Ask the Physiotherapist: What is Diastasis Recti (Abdominal Separation)?

Diastasis recti, or abdominal muscle separation, is an adaptation to the growth of the uterus commonly experienced by pregnant women. But if left untreated, a significant separation can be problematic. The good news is, with the right guidance, it can be resolved, or at least improved. To find out more about this condition, I chatted with Bridget Burns, principal physio at iMove Physio Rozelle.
What is diastasis recti, or abdominal muscle separation, and how common is it?
Diastasis recti where the stomach muscles stretch to the side to allow the uterus to grow with your baby – it is a normal adaptation to pregnancy. It is a very common condition with reports estimating about two thirds of women experience some degree of abdominal separation.
What are some of the risk factors for developing rectus diastasis during pregnancy?
Multiple pregnancies, multiple-birth pregnancies, the birth weight of your baby and your age and physical condition before pregnancy are all risk factors for diastasis recti.
Is there anything you can do during your pregnancy to prevent this separation?
Separation is a normal and natural adaptation to pregnancy, so we do not have total control over it. Working on your core safely before and during pregnancy can help improve the strength of your midsection and make your recovery a bit smoother. This is best done with the guidance of a physiotherapist who will prescribe exercises appropriate to you and advise you of things to avoid.
How can you tell if you have rectus diastasis?
You may notice a bulge in the centre of your stomach particularly when the stomach muscles are tensed when coughing or sitting. It is also possible to self-check for diastasis – my colleague Ivana explains how in this video:

If after childbirth you find you have a two or more finger-width separation, what should you do?
Seek advice and treatment! As a general rule we encourage all new mums to get their separation checked by a physio. If you do have some separation, your physio will be able to advise as to whether it needs treatment and guide you through the process.
Your check-ups with your midwife, GP or obstetrician are also a good starting point to clarify any issues.  Please ask them to assess your separation, even if you think you do not have any separation.
Additionally, it is really important if you are planning on returning to exercise or having more children that you seek advice from a physio to ensure your separation is managed and your body is strong and ready!
If this separation is left untreated, what symptoms might a woman experience?
Separation can lead to a lack of muscular support in the midsection, making other muscles work harder. This can lead to back pain, or other issues in the pelvic region such as pelvic pain. A resolved, or at least improved, diastasis recti will mean that you are stronger and safer performing daily activities and exercising.
It is important to remember that the abdominal, pelvic and pelvic floor muscles are all closely linked.  If you are having other issues, such as incontinence, managing your diastasis can assist. There are specialty women’s health physiotherapists who can help manage more serious or stubborn issues.
How is separation treated?
Strengthening the muscles around the area of separation is the main treatment method for separation. This is best guided by a physiotherapist, who will make sure you start exercising at an appropriate level and progress you safely.
What would you say to a woman who is feeling worried about this issue following childbirth?
Do not hesitate to get your separation checked by a physio! We see this issue all the time and it is generally quite a straightforward assessment and treatment. You will feel stronger and safer for it in the long term. If you are planning on another pregnancy, getting your separation assessed and managed is important to help manage separation in your next pregnancy. Conversely, if you have abdominal separation from a pregnancy that was not so recent and are feeling uncomfortable about it, it is not too late to get it looked at!
You might also like:
Focus on Women’s Health: Childbirth Injuries
Birth Injuries: An Uncomfortable but Important Matter
Beautiful Births

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