Physiotherapists and Physiotherapy students [click here] to be linked to Dayan Werner Pelvic Rehab's upcoming course page that includes a course on DRA.
Abdominal separation or diastasis rectus abdominis (DRA) is the widening of the gap of the linea alba (the connective tissue) between the right and left rectus abdominis. DRA is a very common condition that many women don't even know they have. It is not often brought up in prenatal education and is often missed in many pre or postpartum exercises classes. Some research states that 100% of women in the late stages of pregnancy have some degree of separation1,2 (think about it - something has to give!). Another body of research reported that 39% of women at 6 months postpartum have a DRA, and the authors suggest that at 6 months postpartum, recovery may still be in progress2. Another study shows that left untreated, the gap at 8-weeks remains unchanged at 1-year postpartum3.
It has also been shown that 66% of women with DRA also have some level of pelvic floor dysfunction4 (e.g. bladder or bowel control problems and/or pelvic organ prolapse). Improper training in attempt to correct the DRA can worsen the pelvic floor dysfunction, not to mention worsen the existing separation. I have seen men who have given themselves a diastasis with inappropriate abdominal training!
Even if women or men know they have a DRA, advice on how to resolve the separation varies dramatically. Promises of closing the gap and resolving the diastasis are often given. Unfortunately, these promises rarely deliver - there is often a degree of irreversible connective tissue stretch that does not completely recover. Abdominoplasty, or a Tummy Tuck, is a surgical procedure that closes the connective tissue component of DRA completely. This procedure is major surgery, and is not covered by basic health care. Does that mean that you cannot reduce the gap between the recti with exercise? No, often you can with proper training. You can also improve the tensile strength of this connective tissue, and the tone and strength of the deep abdominals (transversus abdominis). This improves the support and appearance of your abdominal wall as well as provide stability for your back and pelvis.
There is often an emotional component to the DRA for the postpartum mother. With more slack to the abdominal wall, the abdominal organs are not held in as well and protrude outwards when sitting or standing. This tends to get worse as the day progresses and the deep abdominals fatigue. A woman with DRA is often asked if she is pregnant, and this can be understandably upsetting to her. Expectations of our society to rebound right back to the pre-pregnancy state are everywhere - in the media as well as our own pre-conceived notions. Marketed programs for DRA promising to "close the gap" do not help the pressure either.
Proper training of the abdominals is necessary. There are many products and exercise regimens aimed at treating DRA on the market. But here is the thing: everyone’s body is different. The degree of the separation; the awareness and control of the deep abdominal muscles; the strength and endurance of the abdominal muscles; the existence of co-existing pelvic floor dysfunction - all of these is different from person to person. It is unrealistic to paint everyone with a DRA with the same brush. Treatment needs to be individualized.
I can show you how to find your deep abdominals (I promise, they are there!), and confirm this with Real-Time Ultrasound. I will also check to see if there is appropriate co-contraction of the deep abdominals with the pelvic floor, and vice versa. I will show you appropriate abdominal exercises, and show you a hard and fast rule to tell if an abdominal exercise is safe for you.
Treatment of DRA can begin during pregnancy, or in the postpartum period. It can be helpful to learn how to control your deep abdominals properly in pregnancy to prevent worsening the DRA more than it needs to for the pregnancy itself. Proper training may also maintain or improve deep abdominal support for the pelvis and back during pregnancy.
1 Gilliard and Brown (1996), Diane Lee (2013)
2 Mota PGFD, Pascoal AGBA, Carita AIAD, Bo K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015;20(1):200-205.
3 Coldron et al (2008)
4 Spitznagle et al (2007)