Diastasis Recti: A Comprehensive Guide to Post-Partum Recovery

Surprisingly common, diastasis recti is a postpartum condition that affects up to 60% of all pregnant women - often without their knowledge until after delivery. Diastasis recti occurs when the connective tissue, known as the linea alba, that runs down the centre of your abdomen stretches or separates, allowing the two sides of the rectus abdominis muscles (often referred to as the “six-pack”) to pull apart. While it's a natural part of pregnancy, it can lead to various physical and aesthetic issues if not addressed properly.

Understanding Your Body Postpartum

The Science Behind Diastasis Recti

During pregnancy, the body undergoes significant hormonal and physical changes to accommodate your growing bundle of joy. The hormone relaxin, for instance, relaxes the ligaments and joints to prepare the body for childbirth. This relaxation also affects the linea alba, causing it to thin and stretch. As the baby, and uterus, grow, the increasing intra-abdominal pressure further contributes to the widening of the gap between the rectus (six-pack) muscles. Furthermore, the strain on the abdominals during labour and childbirth can also place strain on the abdominal muscles.

Identifying Diastasis Recti

Diastasis recti is not usually painful unless there are other side effects from the separation, but there are some common sensations that can help identify it. Some reports from postpartum women include a feeling of weakness in their core or abdominal muscles, difficulty with physical movements especially lifting or carrying heavier objects, noticing that their abdominals are coning or doming during contraction, which may appear as a ridge or bulge in the centre of the abdominals, or softness above or below the belly button.

To check for diastasis recti, follow these steps:

Lie on your back with your knees bent: This position relaxes your abdominal muscles.
Place your fingertips just above your belly button: Gently press down into your abdomen.
Lift your head slightly off the floor: As you lift your head, feel for any gaps or separations between your abdominal muscles.

If you can feel a gap wider than two fingers (2 or more centimetres), you may have diastasis recti. It is important to consult with a healthcare professional for a proper diagnosis and guidance.

The Impact of Diastasis Recti

As I have mentioned up to 60% of all mums have experienced diastasis recti, but it’s the degree of separation that really matters. Often with the linea alba being so elastic and our bodies being as amazing as they are, after birth the linea alba can often just retract back into place, usually taking around 8 weeks post-partum to resolve itself. However, some women experience a more pronounced separation or have a rectus adbomins which does not return to its prepartum state itself in that period, may need further attention.

The majority of mothers will have it to some degree. For roughly half of these women, the condition will resolve on its own within 12 months of delivery.- Frank E. Campanile, MD | Denver

The severity of the diastasis recti depends on a few factors, such as the width of the gap between the rectus abdominis muscles, the length of the separation and the strength of the abdominal muscles surrounding the separation.

This abdominal separation can lead to various physical and aesthetic issues, including:

Lower back pain: A weakened core or compromised abdominals can contribute to lower back pain.
Poor posture: Diastasis recti can affect your posture, leading to slouching and other postural issues.
Pelvic floor dysfunction: Weakened abdominal muscles can impact the pelvic floor, leading to issues like incontinence and prolapse.
Pelvic instability and hip pain: Often abdominal separation and weakened abdominals can lead to instability in the pelvis, sometimes resulting in hip pain.
Aesthetic concerns: Diastasis recti can cause a "poochy" belly appearance.

In more severe cases it can lead to a hernia which needs to be addressed by a medical professional.

Find out more about your Pelvic Floor

Addressing Diastasis Recti

While diastasis recti often improves naturally over time, there are specific exercises and lifestyle modifications that can accelerate the healing process and minimize its impact. Addressing the diastasis recti involves both doing the right movements as well as avoiding the wrong ones.

What to do:

Core Strengthening Exercises

A physical therapist or doctor can assess the severity of your diastasis recti and create a personalised plan to help assist in the repair of the separation. Together with a certified Pilates instructor, they may recommend exercises that target the deep abdominal muscles, such as:

Pelvic floor exercises: Strengthening the pelvic floor muscles can help support the abdominal wall.
Transverse abdominis exercises: This muscle layer helps draw the abdominal wall inward, reducing the gap between the rectus muscles.
Postural exercises: Proper posture can help alleviate strain on the abdominal muscles.

Pilates is an excellent form of exercise for women with diastasis recti. It focuses on core strength, flexibility, and proper alignment, all of which are crucial for healing and preventing further separation.

Once you've received clearance from your healthcare provider, you can start to incorporate specific Pilates exercises into your routine. Some effective exercises include:

3-Dimensional Breathing

The connection between breathing and pelvic floor health is crucial for core stability and diastasis recti recovery. Deep, diaphragmatic breathing engages the core muscles, including the pelvic floor and transverse abdominis. This can help to draw the abdominal wall inward and reduce the gap between the rectus muscles.

How to do it:

Inhale into the sides of the ribcage, promoting a 3-dimensional breath.
Exhale through pursed lips, imagine blowing out through a straw
As you are exhaling try to bring awareness to the diaphragm and other respiratory muscles, in conjunction gently connect the pelvic floor to around a 30% contraction.
Inhale, release the pelvic floor and focus again on the lateral breath, filling the sides of the body and expanding the ribcage like an accordion.

Imprint/Release

Lie on your back with knees bent and feet flat on the floor, with your pelvis in neutral ( hip bones and pubic bone level with one another, there should be a small curve present in your lower back)
Inhale to prepare; exhale as you gently connect the pelvic floor and your transverse abdominis (corset muscle) as if you were pulling a belt around the hip bones.
Continue the exhale and start to draw your navel towards your spine, encouraging a slight posterior tilt of the pelvis and a gentle lengthening of your back towards the mat.
Inhale to return to a neutral pelvis and release the muscles.

Walk Out’s (Stabilising in Neutral)

Lie on your back with knees bent and feet flat on the floor, with your pelvis in neutral ( hip bones and pubic bone level with one another, there should be a small curve present in your lower back)
Inhale to prepare for the movement, gently engaging your pelvic floor and your TA muscle, think of a T-junction connection, pelvic floor pulling up while the two hip bones feel as if they were narrowing.
Exhale, maintaining the neutral pelvis and complete stability in the lower back step one heel out in front of you, gently placing it on the floor. Keep the legs ‘light’ and imagine you are walking on a cloud.
Next move the second leg out in front of the body also bringing the heel down to the floor maintaining a slight bend in both knees.
During these movements, the pelvis should not rock from side to side nor tilt forward and back. Image your pelvis was a bowl of water and you are attempting not to spill any of the water from the bowl.
On the next exhale breath, bring one leg back to the starting position. Take a short inhale and on another exhale breath bring the second leg back.
Try to alternate leg movements as you do additional repetitions.

Swimming Prep Kneeling

Begin on your hands and knees in a tabletop position, with your wrists aligned under your shoulders and knees under your hips.
Inhale to prepare, then exhale as you extend your right arm forward and left leg back, keeping your core engaged. Try to find a ‘long line’ position while engaging the shoulder girdle to maintain scapula stability and engaging the glute to lift the extended leg.
Avoid arching or ‘hanging’ in the lower back, and maintain the alignment of the pelvis and hips during the movement.
Inhale to return to the starting position and repeat on the other side.

Hip Roll

Lie on your back with your knees bent and feet flat on the floor.
Inhale to prepare for the movement. On the exhale breath think of an imprint and engage your core. Press your body weight into the feet and slowly lift your hips off the floor, articulating the spine by rolling up one vertebra at a time.
Inhale to hold the position at the top of the movement, one long diagonal line from the knees to the chest.
Exhale to lower back down, placing the back of the ribcage on the mat first and then articulating the spine down onto the mat with control.

During all of these exercises, it is important that you remain connect to your TA (Transverse Abdominis muscle) to promote correct abdominal contractions, there should be no ‘coning’ or ‘doming’ as you perform these movements, if this does occur you may be progressing too quickly or not engaging the muscles correctly.

What not to do:

While there are specific exercises which can be incorporated into your daily routine there are also small changes in your lifestyle which can assist with your diastasis recti, such as:

Avoid heavy lifting: Refrain from lifting heavy objects, especially during the initial healing phase.
Avoid High-Impact Exercises (early on): High-impact exercises like running and jumping can exacerbate diastasis recti.
Avoid Sitting Straight up from Supine (lying down position): Rather roll onto one side and use your arms to assist in lifting into a seated position.
Practice good posture: Maintain good posture throughout the day to reduce strain on your back and abdominal muscles.

If you have severe diastasis recti, experience persistent pain, or notice other concerning symptoms, consult with a healthcare professional. In some cases, surgery may be necessary to repair the separation.

Remember, diastasis recti is a common postpartum condition that can be effectively managed with the right approach. By understanding the condition, seeking professional guidance, and incorporating targeted exercises and lifestyle changes, you can work towards healing your abdominal muscles and regaining your strength and confidence, but remember healing diastasis recti takes time and patience. It's essential to be consistent with your exercises and lifestyle modifications. Avoid rushing the process and listen to your body.