Treatment for Diastasis Recti
Diastasis recti refers to the separation between your “six pack” muscles (the rectus abdominis). This is incredibly common in pregnant and postpartum people, but it can actually occur in children and people who have never been pregnant as well! Even though it can happen in any body, we work specifically with pregnant & postpartum people, so that’s what we’re talking about here. The abdomen is the front wall of the core, and the pelvic floor is the bottom of the core, so any concerns that you experience throughout your abdomen are also impacting your pelvic floor - and vice versa.
What Causes Diastasis Recti?
If you visualize those “six pack” muscles, there are muscles on your left and right, with a line down the middle. That middle line is connective tissue, called your linea alba. When you’re pregnant, your uterus grows 500 times its size to support your baby and placenta. As your abdomen grows, your abdominal muscles also stretch many times their normal length to accommodate for that change. This is NORMAL, and the separation that occurs between your abdominal muscles is an adaptive response for your growing baby. However, some people experience more separation than others due to the size of their body and baby, the way the baby sits in the abdomen, their posture and pressure control, and the amount of pre-existing tension in surrounding muscles.
What Does Diastasis Recti Feel Like?
During pregnancy, you may notice that “shark fin” shape down the middle of your abdomen if you try to sit straight up, or do a crunch. That is the space between your “six pack” muscles. Postpartum, you may be able to feel that space between the muscles as squishy, or jelly-like. And honestly, your whole abdomen will probably feel like that for at least a few weeks postpartum as you recover. As you start to regain core strength, you may feel or see a space between the muscles. That is because the connective tissue (linea alba) stretched apart with your muscles. It can feel different and concerning at first, but we want to assure you that it doesn’t need to inhibit your core function or strength.
Treatment For Diastasis Recti
It’s important to note that the latest research shows that core strength and function is not actually as related to the width of the gap as much as the depth - or the tension your abdominal muscles can generate. This means you can have a separation that is a couple fingers’ width, and still have a very strong and functional core. Every body is incredibly different as far as what the healing journey looks like, and what your goals are. Some diastasis recti heals within the first few weeks or months postpartum without any significant treatment. Sometimes, it requires specialized treatment with a pelvic floor therapist. And sometimes, surgery is the best option.
Exercise & Pressure Management
One approach that we use in pelvic floor therapy includes teaching pressure management and exercises to strengthen your core and reduce future pelvic floor symptoms. Pressure management refers to the way your body can control changes in pressure in your core. Changes of pressure occur constantly throughout the day - when you talk, yell, cough, sneeze, jump, etc. If all parts of your core - your abdomen, back, diaphragm, and pelvic floor - are not working well together, you may experience concerning symptoms in one of those areas. That can look like abdominal separation, back pain, or urinary leakage.
Try this: Sit on your hand - so you can feel your entire pelvic floor in your hand. Start talking, quietly at first, and then more loudly. Do you notice your pelvic floor moves up or down into your hand when you’re talking? This can give us information about how your body manages pressure. If your pelvic floor moves down into your hand when you’re talking, you are bearing down and adding pressure down on your pelvic floor.
Now try this: Lay on your back and place one hand on your lower abdomen. Lift both legs into the air. Does your abdomen bulge up into your hand? This is a sign of pressure out on your abdomen. Now bring your legs back down and just lay on your back. On your exhale, imagine blowing out 100 candles very slowly - letting all your air out.* You should feel your abdomen pull up and in, rather than bulging out.
These are a few quick self-assessments to see what your body does and how it responds to pressure. If you’re not sure what you feel, or if it’s what you should be feeling, we highly recommend checking in with a pelvic floor therapist.
Surgery
Many people wonder if surgery is their only option to improve the aesthetics and function of their abdomen. We always recommend conservative treatment (pelvic floor therapy) first to see if your goals can be met without surgery. We recommend at least a year - often more - of dedicated therapy and strengthening before considering surgery. If you and your therapist decide surgery is the best option to meet your goals, there is a long road to recovery and strengthening after your procedure as well. For some people, it is the best option. We also recommend reviewing this information from the Tummy Tuck Team to ensure you are confident in your decision and recovery.
Resources & Support With OWN Your Pelvic Health
When we work with people during pregnancy, we teach pressure management, movement and exercises to strengthen the core and prevent a significant abdominal separation or other pelvic floor concerns. We also teach early postpartum recovery exercises so that you regain functional core strength earlier - before 6 weeks. If you are concerned about your core function during pregnancy or postpartum, we encourage you to reach out to learn what it’s like to work with us!
*This is a technique from Lauren Ohayan from Restore Your Core. We highly recommend her programs!
Written by: Dr. Courtney Trocinski