Diastasis Recti – what is it and can you heal it without surgery?

So many women are affected by weak and separated abdominal muscles, which give them the appearance of being pregnant. We can all imagine the embarrassment at being asked when you’re due when you’re not pregnant. For many women, the problem is purely aesthetic, which doesn’t in any way minimize the effect on their body image and even on their sense of self. However, many women with this imbalance also suffer from back pain, urinary stress incontinence (leaking from laughing, coughing, lifting, running, etc.), pelvic organ prolapse and a weak core. For some women, this means that they don’t feel that they can get on the floor to play with their kids. Many women want to join a gym or a Pilates class but are afraid that they’ll make their condition worse. This is a legitimate concern as it can absolutely happen, so it’s important to learn how to safely engage the core in order to heal the imbalance and to live an active life – doing whatever it is that you enjoy doing.

The woman on the left has normal abdominal muscles. The right and left sides of her rectus abdominis muscle (otherwise known as the “six-pack muscle”), which runs vertically from her sternum to her pubic bone, are held together at the mid line of the body by the fascia (connective tissue) known as the linea alba. The woman on the right has diastasis recti, or diastasis rectus abdominis (DRA), and you can see that the linea alba has been stretched to the point that the two sides of the abdominal muscles have been separated beyond a normal state. A woman may notice this if she sees any doming or bulging between her abdominal muscles when she gets up from lying down on her back.

We know that most women in their ninth month have separated abdominal muscles. And thank goodness for that, so that our bodies can grow babies! All connective tissue is softer during pregnancy to enable our bodies to accommodate a growing baby and to facilitate the widening of the pelvis during birth. The pressure on the linea alba over a long period of time, such as growing a baby, can cause the recti muscles to separate.

We don’t know why the abdominal muscles and connective tissue of some women heal after birth while other women don’t heal. There isn’t much research on this yet. However, alignment and breathing habits also factor into the equation. For example, pregnant women, in their wisdom, make room to breathe in later pregnancy by lifting their ribs and flaring them outwards, creating more space as the baby pushes upwards. However, after these women give birth, there is no motivation to return the flared ribs to their pre-pregnant state so the woman remains with this body behavior. As some of the abdominal muscles connect to the lower ribs, maintaining this alignment is going to keep the muscles apart. Other alignment factors, such as locking the knees with the pelvis pushed forward, will also increase pressure on the linea alba. But separated abdominal muscles isn’t only a problem of pregnancy. It’s basically an issue of pressure on the linea alba. Men and children can have it too if they have prolonged pressure on the linea alba.

While DRA is an extremely common imbalance after birth, it can also affect men and women who carry a lot of visceral fat, meaning, fat that is stored in the abdominal cavity. In this case, too, there is continuous pressure on the linea alba. However, unlike a woman who has given birth, this person still has the cause of the pressure.

Many women with weak abdominals think that they will look better if they suck their tummies in. This is basic physics. Imagine if you have a balloon and you squeeze it in the middle – where will the pressure go? Up and down. Meaning that they will become chest breathers, which is not helpful to healing the core AND they are placing added stress on the pelvic floor, increasing the possibility of urinary stress incontinence and pelvic organ prolapse.

Does every woman with DRA need surgery to repair the separation? The answer is unequivocally no. Only some women do. How do we know which woman does and which woman can heal with functional, progressive exercises?

When checking for DRA, we are checking for the following things:

  1. How wide is the separation? In other words, how many fingers can I fit into the gap between the right and left sides of the rectus abdominis muscles?
  2. How deep is the gap?
  3. Is there tension exerted in the linea alba when you activate your abdominal muscles?
  4. Is there approximation of the abdominal muscles on activation? In other words, do the muscles draw closer to the fingers as the activation increases, i.e. as you lift your head higher off the floor?

Please note the following important considerations about checking:

a. You need to check all of the above measurements at ALL of the following levels: at the navel, below the navel and above the navel. b. The accurate check to determine the width of the gap is just as the muscles start to fire, or just as your head leaves the floor.

While most women focus mainly on the number of fingers they can insert in the gap, i.e. #1 in the check list above, this is definitely NOT the most important aspect of checking to determine the severity of the DRA AND to chart progress. If there IS tension in the linea alba on activation (#3) and there is approximation of the abdominal muscles on activation (#4), then in most likelihood you don’t need surgery and you can heal the area by learning how to correctly activate your core, together with correct alignment and breathing that will support this healing. If there is no tension in the linea alba and no approximation of the abdominal muscles, then you may be a good candidate for surgery. The great majority of women I have worked with, fortunately, have not needed surgery and have successfully healed their DRA and strengthened their core (even a client with an 8 finger separation). However, even if surgery is warranted, it is still helpful to tone the muscles of the core prior to surgery as recovery will be easier and more successful.

A width of up to 2 fingers is normal. A width of 2 ½ fingers or more is considered a separation, or DRA. Depending on several factors, one being alignment, the separation can be more extreme at the navel, above the navel or below the navel. I want to emphasize that the width is not the most important measure in determining core function, progress and even the aesthetic appearance of the belly. This is only one of several factors that are measured when checking for DRA.

All women after birth (whether vaginal or cesarean) should be checked for DRA before resuming abdominal exercises. Many new moms are so weak in their abdominal and pelvic floor muscles that, while doing any abdominal exercises, they bulge out these muscles rather than activating them correctly. This will put even more pressure on the linea alba. It is essential to learn how to activate the pelvic floor and the abdominal muscles, together with the deep back muscles and with efficient breathing, in order to prevent this bulging or doming.

IMPROVING CORE FUNCTION teaches correct alignment and breathing and how to safely and effectively activate the deep core muscles for any exercise. The program is designed to slowly and progressively strengthen the muscles of the core to heal the imbalance of diastasis recti.

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