The Inside Scoop on Diastasis Recti

Women in the postpartum period often wonder if they have diastasis recti. Diastasis recti is the separation of the abdominal muscles, specifically when the "six pack" abdominal muscles separate more than 2 fingers width.

Diastasis recti occurs in almost all full-term pregnancies because the baby needs the extra space to grow. However, following pregnancy, the abdominal muscles can stay in this separated position.

Can I fix my diastasis recti?

It depends! Diastasis recti can heal in as little as two weeks of pelvic health physical therapy through targeted exercises, breath-work, behavioral strategies, and postural changes. On the other hand, some peoples' abdominals never come back together. So why would anyone try to get rid of diastasis recti if some peoples' abs never go back together anyway?

It's all about pressure management

Picture your core region as a can of pop. The front of the pop can is your abdominal muscles, the back is your back muscles, the top is your diaphragm, and the bottom is your pelvic floor muscles. If you have an area of ab separation, this area is a weakened area of the can, almost like if the can has a hole in it. The can is much easier to crush or have dysfunction if there is a hole (diastasis recti).

When the abs are separated, air tends to want to flow into this hole, throwing off your whole internal pressure system. If your abs are separated you might see coning or doming of the abs when you go to sit up out of bed. Or you might see your abs doming if you bear down to poop.

Each time you hold your breath or bear down to perform an activity, air flows into this weakened area, making the abdominal separation more pronounced and sometimes larger.

Yes, some patients never get their abdominal muscles to go back together. However, if people can learn to manage internal air pressure correctly, they can achieve excellent function, be able to get back to sporting activities, achieve a flat stomach (if that is their goal), and not be bothered again by the ab separation.

Why is it important to get treated for diastasis recti?

If people do not learn how to manage air pressure, the ab separation can get worse. In addition, down the road this area of core instability can lead to low back pain, pelvic floor issues, and a higher risk of hernias.

"I don't think I have diastasis recti, but something just doesn't feel right about my core."

I hear this phrase all the time from postpartum moms. It is important to have a pelvic floor physical therapist evaluate your core following childbirth. Diastasis recti is not the only change that occurs postpartum. Many moms have changes such as umbilical hernias. Or you might not have a wide abdominal separation, but you might be able to sink your fingers deep into your belly. Your belly button may look deeper than previously. Both an umbilical hernia and an absence of deep core muscle activation are treated similarly to diastasis recti by a pelvic floor physical therapist.

Summary

Some people will achieve full ab reconnection through various exercises, behavioral strategies, postural changes, and breath work. Some people doing the same exercises will not achieve ab reconnection. Either way, learning how to manage air pressure in your core through pelvic floor physical therapy can lead to a happy, healthy core, flat stomach, return to activities, and eliminate future back pain and pelvic floor dysfunction.

Author: Dr. Maddy Roth, pelvic health physical therapist