As a pelvic floor physical therapist, I get questions about Diastasis Recti every. single. day. There is a ton of information out there on social media and Google, but everyone seems to have a different opinion and it can become confusing very quickly. So, I've put together a list of the top 8 questions I get about Diastasis Recti and answered them. I hope this helps to set the record straight!

1. What is Diastasis Recti?

Diastasis Rectus Abdominis, aka diastasis, DRA, DR, mommy tummy, mommy pooch, or abdominal separation is the stretching of the connective tissue, called the linea alba, between your two six-pack muscles, or rectus abdominis muscles. The linea alba is normally taut, like a trampoline, and when it is stretched, it can sometimes become more like a loose hammock.

2. How common is it?

DRA is very common during pregnancy and after delivery. Studies have shown that 100% of women at 35 weeks pregnant had a DRA (1) and 32% of women at 1 year postpartum still had DRA (2). The linea alba has to stretch during pregnancy to allow for the baby to grow and afterwards, it may have some difficulty returning to its prior tautness.

3. How do I know if I have DRA?

The telltale sign of DRA is “doming” or “coning”. This can be seen when you do a crunch-like movement causing the pressure in your abdomen to push out against the stretchy linea alba. You may start to notice doming during pregnancy, especially if you are in your third trimester.

After delivery, you can measure your DRA more formally yourself or have a trained professional help you. If you want to measure it yourself, lay on your back with your knees bent, place two fingers at your belly button as you curl up. You want to feel for both the edges of your six-pack muscles with the sides of your fingers and the springiness and depth of the linea alba. You may need more or less than two fingers to feel the width of your DRA. Repeat this process a little above and a little below the belly button.

4. How do I close the gap?

“Closing the gap” is a tricky term that I do not personally use when talking about rehabbing a DRA because it implies that in order to be healed, there should be no space between the rectus abdominis muscles. This is simply not true. It is more important to regain proper tension in the linea alba (3) than it is to focus on the width of the gap. I prefer to think of it more as reteaching the core how to work functionally again, regardless if your gap gets smaller. Reconnecting to your core and strengthening it again will take different amounts of time for different people. Some women can resume their normal exercise routine safely within a matter of weeks, some women have to rehab for much longer than that.

5. Will I ever be able to do a crunch or planks again?

Yes! Both crunches and planks have very functional uses in real life. You eventually need to be able to “crunch” up to get out of bed or off a low couch, especially if you are holding a baby! You also need to be able to maintain core stability against gravity (aka hold a plank-like position) for a while when you’re changing diapers! So crunches and planks are a yes, but a yes only when you’re ready. There are no inherently “bad” exercises when you have a DRA, only exercises that you cannot maintain core stability during yet. You need to follow the steps listed in the last question and work your way back up to these advanced exercises in order to do them safely and without affecting the DRA.

6. Is there anything I should avoid doing if I have DRA?

There are a few actions I recommend you avoid as much as possible while your DRA is still healing. The first is getting up out of bed by “crunching”. Instead of getting straight up out of bed, log roll yourself onto your side first, then use your hands to help push you up into sitting. The second is avoiding holding your breath when lifting stuff. I always recommend “exhaling with the effort” to avoid doming when lifting things like the baby, or the stroller, car seat, or anything else heavy. Exhale and try to draw the belly button and pelvic floor in as you lift. Lastly, when exercising, avoid any exercise that makes you dome. This will be different for different people, so you have to pay attention to your own body and see what is doable for you in that moment and what is not.

7. Will a belly binder fix my DRA?

Wearing a belly binder postpartum will not automatically fix your DRA, however, wearing one in the very first weeks after delivery can help give your core some support while it is in the very early stages of recovery. If you’re going to wear one, I recommend wearing it as much as you like for the first 4-6 weeks, then slowly weaning off of it, so your abdominal muscles can start working on their own.

8. Is there a general list of Do's and Don'ts I should follow?

DON’T:

● "Crunch” up when getting out of bed early on; instead log roll onto your side first, then get up

● Do any exercises that make you dome

● Be hard on yourself; strengthening and reconnecting to the core takes different amounts of time for different people, so be patient

● Fixate on the width of your separation

DO:

● Start slow when strengthening core muscles postpartum, focus on reconnecting first

● Exhale with the effort, both when exercising or when lifting heavy things around the house

● Stay positive and consider reaching out to a specialist who can help you with the healing process

Anna McMaster is a PT, DPT, PRPC - Women's Health and Pelvic Floor Physical Therapist. Learn more or schedule an appointment at glowptandwellness.com

Citations:

1. Mota, P. G. F. D., Pascoal, A. G. B. A., Carita, A. I. A. D., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200–205. doi: 10.1016/j.math.2014.09.002
2. Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092–1096. doi: 10.1136/bjsports-2016-096065
3. Michalska, A., Rokita, W., Wolder, D., Pogorzelska, J., & Kaczmarczyk, K. (2018). Diastasis recti abdominis — a review of treatment methods. Ginekologia Polska, 89(2), 97–101. doi: 10.5603/gp.a2018.0016