Diastasis Recti (Rectus Abdominis) is a term used to describe the muscle group that connects your abdominal wall to your pelvic floor. This muscle group consists of two major groups: The Rectus Abdominus (RA), which lies behind the pubic bone, and the External Oblique (EOM). The RA runs from just above your navel up through your pelvis and attaches at the top of your iliac crest. The EOM runs from just below your pubis down through your pelvis and attaches at the bottom of your iliac crest. These muscles are responsible for keeping your body upright during physical activity such as walking or sitting.
The RA and EOM are both innervated by nerves that run along their length. When these muscles contract, they cause the lower part of your abdomen to rise upward. If you have a flat stomach, then this rising action causes your belly button to protrude. The RA and EOM also help keep your spine straight during activities like standing or sitting.
When one of these muscles relaxes, it allows the other to tighten causing the lower part of your abdomen to fall back into place. However, when a muscle stretches excessively, it allows the muscle on the other side to relax excessively as well. This stretching of one muscle group pulls the opposite muscle group to a more relaxed position causing a bulge to form at your midline.
This is what is meant by the term “Diastasis.” The word literally means separation and in this case it describes the separation of your muscle groups at your midline.
During pregnancy, the growing uterus places increased intra-abdominal pressure on your internal organs. Since your abdominal wall is not rigid, it must stretch to accommodate this pressure. While this is generally not a problem in a normal pregnancy, there is a potential for problems if the muscle stretches excessively.
The medical term for an excessively distended abdomen is “Merry-go-round Sign.” This describes the outward protrusion of your abdomen when pushed in as if you were on a carousel. The most obvious symptom is a visible separation of the rectus abdominus muscles at the midline.
In addition to an excessively distended abdomen, a diastasis can also cause back pain and can possibly interfere with the function of your internal organs. If the condition worsens, organs in the abdominal cavity can actually herniate through the open space that is created. Fortunately, most diastasis recti cases are mild allowing the condition to resolve on its own over time.
Diastasis can also be related to excessive weight gain during pregnancy. The average pregnant women will gain between 25-35 pounds with a total of 12-18 pounds of that being gained in the last trimester. However, some women can gain as little as 5 pounds and others can gain over 50 pounds.
If you gain excessive weight during pregnancy, the connective tissue between the left and right sides of your rectus abdominus muscles can stretch excessively. This is not to be confused with pregnancy hypertrophy where the muscles themselves thicken. Excessive weight gain during pregnancy places unnecessary stress on your heart and circulatory system. Not only that, but it also makes it more difficult for you to get back into pre-pregnancy clothing after birth!
In fact, the excessive weight gain can actually cause more permanent damage than just diastasis itself.
Fortunately, you can help prevent or reduce the extent of a diastasis recti by engaging in proper posture and abdominal strengthening exercises both during and after your pregnancy.
The first thing that you can do is to wear a good support belt during pregnancy. This will not only give your abdomen added support but it will also encourage you to take good alignment whenever you are lifting or bending.
Next, engage in frequent back and ab stretches whenever you have a chance. This is especially important after meals when your stomach is full and your abdomen is more distended. In addition to encouraging good posture, these exercises can help you prepare for the post partum exercises that you will be engaged in shortly after birth.
Exercise is also an important factor in the prevention and treatment of diastasis recti. Well before you get pregnant, engage in a good abdominal and back exercise program. This will give your abdomen added support so that it is less likely to excessively stretch during the pregnancy. It will also help to prevent excessive weight gain which can place even more stress on your abdominal muscles and connective tissue.
During pregnancy, continue your exercise regimen. This will not only help to prevent excessive weight gain but will also encourage your uterus to grow against your still developing abdominal muscles.
Sources & references used in this article:
Diastasis recti abdominis—a review of treatment methods by A Michalska, W Rokita, D Wolder… – Ginekologia …, 2018 – journals.viamedica.pl
Progressive therapeutic exercise program for successful treatment of a postpartum woman with a severe diastasis recti abdominis by K Litos – Journal of women’s health physical therapy, 2014 – journals.lww.com
Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women by J Keeler, M Albrecht, L Eberhardt, L Horn… – Journal of women’s …, 2012 – journals.lww.com