Myth Buster: Diastasis Recti Is Not Normal- Get It Fixed!

By Hilary Pentz, DPT OMT FAAOMPT

What Is It?

It is a separation of the abdominal wall into two halves. It can look like a ridge down the middle of your stomach when your abdominals contract, but not always present. (Diastasis Recti, 2013). It has shown to occur in 50-60% of pregnancies during the 2nd and 3rd trimester (Boissonnault, 1988). Some restore naturally on their own while some continue to be present at 6 months or more.

What Causes It?

Due to the increase in hormones and the growing uterus, the abdominals can become overstretched and weaken (Chiarello, 2005). It is important to check throughout the pregnancy (see below on how to do this). Weaker abdominals prior to surgery and multiple pregnancies have shown to increase the likelihood of a diastasis (Boissonnault, 1988 & Diastasis Recti, 2013).

Complications

If the separation doesn’t close, it has shown to cause back pain, hip pain and/or SI pain from poor biomechanics. It can also contribute to urinary leaking/incontinence as well as breathing disorders (Lee, 2008 & Ryan, n.d.).

How To Test For It

This can be done at home or with a health care provider. Lie on your back with knees bent. Lift your head and shoulders off the table with arms forward. The provider or partner can then test the gap in 3 positions with their fingers horizontally into the belly: belly button, 4.5 cm above the belly button and 4.5 cm below the belly button. Two cm or less gap (1 finger) is considered normal (Boissonnault, 1988). A ridge is not normal.

Treatment Options

1. The rectus sheath plication in an abdominoplasty surgery has proven to be successful in folding over and tucking the loose tissue with sutures (Tadiparthi, 2011). Possible complications include hematomas, minor skin necrosis, wound infections, dehiscence, post-operative pain, nerve damage and recurrence (Hickey, 2011).
2. Binders have shown to assist the tissue move inward, but should be avoided during 3rd trimester and 6 weeks post delivery.
3. A physical therapist can set you up on an exercise home program during and post pregnancy to address the entire body mechanics and why it hasn’t resolved on its own. In a study comparing exercising pregnant women to non-exercising pregnant women, 90% of women who weren’t exercising had a diastasis, compared to only 12.5% of women exercising (Chiarello, 2005).

Simple Reminders

1. Avoid doing sit ups or crunches
2. Remember to roll onto your side first before getting out of bed
3. Exhale with lifting to decrease overstretching the abdomen (Ryan, n.d.).

References:

• Boissonnault, JS, Blaschak MJ (1988). Incidence of Diastasis Recti Abdominis During the Childbearing Year. Phys Ther, 68(7): 1082-1086.
• Chiarello et al (2005). The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women’s Health Physical Therapy, 29(1): 11-16.
• Diastasis Recti (2013). Retrieved May 26, 2014 from PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002569/
• Hickey R, Finch JG, Khanna A (2011). A Systematic Review on the Outcomes of Correction of Diastasis of the Recti. Hernia, 15(6): 607-614.
• Lee DG, Lee LJ, McLaughlin L (2008). Stability, Continence and Breathing: the Role of Fascia Following Pregnancy and Delivery. Journal of Bodywork and Movement Therapies, 12(4): 333-348.
• Ryan M, Ritchie L (n.d.). Diastasis Recti.http://www.physio-pedia.com/Diastasis_Recti.
• Tadiparthi S, Shokrollahi K, Doyle GS, Fahmy FS (2011). Rectus sheath Plication in Abdominoplasty: Assessment of its Longevity and a Review of the Literature. Journal of Plastic Reconstructive Aesthetic Surgery, 65(3): 328-332.