Everything you Wanted to Know about Diastasis Rectus Abdominus
Pregnancy-related diastasis rectus abdominus (DRA) is a midline separation at the linea alba (LA) of the rectus abdominis muscles of the abominable wall (also known as the “6-pack muscle”). During pregnancy, the uterus stretches the muscles in the abdomen to accommodate your growing baby.
Prevalence of DRA During Pregnancy
DRA is highly prevalent throughout the perinatal period. During pregnancy, it is reported that 33% of women exhibit a wider separation of the linea alba during the second trimester, which rises to 100% by the end of the third trimester. The prevalence of DRA remains high after delivery, with an estimated 23% to 32% of women presenting with a persistent DRA at 1 year post-delivery.
Why is it a Problem?
A separation of the rectus abdominis muscles leads to weakening of the abdominal wall and the core. A weakened abdominal wall has been proposed to affect one’s trunk stability and mobility, which can lead to low back pain. Additionally, if you have weakened abdominal muscles due to a separation of the RA, your pelvic floor muscles, which work with your abdominal muscles, end up working less efficiently. This can contribute to conditions such as prolapse or incontinence.
How is it Measured?
It is measured by looking at the Inter-recti distance (IRD), which is the distance between the two rectus abdominis muscles. To measure the IRD, we assess how many fingers you can fit between the muscles, when lying on your back and lifting your head. A Normal IRD is 1/2 a finger above and below the belly button, and one finger at the belly button.
Precautions for Women with DRA
- Avoid movements and postures that increase excessive intra-abdominal pressures. For example:
- Avoid straining on the toilet
- Avoid heavy lifting/carrying
- Avoiding repetitive trunk movements or diagonal twists (eg. During tennis serve)
- Avoid exercises that contract the exterior abdominal muscles, like sit-ups, crunches or oblique curls.
- Avoid exercises in which the continence mechanism is not maintained, as this can lead to leakage.
- Avoiding intense coughing when the abdominal muscles are unsupported.
- Avoid high-impact exercises and exercises that cause the abdominal wall to bulge out upon exertion.
Management of DRA
- Learning breathing techniques that promotes a tension-free diaphragmatic and lateral costal breathing pattern
- Abdominal strengthening and corrective exercises
- Pelvic Floor Muscle Training
- Education on proper body mechanics ( For example, rolling to the side to get up out of bed, Proper lifting/carrying techniques)
- Education on labour and birth positions and breathing techniques to help reduce strain on the abdominal wall.
Our Pre & Post Pregnancy Program is designed to help you thrive during pregnancy and to maximize your recovery afterwards. Each woman’s experience with pregnancy and delivery is vastly different, therefore, we tailor this program to your specific needs!
Are you interested in learning more corrective exercises to optimize your posture, and core strength? Reach out to one of our Pelvic Health Physiotherapists at one of our three locations or contact us directly at info@foundationphysio.com
References:
- Core Concepts.(2019). Understanding Diastasis Rectus Abdominis. Retrieved on: https://www.coreconcepts.com.sg/article/understanding-diastasis-recti-abdominis/
- Dufour,S., Bernard, S., Murray-Davis, B., Graham, N. Establishing Expert-Based Recommendations for the Conserative MAnagement of Pregnancy-Related Diastsis Rectus Abdominis: A Delphi Consensus Study. Journal of Women’s Health Physical Therapy. 2019; 43(10). DOI: 10.1097/JWH.0000000000000130
- Pelvic Health Solutions.(2020). What is a Diastasis Rectus: Retrieved from: https://pelvichealthsolutions.ca/for-the-patient/what-is-a-rectus-diastasis/