I have been very interested in postpartum care lately…

We welcome lots of mothers and their newborns coming into our baby-friendly clinic. As pelvic floor physical therapists, we should be educating these postpartum patients on what is safe for them, movement-wise, whether breastfeeding or not. I find that diastasis rectus is overlooked in many cases and should be treated as soon as possible after the birth of a child (if okayed by the physician).

Diastasis recti is a common diagnosis that we treat at 5 Point Physical Therapy with patients that are postpartum. Diastasis means separation and recti refers to abdominal muscles.  Hence, the term and diagnosis diastasis recti.

The big question is – can diastasis be avoided?

Some people may be more prone to it that others due to some genetic factors?  Too much intra-abdominal on the abdomen? Gaining extra weight during pregnancy?

After looking at some of the research, these are the current risk factors noted:

  • Older women > 33 years old
  • Multiple pregnancies and births
  • Carrying a larger baby
  • Greater weight gain > 35 lbs
  • Birth by c-section

Studies have also shown that women who have moderate sway back and/or have abdominal weakness are more apt to experience diastasis.

Lets talk about what abdominal separation actually is.

The basics are that the abdominal muscles get stretched out during pregnancy due to increased size of stomach. To diagnose it, there needs to be around a 2.5 finger width separation between your rectus abdominal muscles at your naval and above/below it.  The linea alba is what actually is stretched and that is a connective tissue collagen sheath that attaches the rectus abdominals.

Depending on how much the connective tissue will stretch may be a cause for hernias.  Sometimes this can lead to lower back pain and urine leaking, etc.   If you had a diastasis in a previous pregnancy, there is a chance of experiencing it again in the next pregnancy.  

Here is a great website that has a video to show how to self check!

And these activities need to be avoided:

  • abdominal strengthening exercises that emphasize rounding the spine, ie. crunches, sit ups
  • yoga poses that overstretch abdomen, ie. backbend
  • heavy lifting
  • straining due to constipation or pushing during labor (the action of straining can put big pressure on weak belly tissue)

During pregnancy or after childbirth, developing good lifting habits can dramatically avoid diastasis recti.

How to lift correctly:

  • bend at your knees and not at your waist or back!
  • keep your back as straight as possible
  • use your leg muscles to stand along with an exhale of breath
  • keep the object close to your body

Here is a great tutorial on proper lifting mechanics during pregnancy 

If you develop a cough from allergies etc., place your hands across your belly and manually splint your abdomen together during coughing/sneezing episodes. This will provide needed additional support, and help to prevent separation of your midline (the connective tissue in between your rectus abdominal muscles).

To protect your mid line during pregnancy, always use the “log roll” maneuver when rising from the floor or out of bed. Log roll: with your torso and head aligned and in one piece, roll over onto your side, then use your arms to help push yourself up to a sitting position.

If you are diagnosed with diastasis, please check with your physician on the next steps to take. Don’t forget that pelvic floor physical therapy can help! For instance, your therapist can show you appropriate exercise guidelines that will protect your abdomen and also guide you for options for more abdominal support:

There are options for surgery as a last resort. If your condition is severe and not improving after appropriate amount of time in physical therapy and abdominal support, it is an option. To be a candidate, the separation has to be as wide as two centimeters (or two finger widths).  The surgery is known as an abdominoplasty.  Some patients fall into the category of only having the abdominal muscle tightened, which can be done through endoscopic-assisted modified tummy tuck.  Some surgeries are more involved where extra skin is removed, muscle is tightened, and belly button is relocated to a new position within the abdomen.