Diastasis Rectus Abdominis – Postpartum Care

Published: October 23, 2023

Pregnancy can be a beautiful and special time in a woman’s life. Your body is growing and adapting as it slowly forms another human being from mere cells. Your body is amazing!  

On the other hand, pregnancy can also take a toll on your body. During pregnancy, as your growing belly puts pressure on the abdominal muscles, they often separate a little under the stress. This separation, called diastasis rectus abdominis (DRA), is typically a slow process and is not painful. 

DRA is a common clinical finding in most postpartum women. Research shows that 66-100% of women have DRA at 35 weeks of pregnancy, and it persists 6 months later in 35-60% of women (Mota et al 2015). So if you’re feeling not quite right in your core, you are not alone! 

What exactly is DRA?

The rectus abdominis muscles run vertically from your rib cage to your pelvis. These are the muscles that we use when we do a crunch. Normally, a tendon called the linea alba holds the right and left  sides of rectus abdominis muscles together. During pregnancy, pressure pushes out from your abdomen, the linea alba gets stretched and the two sides of the rectus abdominis can move away from each. This forms a gap in the front of your body known as diastasis recti abdominis (DRA). 

You may or may not notice this during pregnancy because it often isn’t visible while you are still pregnant. However, it can cause some changes in your ability to roll over in bed or get up from a chair easily. These functional changes may be the only thing you notice during pregnancy.

How do you know if you have DRA?

Another thing I hear from pregnant women is, “I feel like my organs are going to fall out through my belly button!” The pressure in the abdomen has found a weak spot and stretches there. You may also feel pain in the abdomen, pelvis or low back.

Diastasis recti will usually be more visible after pregnancy. The things that women notice most are a gap between the abdominal muscles, doming (a “pooch”) of the abdomen, and/or decreased core strength and function.

Decreased core strength may cause difficulty rolling, getting out of bed, standing up from a chair. You may notice difficulty picking up and holding your child, easily tiring with normal movement, etc. Most women can still do these things, it’s just harder than before pregnancy.

I think I have DRA, when should I go to a physical therapist?

If you think you have diastasis recti, your best course of action is to go to a pelvic floor physical therapist. Physical therapists with this specialty have extra training to assess all the muscles of the core. When I see DRA, I measure the gap between the rectus abdominis muscles in both a resting and an active position. I use two methods of measuring: 1) finger width, which gives a good estimate and 2) a digital caliper, which measures for accuracy to the 10th of a millimeter. I’m also using my fingers to assess the tension of the linea alba. A loose boggy feeling in the linea alba tells me that we have work to do!

Sometimes diastasis recti goes away on its own shortly after pregnancy. Research suggests a physical therapy intervention is needed if it doesn’t resolve within 8 weeks after pregnancy. I’ve been treating this condition for 15 years, and I will say that I do prefer to see women as soon as possible after pregnancy. However, I often treat women months and even years after pregnancy and still have great results.

What will I do in physical therapy?

My first course of action is always to reduce pain if that’s a symptom that you have. From there, I teach women to engage the transversus abdominis that goes horizontally across your belly. This muscle has the power to bring your core together. You’ll learn how to cue those muscles to protect you during various movements throughout your day.

We’ll bring in the pelvic floor and the diaphragm (the bottom and the top of the core). We’ll also include the back muscles so that you have a solid core. When you’re ready, we’ll get to exercises that strengthen the obliques and rectus abdominis (the crunch muscle) to leave you in tip top condition. I will walk you through each step and you’ll understand and appreciate your core like never before.

What changes can I expect with physical therapy?

As a physical therapist, I want to see a measurable improvement in strength of the core, tension of the linea alba, and closure of the DRA. Patients see that the doming of the abdomen has returned to normal and they are able to do everyday things more easily. Patients should feel strong and healthy when changing their baby, picking up a child, putting the groceries away and taking a long walk or run with the stroller. I don’t want their core to limit them in any of their family or work activities. Patients feel like they are back to their previous selves… or better!

Also, if you are having any other postpartum symptoms like pelvic pain, urinary incontinence, prolapse, hemorrhoids, or any other pelvic problems, check out what to expect during a pelvic exam. Back pain? We can take care of that too!

Don’t wait. If you suspect that you have DRA, contact your pelvic floor physical therapist today. You’re one step closer to having the strong core that you deserve!

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