulging along the center of the abdomen (again think of the area to either side of the belly button and also just above and just below it) or feel a deepening of the separation (your finger tips will be able to sink deeper into the tissue), then you have a diastasis. This does not mean that you will never have a functioning core but that there are some steps to take prior to returning to your previous level of activity.
A separation in the abdominal wall should be assessed for in every single postpartum woman (whether the baby was born vaginally or via c-section). Unfortunately, this does not happen. And, most postpartum visits for mom are done 6wks after having baby, meaning 6 weeks have passed without support given to the mom on how to safely move throughout her day. This 6-week checkup is often when new moms are told to return to exercise (if everything else looks good) without any evaluation of how the core is functioning or what to do/who to see if there is a diastasis present. Every woman deserves to know what an abdominal separation is, what it means for function and what ignoring it will mean for her future. If you are given the “okay” to return to exercise, remember that your body is transitioning through something wonderful, and allow yourself the grace to move slowly. “Exercise” after baby may not look like the exercise you were doing prior, but that’s OKAY. When you return to an activity/exercise and there is an increase in the bulge or deepening the separation, you put yourself at risk for worsening symptoms and decrease the ability to fully heal the core.
You can actually begin to start healing the diastasis immediately postpartum with breathing techniques. The most important thing to do is get evaluated by a women’s health physical therapist in order to ensure that the breath pattern is optimal. In the meantime, however, you can self-monitor your activities by feeling for changes in the front of the abdominal wall. Any activity/exercise that increases the bulge or creates a deeper separation is not beneficial for your body at this time and it is better to try something else until you can be evaluated further by a women’s health physical therapist.
A women’s health/pelvic health physical therapist will be able to fully evaluate you and give you a personalized plan for healing and supporting a functional core. If you are currently pregnant, meeting with a physical therapist can help you set up a plan for the immediate postpartum period, as well as guide you through preparing the core for the birth.
It is also very important to note that it is never too late to heal a diastasis. The severity can of course mean that it may take longer to heal but it is still never too late. In extreme situations, surgery may be recommended however this is rare.