What Is It?
Diastasis Recti is a separation of the abdominal wall that occurs most frequently in pregnancy. It can look or feel like a ridge down the middle of your stomach when your abdominals contract. (Diastasis Recti, 2013). It has shown to occur in 50-60% of pregnancies during the 2nd and 3rd trimester (Boissonnault, 1988). Some restore naturally on their own while some continue to be present at 6 months or more post-partum.
What Causes It?
The formation of a diastasis recti can be caused by the abdominals becoming overstretched and weaken due to the increase in hormones and the growing uterus in pregnancy, (Chiarello, 2005). It is important to check for a diastasis throughout your pregnancy (see below on how to do this). Weaker abdominals prior to surgery [if it is a cesarean birth] and multiple pregnancies have shown to increase the likelihood of a diastasis (Boissonnault, 1988 & Diastasis Recti, 2013).
If the separation doesn’t close, a person may experience back pain, hip pain and/or sacroiliac (SI) pain from poor biomechanics. It can also contribute to urinary leaking/incontinence as well as breathing disorders (Lee, 2008 & Ryan, n.d.).
How To Test For It
Testing for a Diastasis Recti is easy and can be done at home or with a health care provider. Simply, lie on your back with your knees bent. Lift your head and shoulders off the surface you are lying on with your arms forward. Your provider or partner can then test the gap in 3 positions with their fingers horizontally into your belly:
- At your belly button
- 4.5 cm above your belly button
- 4.5 cm below your belly button.
A gap of two cm or less (1 finger), is considered normal (Boissonnault, 1988). However, a ridge is not normal and should be addressed.
If you are diagnosed with having a diastasis recti, there are several treatment options that you can pursue:
- Rectus Sheath Plication: Rectus sheath plication in an abdominoplasty surgery has proven to be successful in folding over and tucking the loose tissue with stitches (Tadiparthi, 2011). Possible complications include haematomas [blood clots], minor skin necrosis, wound infections, dehiscence [scar tearing], post-operative pain, nerve damage and recurrence (Hickey, 2011).
- Binders: Binders have shown to assist the tissue to move inward, but should be avoided from the 3rd trimester until 6 weeks post-partum.
- Physical Therapy: A physical therapist can help you establish a home exercise program during and after pregnancy to address the mechanics of the entire body and why the diastasis hasn’t resolved on its own. In a study comparing exercising pregnant women to non-exercising pregnant women, 90% of women who weren’t exercising had a diastasis, compared to only 12.5% of women exercising (Chiarello, 2005).
If you are pregnant, have a diastasis recti or are experiencing back, hip or sacroiliac pain and would like to be evaluated, contact the MTI Physical Therapy clinic in your neighborhood and schedule an appointment with one of our highly-skilled Physical Therapists.
Here are a few simple things to keep in mind:
- Avoid doing sit-ups or crunches
- Remember to roll onto your side first before getting out of bed
- Exhale with lifting to decrease overstretching the abdomen (Ryan, n.d.)
Hilary initially became interested in physical therapy after volunteering at a camp for children with disabilities for 7 years. Hilary later went on to study child development and premed at Tufts University in Boston and then received her Doctorate from the University of Washington. She decided that she wanted to focus her career on orthopaedics and further her clinician skills by returning to school for an additional two years of manual therapy training through the Ola Grimsby Institute, where she learned a hands-on, individual approach to improving joint mobility in order to help people return to their daily activities, work or sports.
Boissonnault, JS, Blaschak MJ (1988). Incidence of Diastasis Recti Abdominis During the Childbearing Year. Phys Ther, 68(7): 1082-1086.
Chiarello et al (2005). The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women’s Health Physical Therapy, 29(1): 11-16.
Diastasis Recti. (2013). Retrieved May 26, 2014 from PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002569/
Hickey R, Finch JG, Khanna A (2011). A Systematic Review on the Outcomes of Correction of Diastasis of the Recti. Hernia, 15(6): 607-614.
Lee DG, Lee LJ, McLaughlin L (2008). Stability, Continence and Breathing: the Role of Fascia Following Pregnancy and Delivery. Journal of Bodywork and Movement Therapies, 12(4): 333-348.
Ryan M, Ritchie L (n.d.). Diastasis Recti. Retrieved from: http://www.physio-pedia.com/Diastasis_Recti.
Tadiparthi S, Shokrollahi K, Doyle GS, Fahmy FS (2011). Rectus sheath Plication in Abdominoplasty: Assessment of its Longevity and a Review of the Literature. Journal of Plastic Reconstructive Aesthetic Surgery, 65(3): 328-332.