Diastasis Recti

3 Steps To Self Examination of Diastasis Recti

Ask about your abdominal diastasis the next time you see a doctor for a post-pregnancy follow up. Diastasis recti, also known as abdominal or stomach muscle separation, is a common condition after pregnancy.

During pregnancy, the stomach muscle is stretched as the womb grows. After giving birth, a palpable gap can be felt between the borders of the superficial abdominal muscles, i.e. Rectus abdominis, and the stretched connective tissue of the abdominal muscle, i.e. linea alba. The likelihood of the gap closing naturally over time depends on multiple factors: age of the mother, number of pregnancy, whether it was an easy pregnancy or not, fitness condition before pregnancy, etc.

The reason why the muscles, joints, and ligaments are easily stretched during pregnancy is due to the hormone relaxin. It is produced from around 7th to 10th week through the rest of pregnancy. The effect of the hormone lasts 1 to 3 months after giving birth. It is during this window period that the abdominal separation is easiest to manage. After 3 months post pregnancy, trying to close the abdominal gap is much harder work either due to internal factors (muscle weakness, muscle memory, postural) or external factors  (baby getting more active, less time to do exercise)

To check your abdominal separation:

  • Lie on your back, bend your knees, keep your feet on the ground
  • Put your hand above the belly button with fingers pointing towards groin
  • Lift your head off the ground and see how many fingers you can fit into the separation

From physiotherapy perspective, one way to reduce the abdominal diastasis (separation) is by exercise. And not just any exercise: Pelvic floor muscle (PFM) and deep abdominal muscle exercise. The PFM rarely works in an isolated way. This means that when the PFM contracts, the deep abdominal muscle is activated too.

Abdominal Diastasis

Self Examination – Abdominal Diastasis

Abdominal Diastasis

Abdominal Diastasis

The 2 abdominal muscles to focus on are:

  • Superficial abdominal muscle, i.e. Rectus abdominis (six pack muscle)
  • Deep abdominal muscle, i.e. Transverse abdominis (corset muscle)

Rectus abdominis muscle is 2 bands of fibers that run from the lower rib down towards pubic bone, and are connected to each other by soft tissue called linea alba. Due to this, rectus abdominis is easily stretched and “separated” during pregnancy to make room for the growing baby.

Transverse abdominis muscle fibers encircle the abdominal region, starting on the left of the spine and ending against the right side of the spine. If activated properly, this muscle acts like a natural corset for the body. This is also called the core muscle, which has become popular in Pilates, yoga, and fitness training industry.

The PFM and transverse abdominis usually work together, so by activating PFM the transverse abdominis will contract which supports the abdominal region and lessens the abdominal separation.

PFM exercise is more commonly known as Kegel exercises described by Arnold Kegel in 1948. (http://en.wikipedia.org/wiki/Arnold_Kegel)

To test how well your PFM is contracting on your next visit to the toilet, stop your pee mid flow. The muscle used to do this action is PFM. Or the feeling as if you want to pull your tampon in further. Try to remember this pelvic floor contraction feeling. When you are pulling the PFM up, you will notice the lower abdomen (stomach region below belly button) getting flat. If the whole abdomen is flat, or even hollow, you are probably “sucking-in” your stomach and most likely holding your breath while doing so. This is a common mistake. With some training and body awareness, you will be able to get the correct contraction.

If you think you are doing PFM contraction correctly, go back to the “checking abdominal separation” position:

  • Lie on your back with feet on the ground and knees bend up
  • Put your hand above the belly button with fingers pointing towards groin
  • Pull your PFM up, keep breathing normally
  • Lift your head up
  • Your separation should be noticeably less compared to when you are not activating your PFM

If the abdominal separation is still the same, it is usually due to weak PFM or overactive rectus abdominis. If you are not sure whether you are activating your PFM correctly, visit your doctor or physiotherapist for a consultation.

Gita Go, BSc (Hons) Physiotherapy (Hong Kong Polytechnic University), Registered Physiotherapist