Post-natal care: What is a diastasis recti, and why do I need to know?

In the previous article: Why have I still got a mummy tummy, and what causes it? I touched on the topic of diastasis recti (aka diastasis split/ abdominal split/ abdominal separation) and the huge physical impact that this condition can have on our bodies, particularly on the tummy, both during and after pregnancy. A diastasis recti can be a major contributing factor to many a mum’s long suffering ‘mummy tummy’ without them having any knowledge or awareness about it. When I say ‘mummy tummy’ I am not referring to the very natural post- natal swelling that occurs after giving birth, we are talking about the many women who suffer with a permanent pooch despite very following healthy diet and fitness regimes. These pooches can range from small bumps to the more severe cases which can have the appearance of being 4 or 5 months pregnant lasting from a few to many years after giving birth.

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So what exactly happens?

The muscles on the front wall (rectus abdominus or six-pack muscles) of the stomach separate, and are no longer connected together. In the image above you can see examples of the different ways in which the rectus abdominus can separate.  The reason for the separation of the tummy muscles is due to the stretching and thinning of the soft connective tissue in the centre of the abdomen, caused by the growth of the baby whilst in the uterus. This tissue connects all of the the six-pack muscles together, but tends to be stretched most down the central vertical line (the linea alba) from the bottom of the rib cage down to the top of the pubic bone.
The separation can be partial, either just above or below the pubic bone, all the way from the rib cage to public bone or complete – where all of the muscles vertically and horizontally are separated.

For some people this stretching is temporary and the diastasis heals naturally. For others, particularly women who have had multiple pregnancies or larger babies the separation does not heal. This permanent separation, which not only happens to post-natal women is often the symptom of a weakened core, or the inner corset muscle (transverse abdominis), which when coupled with certain physical movements, postures and exercise that puts pressure on the front wall muscles, makes the diastasis worse and does not provide the best opportunity for healing, particularly post-baby. With the correct rehabilitation however this  condition can be encouraged to heal or at least improved, or perhaps even avoided entirely. If women understood what was best for them in terms of movement and exercise after a baby and what the risks were in terms of creating or exacerbating this condition they would have a much better chance of being able to manage it well. As we speak there is too little information provided, and very little awareness created about this subject, particularly in the UK.

What effect does it have?

What often happens is that often a bulge appears in the tummy area. There is only a weak, thin band of connective tissue holding the muscles together and the core is weak, so there is no longer the right support to hold the uterus, bowels, and other organs in place.  This bulge is what we refer to as a ‘mummy tummy’, for some presenting itself with the look or feel of still being pregnant.

A diastasis recti can affect more than just the appearance and general tone of a post-natal mum’s tummy. There are a number of secondary issues, making it equally as important to repair. If you have diastasis recti, there is a strong chance you may also have:

1: A weak pelvic floor: With a diastasis recti the transverse abdominis (inner corset muscle)  is weakened and unable to effectively support the abdominal organs, allowing them to rest too low in the pelvic bowl. This extra pressure pushes down on the pelvic floor, putting too much demand on the muscles that control the flow of urine.

A study done in  by Spitznagle et al (2007) examined the prevalence of diastasis recti in a patient group, and found that 66% of all patients with a diastasis recti had support-related pelvic floor dysfunction (SPFD), diagnoses of stress urinary incontinence (leaking urine unintentionally when coughing, running jumping etc), faecal incontinence, and pelvic organ prolapse.

2: Lower back pain: The instability of the abdominal muscles and core area can also compromise posture and contribute to back pain. Back pain is one of the most common manifestations of a diastasis recti.

A diastasis can even make it harder to breathe and to move normally. It’s rare, but in extreme cases, the tissue may tear, and organs may poke out of the opening, creating a hernia.

Why does it happen?

This separation occurs in the 3rd trimester of pregnancy to allow fo the uterus to stretch to hold the growing baby, and is considered a normal effect of pregnancy as it occurs in an estimated 66% of women. The separation should heal and reconnect the muscles, normally by about 6 weeks postpartum (after giving birth), but in some cases it does not return to normal within this time, in fact it does not return to normal at all, leaving many mums with that lingering ‘mummy tummy’, or ‘pooch’, often despite best efforts to diet or exercise.

This can happen for many reasons. Sometimes due to the separation being very large during pregnancy, perhaps due to a large baby, multiple pregnancies, several pregnancies in succession, or by incorrect pressure on the abdominal muscles, specifically by following an incorrect exercise regime after having the baby, or by having a weak core prior to pregnancy.

How to diagnose

The condition is quite simple to diagnose, and there a simple process that women can do to examine themselves before seeking help from a medical professional, or you can of course go straight to an expert for advice.

It is felt that diastases should heal by approximately 6 weeks after giving birth, so this is a good time to check.

The separation, or gap between the muscles is measured in fingers. We all have different sized fingers of course but this does give us a good guide.

So how do you check yourself for a Diastais recti / abdominal separation?

  1. Lie on your back with your knees bent, and your feet on the floor.
  2. Place your fingertips of one hand at your belly button and while your abdomen is relaxed, gently press your fingertips into your abdomen.
  3. Lift the top of your shoulders off the floor into a “crunch” position.
  4. Feel for the right and left sides of your rectus abdominis and take note the number of fingers that fit into the gap.
  5. You will want to test this again approximately 1-2 inches above and below your belly button to determine the length of the gap.

What to look for:

Any gap that is more than 2.5 fingers wide when the tummy is contracted is considered a separation.

Look for any small dome shapes or protrusions along the length of your midline.

The gap does not shrink as you contract your abdominal wall.

How common is this condition?

There were nearly 700,000 births in the UK in 2015 (according to the Office for National Statistics), with that number increasing year on year. There is an estimated 66% of woman who suffer from diastasis during pregnancy in the UK and, approximately half of those women (33 %) women will go on to suffer long term issues, or be in need of intervention to help them heal.

Awareness

Some women may have heard about this condition before either from a friend or having suffered from it themselves – but this will most likely be with reference to the more extreme cases (where the separation is very large, but it is often the more moderate diastasis splits that people live with on a day to day basis, that have very little awareness. This of course means that people can be making their condition much worse often by doing the wrong kind of activity or exercise, or that they are living with pain or discomfort unnecessarily, unaware that they can improve it or fix it completely.

I only became aware of this after living with the condition for 2 years, and doing all the wring kind of exercise which made my condition  so much  worse,  so now I want to shout about it a much as possible, to ensure that other mums don’t make the mistakes that I did, and even better can prepare them selves for it so that it doesn’t happen or has very little impact if it should.

Who can suffer form this condition?

Men can also suffer from this condition. If they have been performing incorrect weight lifting or sit-up routines. They can also suffer from this condition if they have put on a few too many pounds of weight around the abdominal area (often referred to as a ‘Beer Belly’) which weakens the transverse abdominis.

Sometimes babies can also be born with this condition, but it will often heal and close as the baby develops.

So what can we do?

Well it’s not all doom and gloom. With awareness, knowledge and the right course of action, you can prevent, heal or at least manage the condition quite easily. But as most of us are unaware, we do the wrong kind of thing, particularly with our exercise regime that makes the condition so much worse, and so much more difficult to repair. We are all under such pressure from society to go hell for leather on exercise post-natally and pop back into our pre-baby bodies. This can actually just physically damage us, sometimes beyond repair. We want to avoid this, be conscious and take the right steps to heal as best we can.

It is so important to look after ourselves physically and mentally after having a baby, the two of course are very much interconnected. Given the impact that this condition can have on our bodies, and how unnecessary that this might be it is so imortant to be aware, and take action.

In my next few blogs about this topic, I’ll be talking about the most immediate do’s and don’t do’s with regards to ensuring you that you have the best chance of healing post baby, and discussing/ demonstrating some of the techniques that other people have used to correct it.

Why are we not made more aware of this?

The big question is why are we not told about this?  Why is there such is the lack of information, awareness and knowledge provided before and during pregnancy in the UK, for what seems to be a fairly common and preventable, or at least easily manageable condition?

Since learning about it (and being diagnosed with it), I really think it is important for any expectant mum to have some awareness so that they can be mindful not to cause or exacerbate their situation before, during and after pregnancy, or through taking the right steps prevent it from happening at all. Part of the reason I write this today is that I am determined to raise awareness of this with mums, and any other people else that this may affect.

Ultimately it would be great for midwives and other health professionals to offer some advice about this pre-natally, but even to get mums actively discussing through our many networks would be a triumph.

The ‘Mummy Tummy’

I will just take this moment to say that a diastasis recti, or mistreatment of this is of course not the only cause of a ‘mummy tummy’. We know that the correct diet, correct exercise regime and general life-style choices including small amounts of alcohol and caffeine consumption, drinking lots of water and getting the right amount of sleep (baby permitting of course) are critical, but it certainly seems to affect enough people to warrant talking about, and acting on.

Further information

As mentioned, I’ll be talking a little more around this topic in the coming articles particularly with regards to the immediate do’s and don’ts, but it would also be great to hear any of your stories or experiences of having an abdominal split and how you managed it, and any advice you think important to share.

Thank you for taking the time to read. It would be great if you could share this article with friends and family, and wonderful to get an open dialogue going about this topic on our amazing mums online communities.

Thanks again, KOKOKALM xx

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