Let’s begin by explaining what is a diastasis recti abdominis (DRA). This is a fancy medical term for separation down the midline of rectus abdominus or better known as the six-pack abdomen muscle. It is technically classified as a diastasis if there is an inter-recti separation of greater than 2 cm at any point along the midline, or a visible bulge in the midline with exertion.1-3 Much of the research supports that a high percentage of pregnant women will have a DRA. While not as common, the separation can present itself as early as the second trimester. In the third trimester, however, nearly 66%-100% of pregnant women will have a DRA. While carrying a child lengthens the abdomen, the process of birthing a child can put increased pressure and strain on the abdomen wall as well, leading to a DRA in approximately 53% of women postpartum. 4-5
In the presence of a DRA the core becomes increasingly unstable and more susceptible to further damage due to the inability generate tension or strength to resist high pressures within the abdomen. Other symptoms of a DRA can include abdominal pain or discomfort, back pain, and can even contribute to incontinence or prolapse.6-8 It is worth noting that you can have a DRA without any of the mentioned symptoms but in most cases a symptom presents itself with varying degrees from either mild to severe.
Now that we’ve covered some background information, how can you test to see if you have a DRA? Start by laying down on your back, legs can either be bent or straight. Gently lift your head up off the table and assess what the midline of your abdomen looks like. Is there a tenting or bulge within the midline? How much separation is occurring at the midline? Assess the tension within midline, does your finger sink in or does it feel like there is tension that prevents that from occurring? If you did not show any signs of a diastasis, that is great news. If, however, you did have signs of a DRA, I would like you to try again. This time tighten your abdomen and bring your belly button closer into your spine. Don’t hold your breath and gently lift your head off the table and re-assess all of the aforementioned variables again. Are your results better, the same, or worse? If the separation is the same or worse, don’t be discouraged as it may be as simple as contracting your abdomen incorrectly. If you noticed that your diastasis appeared to decrease, that is a positive sign that you are able to generate tension.
My advice for anyone wondering whether or not they have a diastasis is to have a trained professional test for it. If you are postpartum, a routine postpartum checkup should include an abdominal assessment to rule this in or out. Additionally, research supports that proper activation of the deep core is essential in preventing and decreasing a DRA. Therefore, if you do not have experience with deep core stability exercises, it is important to seek care from a trained professional to teach you how to properly activate muscles and appropriately progress through exercises.
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2. Noble E. Essential exercises for the childbearing year:a guide to health and comfort before and after your baby is born. 4th ed. Harwich, MA: New Life Images; 1995.
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4. Hanneford R, Tozer J. An investigation of the incidence, degree and possible predisposing factors of the rectus diastasis in the immediate postpartum period. J Nat Obstet Gynaecol. 1985;4:29–32.
5. Candido G, Lo T, Janssen P. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health. 2005;97:49–54.
6. Carlstedt A, Petersson U, Stark B, Bringman S, Egberth M, Emanuelsson P. Abdominell rektusdiastas kan ge funktionella besvär. Lakartidningen. (2018) 115:1–3.
7. Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. (2014) 100:1–8.
8. Keshwani N, Mathur S, McLean L. Relationship between interrectus distance and symptom severity in women with diastasis recti abdominis in the early postpartum period. Phys Ther. (2018) 98:182–90.