I checked tummy muscles for 7 years as part of routine post-natal check ups in the Maternity Hospital and read and reviewed all the studies and literature related to Diastasis Recti as part of my Masters in 2012-2014 ( when I escaped from acupuncture for 2 modules!). This sounds like a good thing but sometimes in physio, the more you study the less you are sure about things! I could talk about this forever but these are the important things to know:
WHAT IS DRA?
Diastasis Recti Abdominis (DRA) is a very common condition that occurs during and after pregnancy. Studies report that up to 100% of women have DRA in the third trimester of pregnancy and that 58% of post-natal women have DRA. Studies have also found that DRA can be present in the absense of any clinical problems.
It can be defined as an excessive widening or separation between the two bellies of the rectus abdominis muscles. During pregnancy, hormonal changes caused by relaxin, progesterone and estrogen combined with uterine growth cause stretching of the abdominal wall, affecting mainly the rectus abdominis and the linea alba.
HOW DO WE DIAGNOSE DRA?
The procedure that is most commonly utilised as a diagnostic tool in clinical practice is the finger width measure. Other methods used are dial calipers and realtime ultrasound. The horizontal distance between the Rectus Abdominis borders is measured 4.5cm above and below the umbilicus, and at the umbilicus. An Inter-rectal distance (IRD) at the level of the umbilicus of more than 2.7cm has been suggested to be pathological of DRA and in clinical practice, an IRD of 2 or more fingers on partial sit-up at the umbilicus is used as diagnostic of DRA. Severity of DRA ranges from mild, 2.5 to 3.4 cm wide and up to 12cm long with or without bulging, to severe greater than 5 cm wide and up to the entire length of the rectus muscles.
The measurement of DRA is not an exact science; In fact the measurement originated from surgeons who measured the distance between the abdominal muscles before abdominal surgery for reasons unrelated to pregnancy or the post-natal period.
TREATMENT OF DRA
Currently there are many treatment approaches used in addressing DRA, from various exercise programs, to support belts. The evidence for most treatment programs is not great but there are some interesting studies that encourage us to be sensible about the whole business of DRA.
There is evidence to suggest that DRA occurs in many pregnancies and that, despite natural post-natal recovery, the distance between the abdominal muscles in post-natal women remains greater than those who have not had a baby (nulliparous women), with most of the recovery happening in the first year after pregnancy.
Stretching of the linea alba, which is what we are feeling between the bellies of the rectus muscles, may have an effect on the abdominal muscle function because of its role as insertion to the deep abdominal muscles. Under normal circumstances, the abdominal muscles function in a coordinated manner, along with the diaphragm, lumbar multifidus, and pelvic floor muscles, to produce and control intra-abdominal pressure and transfer loads around the trunk through their associated connective tissues.
When the insertion of the muscles has become lengthened, it reduces the ability of the core muscles to function at their best and this can lead to problems down the line e.g low back pain and pelvic floor dysfunction.
WHEN DO I NEED PHYSIO?
If you are concerned and don’t know what you are feeling when you self-check your tummy muscles post-natally.
If your tummy is bulging forwards and you feel like you still look pregnant months after baby was born, despite getting back to your usual exercise program
If you have other symptoms as well as your DRA such as low back pain, pelvic girdle dysfunction or pelvic floor issues such as incontinence.
It is important to know that you can live happily ever after with a DRA. If you are strong, have good posture, are pain-free and don’t have issue with your pelvic floor, you are doing fine and you can have a little gap between the bellies of your tummy muscles.
If you have DRA and have other problems associated with your core, then it is important to address your DRA as part of your overall post-natal return to you. An assessment of all aspects of your core and a tailored exercise program will address the underlying factors contributing to or caused by your Diastasis Recti.
The first thing that we need to establish is whether or not you have a DRA. If your tummy muscles separated during your pregnancy, it does not mean you have DRA for life. We know from the research that up to 2 in 3 pregnant women have DRA by the end of the pregnancy so this is not abnormal.
What we do, or don’t do, in the first few weeks post-natal is important to allow the tummy muscles to return as close as possible to their prenatal shape. Some advice:
1) Be careful to avoid heavy lifting. Your baby and his or her light paraphernalia should be enough..take all the help you can with your toddler, car seat, buggy etc
2) Sit and stand well. Don’t let your posture slip in the first few weeks post-natally. Sit up well and use pillows to support yourself when you are feeding etc. This will encourage your tummy muscles to resume their proper activity.
3) Do your pelvic floor exercises and your pelvic tilting as advised by your Chartered Physiotherapists in the Maternity Hospital.
If after 6-8 weeks you are in a position to avail of post-natal classes, DVD’s, Pilates or anything similar, go for it! These exercise sessions will be specific to your needs and may often include your baby so you don’t need to look for a babysitter at this early stage.
If you have a DRA that demands specific attention, a class might be too hard on your tummy muscles at the beginning, this is when individual attention may be required. Physiotherapy treatment will focus on any weakness or muscle imbalance found on assessment. This will involve assessing your whole core and coming up with an exercise program that will suit your needs at this time.
Sometimes, despite all efforts, your Diastasis may remain and the decision becomes one of living with it or considering surgery. The surgery ( abdominoplasty or tummy tuck as it commonly called) is considered to be cosmetic at present, in the absence of a clinical condition such as a hernia, so as far as I know it will be not be covered by your Health Insurance.