After giving birth, many moms are left with an abdominal pooch or bulge for months or years.  This is sometimes due to some extra weight that isn’t lost postpartum, but it may also be due to the condition known as Diastasis Recti Abdominis (DRA) that many women don’t even know is a condition. 

This condition causes frustration for many women when they do lose the weight but still have this abdominal pooch that just won’t go away.  In medical terms, a DRA is the separation between the two bellies of the rectus abdominis at the linea alba and this condition may occur with more than half of all pregnancies.  When a woman is pregnant her abdominal wall expands and while most abdomens can stretch to accommodate these changes that occur during pregnancy others are damaged extensively.  

Related: PostPartum Exercise Recommendations: How, When & Why

Exercise during pregnancy may help to decrease the presence and size of a DRA.  The traditional determinant of the diagnosis of DRA is at least a 2-3 finger width or a 2.7 centimeters separation of the abdominal muscles.  

DRA does not spontaneously resolve for many postpartum women.  This condition can cause women to have trouble fitting into their pre-pregnancy pants even when they are the same weight and size as they once were.  DRA can also be connected to abdominal pain and pelvic problems.  Many women don’t know about the condition and just think they need to lose more weight. The problem is even if the weight is lost the abdominal wall still “pooches” out because of the separation of the muscles.  

Do you have Diastasis Recti?
To check to see if you have diastasis recti, first lie on your back with your knees bent and feet flat on the floor. Then place your fingers with the palm facing you on your belly button. Lift your head and neck just slightly off of the floor like you are doing a crunch while you press down with your fingers. If there is a gap this would mean you have a diastasis.  You should conduct the test just above your belly button and just below the button since the gap can measure differently in these places.  

How can I fix Diastasis Recti?
So maybe you did the Diastasis Recti test and you realize that yes you do have this condition. Now you may be wondering what to do about it.  Smaller gaps can be helped with specific exercises while severe cases may need physical therapy or even surgery. There are Diastasis Recti exercises that can be done at home - as well as exercises that you should avoid. If you still feel like you aren’t improving you may need to seek medical attention - keep in mind that you should always talk to your doctor before starting into any exercise program, especially after pregnancy.

What exercises to avoid with Diastasis Recti?
Many exercises that are thought to promote core strengthening need to be avoided. Performing exercises like planks and crunches can actually make the condition worse.  You should also avoid exercises that require lying backward over a large exercise ball, Yoga postures that stretch the abdominal muscles and other abdominal exercises that flex the upper spine off the floor.  Avoid lifting and carrying very heavy objects.  Don’t perform exercises in quadruped (on your hands and knees) without adequate abdominal support and try to avoid intense coughing without abdominal support.

Are there exercises to help improve Diastasis Recti?
The main focus of exercises for a DRA needs to be improving transverses abdominis control.  

There are many exercises that can help strengthen the transverse abdominis muscles or the body’s internal “girdle” which when contracted, compresses the abdominal wall.  You should also focus on full body movements like squats and lunges using good form and performing a transverse abdominis (TA) contraction.

More: Diastasis recti exercises that help & what to avoid

You also need to make sure you get up correctly from a laying down position and are always aware of your posture especially with movement.  Splints have mixed reviews in whether or not they help heal or inhibit the muscles from doing what they need to do but that is your decision and your health care provider should be consulted. It may help you more with pain and healing in the immediate postpartum period especially if you have also had a cesarean section.  It may also help once you have established a strong TA contraction to use a towel or sheet to help to draw in the abdominal muscles while performing exercises which acts as manual splint to draw the muscles even closer together. It is important to establish some control prior to using external sources of stability in order to maximize the results. 

If you have tried these exercises and it still doesn’t seem to be helping you can go to your doctor and they can determine if you need physical therapy and then go from there.  It’s a common problem that doing exercises can help, but if you don’t know the condition exists, then it is hard to fix.  

Written by: L. Augustyn, Physical Therapist

Have you dealt with diastasis recti? Have you had success with specific training styles or physical therapies?

References
Chiarello C, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. Journal of Women’s Health Physical Therapy. 2005; 29: 11-16. 
Lee, D. Diastasis rectus abdominis & postpartum health consideration for exercise training.  (Adapted from Stability, Continence and Breathing - The role of fascia in body function and dysfunction and the potential consequences following pregnancy and delivery. Journal of Bodywork and Movement Therapies. 2007; 12: 333-348. 
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