diastasis recti
what is diastasis recti?
Diastasis Recti, also referred to as ‘Divarication of the Recti’, DRA or ‘Rectus Divarification’, is the widening of the gap between the 2 sections of the Rectus Abdominis (or 6 pack) abdominal muscle.The split occurs at the Linea Alba, the mid-line collagen structures of connective tissue at the front of the abdomen. 100% of women have some level of diastasis of the rectus abdominis in the third trimester.
Importantly, for many women the gap remains widened at 8 weeks, and left untreated, this distance at 8 weeks remains unchanged at 1 year postpartum.
66% of women with diastasis recti have some level of pelvic floor dysfunction. Diastasis recti and pelvic floor problems tend to go together.
​
The Linea Alba (seam of tissue structures that form the meeting point of the 2 sides of all the core musculature) no longer provides tension and stability. ALL the muscles of the abdomen-transversalis, internal and external obliques, as well as Rectus Abdominis – meet at this centre midline. So all are compromised. This lack of protection and stability affects the whole body both aesthetically and functionally.
what does diastasis look like?
You may see a ‘pooching’ or ‘doming’ of your stomach, especially when coming up from a lying position on your back. Sometimes you appear still a few months pregnant. As well as the aesthetic concerns, diastasis recti is associated with a weak core (and pelvic floor). This can lead to a lack of strength and stability in the entire pelvic region and midsection.
what causes diastasis recti?
Diastasis Recti is the result of excessive intra-abdominal pressure or loading. It is common in the later stages of pregnancy, particularly second or subsequent pregnancies. It is important to note though, that pregnancy does not cause a diastasis. The increased load and further shifts in alignment of pregnancy exacerbate the root problem: excessive, ‘un-contained’ intra abdominal pressure.
​
The Rectus Abdominis is only 1 of 4 layers of abdominal muscles: the Transverse Abdominis (deepest muscle layer) the Interior and Exterior Obliques (next 2 layers) that form your waist, and then the Rectus Abdominis is on the outside.
Unfortunately when the 2 parts of the muscle separate or come apart, the connective mid-line is stretched and weakened as it takes all other muscular and fascial support structures along with it. This leaves the front of the abdomen unsupported and unstable. This seam of connective tissue is designedto be taut, at full length and aligned in a vertical (breastbone to pubic bone) plane. But it cannot perform or function optimally when alignment is ‘out’. So it’s alignment we need to address to address a diastasis!
​
Diastasis Recti is a symptom of excessive and unsupported intra abdominal pressure. This is the same issue that creates other pelvic and abdominal problems including hernia and prolapse. DR should therefore be treated as part of an integrated program designed to re-align, re-connect and then strengthen the entire core musculature, rather than be addressed in isolation. The focus should not be only on ‘closing the gap’.
how to test for diastasis recti
Lie on your back with your knees bent and your feet flat on the floor. Relax your head and shoulders and place your fingers (palm facing you) just above your belly button.
​
Lift your head and neck very slightly off the floor and press down with your fingertips. If you feel a gap, that’s the diastasis. You will feel the muscles close in around your fingers as you lift your head and neck. Don’t lift your shoulders. Repeat the test in two other place: directly over the belly button, and a couple of inches below.
​
A diastasis recti gap is measured in finger width’s. You are aiming for a 1-2 finger gap or less, but don’t panic if it’s much bigger at first.
​
Even more important than the width of the gap though, is the tension (or lack of tension) in the midline – the linea alba. Contracting the muscles should create tension and resistance when you apply gentle pressure with your fingers to the midline. If it doesn’t – you have some re-connecting to do…
pelvic floor
what do the pelvic floor muscles do?
When the pelvic floor is strong, it supports the pelvic organs to prevent problems such as:
-
incontinence (the involuntary loss of urine or faeces)
-
prolapse (lack of support) of the bladder, uterus and bowel.
The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to 'hold on' until an appropriate time and place.
what causes pelvic floor muscle weakness?
Some of the common causes of pelvic floor muscle weakness are:
-
childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
-
being overweight
-
constipation (excessive straining to empty your bowel)
-
persistent heavy lifting
-
excessive coughing – causing repetitive straining
-
changes in hormonal levels at menopause
-
growing older.
how do I strengthen my pelvic floor muscles?
It is recommended that all women exercise their pelvic floor muscles every day throughout life, to prevent weakness or improve strength. Exercising weak muscles regularly, over a period of time can strengthen them and make them work effectively again. Regular gentle exercise, such as walking can also help to strengthen your pelvic floor muscles.
​
Exercise 1
Step 1:
Sit, stand tall, lie on your back with your knees bent and legs comfortably apart or kneel on your hands and knees.
Step 2:
Close your eyes, imagine what muscles you would tighten to stop yourself from passing wind or to 'hold on' from passing urine. If you can’t feel a distinct tightening of these muscles, ask for some help from a women’s health physiotherapist. She will help you to get started.
Step 3:
Now that you can feel your pelvic floor muscles working, tighten them around your front passage, vagina and back passage as strongly as possible and hold for three to five seconds. By doing this, you should feel your pelvic floor muscles 'lift up' inside you and feel a definite 'let go' as the muscles relax. If you can hold longer (but no more than a maximum of eight seconds), then do so. Remember, the squeeze must stay strong and you should feel a definite 'let go'. Repeat up to ten times or until you feel your pelvic floor muscles fatigue. Rest for a few seconds in between each squeeze.
Steps one to three count as one exercise set. If you can, do three sets per day in different positions. Do your pelvic floor exercises every day for the rest of your life.
Exercise 2 (quick squeeze for power)
Squeeze and lift your pelvic floor muscles as strongly and as quickly as possible. Do not try to hold on to the contraction, just squeeze and let go. Rest for a few seconds in between each squeeze. Repeat this 10 to 20 times or until you feel your pelvic floor muscles fatigue.
If you can, do this exercise set one to three times per day.
During both exercises you should:
-
feel your pelvic floor muscles 'lift up' inside you, rather than feel a downward movement
-
relax your thighs and buttocks
-
keep breathing normally
-
stop exercising if your muscles fatigue.
​
posture
what is good posture?
How does it look? While standing straight, imagine an invisible puppet string holding you in place. Feet are flat, the back is straight and the head is properly aligned over the body, not pushed forward. The spine should have a slight S curve. Check your posture right now. How does it feel? Is your body tight, tensed? Relax. Where are your shoulders? They should be held back with your chest forward, a natural feel, not exaggerated. How does your abdomen feel? Pull it in and you automatically straighten your torso. The key to good posture is body awareness and a strong core, your mid section.
​
It's really rather pleasurable to become more aware throughout the day of your body's alignment because it instantly feels better if you catch yourself slouching and 'fix' yourself. Good posture does not feel rigid or tense, it feels good. If you're tight, simply relax that area. It's all about body/mind awareness, being in tune with our whole self and not just our thoughts. I find myself 'fixing' myself without conscious effort now, but it takes time to train yourself, and ideally the best time to learn it is as a young child. Even as an adult you can make a game of it, perhaps call it, how is my posture NOW?
​
The neck has a lot of work to do. We abuse our poor necks probably more than any other body part. Try to keep the head over your shoulders, not pushed forward or bent to the side. It helps to do gentle neck rotations periodically throughout the day or simple neck exercises.
​
good posture while sitting
When we're sitting, we focus on what's in front of us. If we push our neck forward, our body follows and we're no longer balanced. It increases muscle fatigue and stretches the spinal ligaments, which can lead to back and neck pain.
​
Sitting at a desk is another area where ergonomics is important to know. As much as possible, have the reading material held away from you, preferably at eye level if possible. If writing or working on a keyboard, try to keep the head over the upper body even if you have to lean forward for a small period of time. Always keep your back straight even if leaning forward. A great investment if you do a lot of sitting at a desk is an ergonomic chair. If not currently in the budget, place a small pillow or rolled-up towel at the small of your back. It helps a lot.
Strengthening Abs Helps Pregnant Women
​
good posture affects pregnancy and birth
The woman's body shape will affect both pregnancy, labor and birth. "The position of the baby is influenced by the shape of the woman's abdomen, back and pelvis and the postural tensions in these areas. The fitter the woman is and the stronger her core muscles are will influence and often determine the ease or difficulties of pregnancy, labor and birth. Strengthening abs during pregnancy helps to tone the woman's body to keep it strong during the entire pregnancy enabling an easier labor and delivery. It requires strong muscles to push the baby through the birth canal. after Bub arrives it is so important to keep the awareness of our posture in our minds, I know its easier said then done when you are totally exhausted but that is when the damage can be done, especially if your carrying and feeding your baby all the time, being aware of your posture will help with back pain and also forces you to use your tummy muscles.
​
benefits of good posture
So, our mothers and grandmothers knew what they were talking about when they told us to sit up and stand tall, pull your shoulders back. If you're a mother, maybe you have said the same thing. We need to keep saying it and help our children (and ourselves) understand why it's important. There are wonderful, healthful benefits to maintaining good posture, not only for our body, but for our whole self.
-
improves overall appearance
-
confidence booster
-
aids in digestion
-
helps to prevent back and neck pain
-
helps with less problematic pregnancies, labor and quicker postpartum recovery
-
strengthens, energizes and revitalizes the body
-
helps to prevent sciatica
-
helps to prevent postural kyphosis (often found in children and adolescents)
-
feels good to have body in balance
