Diastasis Recti is a common concern for pregnant and postnatal women. It is also known as abdominal separation, Diastasis Rectus Abdominis, DRA or “mum-tum”. A question I am often asked by women is “When is a Diastasis Recti considered severe?” and sadly there is a lot of misinformation available online. I understand why women ask this question, and can be fearful to exercise, or “do something wrong”. Diastasis is a condition that is not completely understood yet, although there is growing research in this area.
To understand what is considered “severe” we first need to understand a little more about the body.
Understanding the abdominal wall
Diastasis Recti is often described as a separation of the abdominal muscles. But I would say that is a very simplistic definition, and it sounds quite aggressive and final. Instead let’s start by thinking about the way our abdomen is made up, from a muscular point of view;
First, and deepest/closest to our spine, we have a large corset shaped muscle called our Transverse Abdominis (TVA). This wraps around our core (like a corset) and acts to stabilise the pelvis and lower spine. It’s an important muscle in postpartum diastasis recti exercises and postnatal rehab.
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Then we have our internal obliques and external obliques that run diagonally between the ribcage and pelvis across our stomach. These oversee lateral flexion (side-bending), rotation, and flexion of the spine.
Finally, we have the well-known “6-pack abs” – the Rectus Abdominis. These two muscles run down the stomach, from the ribcage to the pelvis, like 2 strips of fabric running alongside each other. They are not connected directly to each other but are instead connected to a connective piece of tissue called the Linea Alba.
What happens to our abdominals during pregnancy?
During pregnancy our uterus grows outwards, and this requires a stretching of the abdominal muscles. The Rectus Abdominis muscles begin to move away from each other, which in turn stretches and thins the Linea Alba between them. This is what we define as Diastasis Recti – “a thinning and widening of the Linea Alba and associated increased laxity of the anterior abdominal wall” (Mommers et al. 2017).
Studies suggest Diastasis Recti occurs in 100% of pregnancies by the end of the third trimester (Sperstadet al 2016; Fernandes da Motaet al 2015). This means that an attempt to “avoid Diastasis” during pregnancy is potentially pointless, however Diastasis exercises after pregnancy can help. Diastasis during pregnancy can usually be seen when doming occurs (the stomach looks pointy down the midline when load is applied to the core).
When is diastasis recti considered closed?
An estimated 23%-32% of mothers still present with a Diastasis 1 year post-delivery (Sperstadet al 2016; Coldronet al 2008) – but that means that over 2/3rds of women don’t. For many women Diastasis will resolve itself. In postpartum women Diastasis usually presents itself as doming when too much load is applied to the core, invagination (your skin falling inwards at the midline of your stomach), a pendular appearance of the stomach, or/and a difficulty performing certain movements.
The best way of testing for Diastasis is with ultrasound. This would be performed by a health professional. However we can also try to assess ourselves simply using our fingers to feel for the gap created during an abdominal exercise (such as an abdominal curl). What we want to feel for is the width of the gap, but also the depth of the gap. This can give us an idea of how severe our Diastasis is.
Somewhat confusingly there is no firm agreement on what constitutes a “normal” gap. But, it is commonly cited to be within a normal range when the gap is up to 15mm at the base of the sternum, 22mm at 3cm above the belly button, and 16mm at 2cm below the belly button (Beer et al 2009). Therefore, aiming to “fully close” a Diastasis is not the aim. A gap of some degree is “normal”. Postpartum ab exercises may help to reduce the width and depth of the gap, if performed correctly.
When is diastasis recti considered severe?
There is equally no consensus of what constitutes a “severe Diastasis” however Diastasis expert Dianne Lee explains that if a postpartum woman fails to 1) progress in their exercise program 2) regain pain-free function 3) regain urinary continence and has noticeable stretch damage to her abdominal wall associated with a diastasis of the rectus abdominis it would be wise to seek support from a physiotherapist. In the UK your first port of call would be to speak to your doctor and ask to be referred to a specialist physiotherapist.
Conclusion
In summary Diastasis is a very common part of pregnancy, and for many women it resolves itself postnatally. If you are worried that your Diastasis has not improved postpartum, you are still struggling with doming, invagination/sagging, or a pendular appearance to your abdomen, please do ask your doctor for support. There are postpartum diastasis recti exercises that can help improve the integrity of your Diastasis, many of which are included in The Bump Plan Postnatal.
Useful Links
- Advanced Pelvic Health Physiotherapist Gráinne Donnelly – click here to find out more
- Anthony Lo – The Physio Detective – click here to visit his website
- Diastasis: How Can You Train Safely With it and How to Manage It – click here to read
Related Blogs
- Postpartum Pelvic Floor Exercises
- How Soon After Pregnancy Can You Exercise – Exercise After Birth?
- Diastasis Recti Abdominis – What it is & How to Identify it
