If you have a 'mum tum' after having your baby, have you checked for Diastasis Recti?

What is Diastasis Recti?

Diastasis recti is the stretching or separation of the rectus abdominis (6 pack) muscles caused by the thinning of the linea alba (midline connective tissue), which can happen during pregnancy to allow for your growing baby but it can happen for other reasons such as over-exercising. Diastasis recti separation leaves your abdominal organs unsupported, and if severe, can expose your digestive organs creating a stomach bulge.

This separation can range from being isolated above the belly button, within the belly button, and below the belly button sitting above the pubic bone. In some cases, the separation encompasses the entire mid section of the core.

In both men and women, this gap can be created in the midline of your belly anywhere from the pubic bone to the base of your ribcage. During a crunch or sit-up, where one would normally feel tension and closure, there is a space in between.

What Does it Look Like?

Diastasis recti looks different from person to person. Although in some cases the symptoms can be painful and more present, in some people they aren’t noticeable at all. These are the most common and present symptoms you should be aware of in determining whether or not you may have a diastasis recti:

Abdominal Bulge

An abdominal bulge is not always an indication of a diastasis recti, yet, it can be a symptom. This bulge, or stomach “pooch,” occurs when the abdominal organs become unsupported by the rectus abdominis muscles. This can appear as a cone shape or ridge above and within the area located close to the belly button. However, depending on where the diastasis recti has become isolated, the bulge can range from above the belly button, on the belly button (causing the belly button to flatten), or below the belly button just above the pubic bone.

Muscle Separation & Linea Alba Stretching

This is the most noticeable and common symptom of diastasis recti (whether you have significant body fat or no body fat at all). A minor separation (one of 1-2 finger widths) is not a significant injury, but in more severe cases, the separation can be that of 5-10 finger widths. This effect is much more noticeable and can be seen as a crevice or significant gap within the abdominal core. Diastasis recti is also measured by shallowness or deepness. Someone could potentially have a 10 finger width separation but it’s shallow. In this case, exercise and safe core strengthening routines can help restore the core to its natural state.

How to Test for Diastasis Recti:

1. Lie on your back in a comfortable position. Bend your knees and put your feet flat on the floor.

2. Place one hand on the midline of your core with your fingers flat on your midline.

3. Place your other hand under your head and neck for support. Lift your head slowly and begin adding pressure through the pads of your fingers.

4. With no diastasis recti, there is the sensation of a toned wall as you lift your direct. If you feel a space, or your fingers sink into your core, you likely have diastasis recti.

5. Repeat the procedure for the areas directly above your belly button down to the pubis to determine whether the diastasis recti is isolated or in your core as a whole.

How to Tell if You Have a Diastasis

Rectus abdominis separation can lead to a stomach bulge (aka stomach pooch), pelvic floor issues, unnatural posture, and stomach and back pain. The symptoms of diastasis recti include but are not limited to:

• Abdominal Bulge

• Abdominal Gaping

• Lower Back Pain

• Sensation of bloatedness without bloat

• Incontinence (leak pee)

• Poor Posture

• Constipation & Bloat

• Doming or invagination of the linea alba when when performing crunches or other traditional ab exercises

• Difficulty with everyday activities due to a lack of core function.

Unless you have a low body fat percentage or have an overly toned core with a visible 6-pack, it is very hard to diagnose a diastasis recti on appearance alone. The linea alba lies beneath the fat layer of your abdomen, so it cannot be seen. Many people have a diastasis recti for years before learning they have it.

Does Coning Always Mean You Have Diastasis Recti?

Abdominal coning is most commonly a sign of diastasis recti. Diastasis recti during pregnancy can be a cause of the core doming or coning. This is a result of the expanding uterus as it makes room for your child. Although the separation of the muscles and the stretching of the connective tissues is normal, coning may present its own problems. If your belly is changing its shape from being round and reverting to a coning shape, this could be an indication that diastasis recti is present and will extend into the postpartum period.

What does Mild Diastasis Recti Look Like?

Similarly to the above, mild diastasis recti can show signs of an abdominal bulge or look like the midline of your abdomen is “coning.” During a self-assessment or if you have a physical therapist or medical professional assess you, diastasis recti looks like a separation in your core. In mild cases, this gap can be 1-2 finger lengths wide, yet present little to no symptoms. It is best to consider core strengthening programs even if the gap is not severe in order to prevent the gap from widening.

What to Do If You Think You Have It

Prehab

One of the best things you can do during pregnancy is prehab. Many people are able to prevent their diastasis recti from returning with subsequent pregnancies by working their core in a smart, functional way the entirety of their pregnancy. Many report that their core felt stronger than ever with the prehab work that they did.

Pregnancy is not an illness, there is no need to halt all exercise. We do, however, want to make good exercise choices. It is very important to exercise your core during pregnancy but not to increase intra ab pressure as you do so. So avoid crunches, weighted movements such as Russian Twists, and when don't sit up directly from a lying flat position (always turn onto your left side and push up sideways with the help of your upper body)

Postpartum

Diastasis recti is often more apparent postpartum. We recommend waiting at least 6 to 12 weeks before checking for a diastasis recti. Here are a few tips that can help prevent and/or heal a diastasis recti:

1. Rest

Rest is so important for healing your body postpartum and ensuring that you do not damage your core and your pelvic floor. We recommend getting back into exercise at least 6 weeks postpartum (and longer if you have had a c-section), but even then, easing into it is key. The “I want to get my body back” sentiment can be very harmful to a recovering body. Check with your midwife or doctor on any recommendations they have for your post-partum return to exercise too.

2. Exercise/Rehab

Once you are cleared for exercise by your medical professional, you want to focus on core building exercises which properly strengthen your core without worsening any existing diastasis recti.

A great way to prevent exacerbating Diastasis Recti is to avoid exercises that increase intra-abdominal pressure, such as crunches, planks, twists, or heavy lifting. You don’t want to do anything that causes a visible doming of the abdomen. Below are 7 top exercises you can incorporate into your training to rehabilitate your core:

Candles/Core Engagement:

Come to sit tall or stand. Inhale and on the exhale, imagine you are blowing out 100 candles. As you blow, you should feel your core tighten and draw inwards. This can and should be practiced whenever working out and managing a load, a weight, a core move. It automates the core and begins to integrate the function of the core to the activity that you are doing.

Tabletop or Reverse Marching:

Lie down similarly to that of a diastasis test. On each exhale, practice candles. As you exhale, alternate bringing your knee, while still bent, toward your body.

Seated Side Bend:

Sit comfortably. Possibly on a block or some pillows. Hold a yoga strap or belt overhead. Bend your elbows slightly to take the stress off of your neck and shoulders. Exhale, blow candles, tighten your core and side bend right and then exhale to go left. Your core should not bulge, brace or push out as you do these. These are great for upper body mobility, torso length and strength and are a great way to work your core without strain.

Goddess Side Bend:

While standing with wide feet placement (knees aligned with feet), begin candles exhale and bend your knees slowly until they are level with your ankles. Stabilize your body by pressing your heels into the floor. Side bend by raising your arm while maintaining resistance. Repeat side rotations 3x and then return to a standing position.

Goddess Squat Twist:

Repeat steps outlined above but have your arms stacked across your chest. While in the goddess position, twist by using your ribcage and not your arms. Repeat side twists 4x and return to a standing position

Lunge with a Twist and Chop:

Practice lunging. As you bring one leg forward–all while maintaining correct posture–lift your hands, palms crossed, in front of your face. Then slowly begin to twist toward your forward leg. As you twist toward your forward leg, bring your arms across your thigh in a chopping motion.

Opposite Reach:

For this exercise, you will come onto your hands and knees and slowly lift the opposite arm and leg. If that is too hard, do just one at a time. As you lift, you exhale and blow candles, feel your core engage and be extra sure not to bear down, brace or bulge your core! Amazing for your shoulders, arms, core and booty.

Although diastasis recti is not completely avoidable in some cases, the list above helps paint a clear picture on how to protect your core while still staying active. The key is to be mindful of your body’s function and how to increase your functionality and build strength without causing harm to your body.

Is Diastasis Recti fixable?

Diastasis Recti is not always a permanent condition and can often be healed through strategic core rehab. It does take time and it will require hard work and dedication on your end, but it is usually possible to close the gap. However it's important to note that your gap may not close all the way.

In some cases exercise routines and strength building therapy do not accomplish the desired result. When this occurs, surgery is an option for “fixing” diastasis recti. However, surgery should be the last option you consider.

Diastasis recti surgery is very invasive and the recovery process can also take several months to a year depending on the severity of your diastasis recti and the extent of the surgery. We encourage at least a year’s time of rehab before considering surgery, but also speak to your doctor about your options and what is best for you.