Postpartum Recovery: What is Diastasis Recti?
Diastasis recti, also known as the “mommy pooch” or abdominal separation, is the thinning of the connective tissue that connects the right and left sides of your abs, also known as the linea alba.
Linea Alba
During pregnancy, it is completely normal and necessary for the linea alba to thin to create space for the fetus. 100% of women in their third trimester will have a diastasis recti. While this may seem scary, it's normal and nothing to stress about.
Typically after delivery, a diastasis recti will heal on its own within 6-8 weeks. However, for some it can take much longer and requires the help of a pelvic floor physical therapist. 60% of women still have a diastasis at 6 weeks postpartum and 32% have one at 12 months postpartum. (Sperstad et al).
What are Symptoms of Diastasis Recti?
Symptoms of Diastasis Recti include
coning or doming with abdominal exercises
core weakness
low back pain
pelvic floor dysfunction
Can I check myself for Diastasis Recti?
Yes, you can! But it’s also a good idea to have it checked by a professional such as a pelvic floor physical therapist. While knowing if you have a separation is helpful, it's actually more important to know how you are managing your pressure with that separation. If you are holding your baby in a way that puts more pressure on the front of the abdomen, you could be placing undue stress on the linea alba that is already thin from pregnancy and needs time to recover.
Does Diastasis Recti Impact the Pelvic Floor?
Yes! The core and the pelvic floor work in unison to manage pressure in the body. (For more information on the pelvic floor, check out this article here). With the diaphragm, these three structures work as a canister to maintain pressure. Too much pressure going out front on the abdomen or down on the pelvic floor can contribute to diastasis recti and pelvic floor dysfunction. This is common in the postpartum period with the increased demands of lifting and holding a baby while recovering from a major injury (birth is trauma to your body regardless of which way you deliver).
Do I need a pelvic floor exam if I have a diastasis recti?
A pelvic floor examination will give us valuable information if you have a diastasis recti. The core and pelvic floor are best friends and need to work together. If you have a diastasis, your pelvic floor might not be working properly. It is important to learn how to coordinate the core and the pelvic floor to heal your diastasis recti, and the best way to do this is with a pelvic floor examination by a pelvic floor physical therapist.
How Do You Heal a Diastasis?
The best way to heal a diastasis recti is to see a pelvic floor physical therapist. Because of the core and pelvic floor connection described above, it’s imperative to know if the core and pelvic floor are working together. If one is dysfunctional, it’s likely that the other is dysfunctional as well.
Your Pelvic Floor PT will assess your abdomen for separation. The depth of the diastasis is actually more important than the width. If there is increased depth when you sink your fingers in, this generally means you are not managing your pressure well. The good news is that this can be corrected by learning how to properly activate the core.
Because adequate ribcage mobility is imperative for healing a diastasis, it’s also important to look at the thoracic spine, or your upper back. Your ribs attach to your upper back. If your upper back is not moving the way that it should, it can decrease rib expansion with breathing and potentially contribute to diastasis symptoms.
What Should Your Pelvic Floor Physical Therapist Look at If You Have a Diastasis?
There are so many factors that play into a diastasis recti. Some are uncontrollable such as genetics, the baby’s size and the position of the baby. But there are some factors that can be controlled and manipulated that your pelvic floor physical therapist should look at. These include
Posture
When you stand, are you arching your back and putting increased pressure on the abdomen, especially while holding your baby? If you are newly postpartum, this can cause unnecessary stress on that linea alba which is already thinned from pregnancy.
Breathing mechanics
Your Pelvic floor PT will also assess your rib mobility and your breathing. Many of us tend to breathe up into our chest and directly out into our belly, which can put increased load on a healing diastasis recti. Instead, when you breathe, that core canister we described above should open like an umbrella. What this means is that your breath should expand into your ribcage, back and abdomen. Here is an example of this 360 breath.
Lifting mechanics
Do you hold your breath when picking up your baby, toddler, carseat, groceries, or other heavy objects? Breath holding does not allow this core canister to move the way that it should and can impact healing.
Pelvic floor function
Are your core and pelvic floor coordinated and working together like they should be?
How you carry your baby/toddler, carseat, other heavy objects
How you manage pressure while exercising or doing core specific exercises
Finally, Your pelvic floor PT should be watching you perform your core exercises. They will look for any coning or doming. If you experience this, your pelvic floor PT should be able to modify the exercise or teach you how to activate your core more efficiently so that this goes away.
If you are currently seeing a pelvic floor PT for diastasis recti, they should address all of these things listed above. If they don't, come see us!
Are there certain exercises that I can’t do if I have a diastasis?
Learning how to activate the core correctly is the most important thing to do if you have a diastasis recti. There is so much conflicting information about exercises you can and cannot do if you have a diastasis. It’s actually very important to load the abdominal wall to strengthen it if you have abdominal separation. Loading the tissue will make it stronger and allow it to withstand more pressure.
The truth is, you can do any exercise if you have a diastasis, but first you need to learn how to activate your core efficiently.
Now, this does not mean you should be doing crunches immediately after giving birth. Birth is trauma to your body regardless of which way you delivered, and your abdomen has been stretched for NINE months! It takes time for the abdominal muscles to return to their normal resting length after giving birth, which is why it’s so important to take a rehabilitation approach to postpartum recovery. Being cleared at 6 weeks postpartum is not the time to immediately jump back into your pre pregnancy exercise routine. Working with a pelvic floor physical therapist who can apply the principles of progressive overload is vital to healing a diastasis recti.
If you think you have diastasis recti and would like to be assessed by one of our expert pelvic floor physical therapists at Cappuccino Physical Therapy, fill out this form.
