Diastasis Recti After Pregnancy: What You Need to Know
In this article, Rosie shares her knowledge about diastasis and the appropriate steps you should take if it ever presents as an issue for you. She is a Women’s Health interested Physiotherapist who just had her baby #4, so she is well-versed with the subject.
What is diastasis?
It is an increased gap, a widening of the bellies of the rectus muscle. It is a normal part of pregnancy because as the baby grows and the abdominal wall is stretched, this has to occur to allow the growth of the baby. And the line that you see in the middle of a very well- defined tummy is called the linea alba, and it's the connective tissue area that separates the two bellies. And this is where the separation happens, and we get an obvious gapping distance between these two bellies.
Recent studies suggest that by 30 weeks, 100% of pregnant women will have diastasis. This will persist in the early postpartum period for most women. It’s considered normal if the gaps are around less than a centimeter. However, you will find that it’s not just about the gap,, but also about the way we transfer load using the abdominal muscles.
Another recent study suggests that 66% of women will still have an abnormal gap until 6 weeks postpartum. 41% will have it at 6 months postpartum, and 33% will still have it at 12 months postpartum.
If you are going to recover spontaneously from diastasis, the gap will usually be back to normal after 8 weeks. But we know that a big percentage of women will still need rehab and recovery. The importance of a women’s health physio check up can’t be stressed enough.
In assessments done in a clinic or in a PT studio, they’ll check the gap if it’s more than a centimeter wide. They will also check if the tissue underneath, like if there’s any bulging, also called doming, or the opposite when the tissue is sucked in, or invagination. Especially, when the tissue is soft, doesn’t transfer load well or causes these and other symptoms, rehabilitation is needed due to that loss of energy through this space.
Although you might be back to a normal size after having a baby you might still have a ‘ pooch’ where you still look like a few months pregnant even though you’re already postpartum. This can be because of the loss of tensional integrity of the abdominal wall.
It’s important because for some women the aesthetics or appearance can leave them feeling less than amazing, but also that some women don’t feel like their old selves, and often there are other associated symptoms which can affect quality of life.
Recent studies suggest that 66% of women with diastasis will have other pressure related problems or symptoms such as stress urinary incontinence, fecal incontinence or pelvic organ prolapse.
In terms of rehab, we really need to treat the whole person. Look into what other symptoms they might have, particularly if there are other continence or pressure related issues, fecal incontinence, or pelvic organ prolapse. This will present as perhaps heaviness in the vagina, you might have the obvious protrusion of some of your pelvic organs below the entrance to your vagina.
Diastasis can also affect your recovery, posture, the way you breathe and the way your muscles transfer load in general. It’s really not just about closing the gap, but it’s also about restoring the intrinsic core function, and the pelvic floor function is an important aspect of that.
The pelvic floor function and transverse abdominal function has a natural network of synergy that is often lost in pregnancy and childbirth. This happens with vaginal birth and caesarean sections. This is why the correct way to activate the pelvic floor and deep core is important.
It helps to do the work in pregnancy to help get the brain and the core connected to help minimize the extent of the diastasis in pregnancy. So the more you understand load transfer and correct breathing, the more you can support your abdominal area with good technique and apply it in your everyday tasks. You should avoid things like sitting straight up in bed or from the couch in pregnancy. It can also be avoiding that concentric shortening or lots of ab work in pregnancy where you'd be compressing the tummy.
The more we can prepare in pregnancy, then we're going to set ourselves up for better success postpartum. To learn more about postpartum recovery after childbirth head to episode 59 of the Mama Matters Podcast :)