December 1, 2021

A woman's body undergoes a significant transformation as it prepares to bring a new life into the world.

While so much of the experience of pregnancy and delivery is incredible, once your baby is earthside, it can be challenging to adjust to your body's new normal.

After delivery, the focus tends to shift from the pregnant momma to the new addition, ignoring or minimizing whatever physical changes a new mom is dealing with. Women also may not feel comfortable sharing these issues about their bodies. Add to that, many new moms only see their OB/GYN for a brief follow up six weeks after delivery. As a result, women lack information about their postpartum body, so reparable physical issues go undetected.

Many women expect that once their baby is delivered, their body will go back to normal. Then they feel frustrated if it doesn't. Celebrity moms are often seen "bouncing back" quickly after giving birth. This only reinforces the idea of its simplicity. Other women know moms whose bodies never returned to normal. So if their own body doesn't, they just learn to deal with it much to their frustration and disappointment. If you continue to have a "mommy tummy" or struggle with abdominal strength after pregnancy regardless of what you do, you may have a condition called diastasis recti.

What is diastasis recti?

Diastasis means separation, and the recti, or rectus abdominis, are the two abdominal muscles running vertically down the torso. These are sometimes referred to as the much desired 'six-pack' when visible. The rectus abdominis muscles allow the body to bend forward and are responsible for keeping your organs in place and assisting with bowel movements, childbirth, coughing, and holding in the abdomen. Diastasis recti refers to a separation of the connective tissue between the rectus abdominis muscles called the linea alba.

How is it caused?

Diastasis recti can happen with any extreme stretching of the abdominal area, which severely loosens the elasticity of the connective tissue between the abdominal muscles. While it can happen to anyone, pregnancy is the most common cause of diastasis recti.

During pregnancy, the uterus expands to accommodate the growing baby, which in turn stretches out the abdomen. The body also produces hormones during pregnancy to loosen ligaments and connective tissues. After the baby is delivered, the uterus and abdomen begin to slowly shrink down and come together. But if the connective tissues were stretched too far, they may be too weak to pull the abdominal muscles back together, leaving a gap between the muscles.

Some risk factors for developing diastasis recti during pregnancy include being over 35, giving birth to more than one child, having pregnancies close together, and having a petite stature. 

What are the symptoms?

The most apparent symptom of diastasis recti is a separation between the abdominal muscles. Even if you lost the weight you gained during pregnancy, your stomach may not be as flat as it once was. Some people call this a "mommy tummy" or "pooch" that may make you look like you are still a few months pregnant. Even if you don't have an obvious separation, you may have a bulge from diastasis recti that appears when tensing those muscles.

A separation of 2.7 centimeters (about two fingers width) or larger is considered to be diastasis recti. You can check for separation at home but should see your healthcare provider or physical therapist if you are concerned. These professionals can use a tool called a caliper to measure the gap, or send you for an ultrasound to examine the damage and get a more accurate measurement.

How does diastasis recti affect women?

While diastasis recti isn't necessarily dangerous to your health on its own, it can lead to some other health problems. Your abdominal muscles are connected to so many parts of your body, that if the muscles aren't held together well, other areas or organs may be affected. Chronic low back pain, urinary incontinence, constipation, hip pain, pelvic pain, and pain during sex are all possible side effects. In extreme cases, it can lead to a hernia. Not to mention, it's very frustrating when your stomach doesn't return to its former shape and strength, or you're unable to fit into your pre-pregnancy clothes even after losing the weight.

Is there any way to prevent it?

Since diastasis recti affects the strength of your abdominal muscles and the connectivity between them, the best prevention is to try to strengthen your core before becoming pregnant.

During pregnancy, there are also some ways to prevent extensive abdominal separation. Avoid any exercises or movements that push the rectus abdominis muscles too hard, including crunches or sit-ups, heavy lifting, and straining with constipation. Be conscious of keeping good posture and supporting your growing belly when changing positions.

The log roll is a helpful move when your baby bump is getting bigger, and you need to change from lying down to sitting up. Avoid lying on your back and crunching up, which strains your abdominal muscles or stretches out the connective tissue. Instead, roll to your side with your upper body aligned. Then, use your arms to push yourself up to a seated position.

There is also some evidence that moms-to-be who continue safe prenatal exercise programs during pregnancy are less likely to have diastasis recti. If you attend a fitness or yoga class, talk to your instructor about safe modifications you can do, or switch to prenatal fitness classes for the duration of your pregnancy. There are many prenatal exercise programs and videos available to purchase or for free on streaming services like YouTube. Pregnancy is not the time to exercise too hard and push yourself physically. Listen to your body and stop if you feel any strain.

Are there any treatments or repair options?

Diastasis recti doesn't seem to be able to heal on its own, but there are some ways to treat or repair the damage. Even if it's been years since you were last pregnant, you can still heal a separation in your abdomen.

With minor separations, it's possible to use exercise to strengthen the abdominal muscles and connective tissues to pull it back tighter again. But it's essential to give your body time to heal and contract on its own after pregnancy. You should also get cleared by your doctor before beginning any type of exercise program. Even once you are cleared, start slow, so you don't further strain your body and make the problem worse.

There are many postnatal exercise programs available to help strengthen and heal abdominal muscles in a safe way. Avoid potentially problematic moves like traditional crunches, sit-ups, and planks. A great way to start is by practicing deep breathing with your diaphragm, which will gently work the abdominal muscles.

Some evidence suggests that wearing an abdominal binder or corset during the postpartum period may also help with diastasis recti. These garments hold together the whole torso as the uterus shrinks, supporting the muscles, so they aren't strained by trying to adjust to the rapid physical changes after delivery. Other experts believe that by using external support, you actually prevent your muscles from doing the work and thereby keep them from building up strength.

A physical therapist or postpartum fitness specialist can make a huge difference in your recovery from pregnancy, childbirth, and especially diastasis recti. These specialists know how to measure and track your gap and set you up for the most effective and safe exercise program for your needs.

If you have an extreme separation, or it severely impacts your day-to-day functioning, surgery is also an option to repair diastasis recti.

Dealing with diastasis recti on top of all the chaos of having a newborn may feel overwhelming or frustrating. Try to not put too much stress on getting your body “back” too quickly. Realize, it took time for your body to grow a baby, and it will take time for it to adjust back to normal.


By Kimberly Blaker

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