What is diastasis rectus abdominis?

Clare Pacey, specialist women’s health physiotherapist explains it all, and shares her top tips with Restore and Reform on how to fix it.

Diastasis rectus abdominis is a thinning of the linea alba that allows a mother’s abdomen to stretch to accommodate a growing uterus; it is a natural part of pregnancy and essential to allow the baby to grow in a closed space without crushing your organs. Approximately a third of women remain abnormally wide at 8 weeks postpartum onwards.

Many women think the presence of any abdominal gap means they have a diastasis (pathology). This is incorrect. Your abdomen needs give in it to open and close as you breathe and we all appreciate that gap after a big meal! So some gap is normal or natural. The key is how your abdomen is functioning and how well the sides of the abdomen are communicating with one another through the gap and fascia.

Conservative diastasis resolution is possible at any time with good education and training. Improvement has to do with the body’s capacity for fascia recovery and the willingness of the individual to change how they are using their body. I regularly help women who are years beyond their last delivery – here are my top tips to fix a diastasis.

Realign

The number one piece of advice I can offer any woman is to know what good alignment is and to maintain it as best they can throughout pregnancy and beyond. This is a vital part of correcting a diastasis. Standing, sitting, moving in a lousy position all day can keep the abdomen separated.

Many women lean back as their tummy grows during pregnancy and often this continues postpartum, too.

Take a look in the mirror – Is your rib cage too far back, are you breathing with your upper chest, is your pelvis tucked under?

If so untuck your bottom and shift the ribcage over the top of the pelvis. This is the optimum position for the pelvic floor and gluteal muscles to activate.

Remember to be conscious of your alignment when exercising too. Exercising in correct alignment will promote a better result from your fitness program.

Breathe!

I encourage my clients to gently squeeze their pelvic floor muscles and exhale/ blow out prior to movements, such as lifting their baby. This activates the inner core. Continuing this exhale throughout the exertion will help protect and maintain diastasis closure throughout the activity. It also prevents breath holding which causes increases in abdominal pressure.

Exercise

Unfortunately, dealing with diastasis recti isn’t simple and straightforward and there is no set protocol for all women. Generally it requires individual assessment of the deep central stability system (diaphragm, transversus abdominis, multifidus, pelvic floor) that creates tension over the fascia and regulates abdominal pressure and a personalised progressive exercise programme to rebuild the abdominal wall and restore optimal function. In some cases this may include bracing or taping when appropriate but not in everyone.

No abdominal exercises are forbidden – your ability to perform an activity needs to be assessed. My overarching rules I set for my patients are if you lose your breath (need to breath hold) or your alignment during the activity, it is too challenging. Exercise that makes the abdomen bulge or causes you to fix your abdominals is also best avoided.

Pregnancy

Exercising the abdominal muscles correctly during pregnancy decreases the presence of diastasis rectus abdominis post natally by 35%.

We need a lot more research in this area but during pregnancy I would recommend avoiding any activities that cause the abdomen to bulge, to stop sit ups once the uterus comes above the pelvis brim (12-14 weeks), to minimise twisting and overhead activities if you have a diastasis and maintain good alignment.

Surgery

For some women physiotherapy is not enough and a surgical abdominoplasty is necessary. A woman would be appropriate for this if she has completed her family and is 1 year postpartum, has trialled and failed a multi tiered rehabilitation programme supervised by a physiotherapist and is unable to generate sufficient tension through the abdominal wall for resolution of function. Surgery should always be combined with a rehabilitation programme as an abdominoplasty will restore anatomical structure but not the abdominal muscle function.

You can book to see Clare at www.clarepacey.com and follow her on Instagram @womenshealthbyclarepacey

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