Diastasis Recti:
What is all the fuss and do I need to worry about it leading to incontinence?
With the stats are saying is that 100% women will experience diastasis recti by their third trimester (Mota et al 2015), you may begin to see some natural changes occurring in your abdominals down along the centre line in your second and third trimester as it expands to accomodate your baby. It can be natural too to see a dark line occur due to hormonal changes called the line nigra and fades once baby is born. As hormones kick in there is a normal softening of connective tissue to allow baby to grow.
So what is diastasis recti?
The two sides of the abdominals ( the rectus abdominals) join together centrally through a thinner piece of connective tissue called the line alba in the middle. This piece gently stretches and the two sides of the abdominals will stretch apart to allow for growth of your baby.
How do you know if this stretch is occurring?
You may notice doming or coning in the centre of your stomach particularly during actions that ask alot of your abdominals but fear not! : simple movements like getting out of bed directly from your back and laying back down into the bed works the abdominals and as they are on stretch when pregnant anyway, they can peak in the middle as they attempt to work at their length. Your belly button may become more prominent as the belly expands.
The abdominals hold our organs in as well as helping us to move. They form part of the ‘ core four’: the abdominals, the pelvic floor, the back muscles and the diaphragm at the top. It forms a core canister in our middle like a drink can. As we grow the core is naturally stretching and so as space gets less and the abdominals are stretching more it can more normal to see doming / coning as pressure inside is managed effectively by your body.
Can I reduce how much my abdominals stretch and how wide the diastasis is?
Some women seem more prone to an increased diastasis more than others. It can be to do with the amount of babies you have carried, the size of baby, your specific collagen type and also your torso length.
However, you can reduce the effort the abdominals have to go through by balancing how much strain you put on the tummy muscles with gently keeping them strong and assisting them in their stretch during pregnancy.
Avoid constipation: when we are bunged up, which can certainly occur with hormone change and then also if we are taking an iron supplement during pregnancy, our tendancy may be to strain downwards on the pelvic floor , holding our breath while we do so. This can not only put strain on our pelvic floor but also our abdominal muscles. This is because when we hold our breath we increase that internal abdominal pressure possibly putting too much effort through already stretching abdominals. Instead, use a foot stool, eat high a high fibre diet and stay on top of hydration.
2. When moving out of bed: avoid what we call ‘ jack-knifing’ as your pregnancy progresses and
overloading your already hardworking abdominals. Roll to your side and push yourself up
Using your elbow. This can be useful to do the first few weeks postnatal too as everything is getting stronger.
3. Keeping strong and continuing to exercise during pregnancy but modifying as you grow to progressively deload as opposed to increasing weights and level of intensity as the pregnancy progresses.
There are many keep up a good exercise programme right until the end. Your physio and specialist prenatal trainer can help modify accordingly exercises like sit ups and planks.
But don’t hold back on strengthening the core !: pilates is an excellent way to continue maintaining strength and length in the muscles as a compliment to other cardio/ gym based exercise. You can can stay strong and active , you may need to check in with a women’s health physio if you unsure of what you can and can’t do and it will vary with every individual during their pregnancy journey.
Will the diastasis go away after I deliver my baby?
It’s very interesting to observe the effects post delivery. Many women by the time they arrive for a 6 week check with me are on their way to full recovery of the central stretch of the abdominals. Their abdominal muscles will still be lengthened and weak but this is totally normal.
The research would say that by 8 weeks most women are fully recovering/ closing over so that the two sides of the abdominals are coming back together and tension in the line alba between the rectus abdominus is recovering. At 6 months postnatal there is a 35-39% prevalence of diastasis recti and these women will benefit from optimising their rehabilitation through a physiotherapist ideally.
Many women worry about ‘fully closing’ over but as I always tell them in some people there is actually can be natural gap there of up to 2 cm and it not be of any issue for women both functionally and aesthetically.
In the early stages postnatally breathing and using your pelvic floor muscles, good nourishment and rest are your starting points. Some women will need some abdominal support and can speak to the physiotherapist in their hospital if worried about their abdominals about tubigrip support. Don’t automatically belly bind. You are best to get guidance on this one as it isn’t for everyone.
Continue to use your foot stool to pass a bowel motion and avoid constipation.
What do I do if I’m noticing a large gap between the abdominals, that isn’t regaining tension and that may be bothering me aesthetically and also restricting my ability to return to even gentle exercise due to weakness?
I will have many women attend as they are concerned about the recovery of their abdominals. They are worried about what they can and cannot do. They are worried about making it worse if they exercise too much.
Some women, approximately one third may need assistance to get strong in their abdominals again so that the tension returns in the gap and the diastasis becomes smaller. Your women’s health physiotherapist, who is a Chartered Physiotherapist that has specialised in pelvic health and who has highly specialised training to examine your pelvic floor internally, is the best place to start to get guidance, an exercise programme and support while returning to exercise.
I often see women many months after their delivery that may have a diastasis recti and they are scared of exercising. They often ask me questions like can I do a plank in an exercise class, can I run and can I lift weights?These are all good questions and as part of our assessment we will assess the entire body including the pelvic floor to ensure they can return to exercise and achieve their goals of returning to fitness. We can and do return to being strong after having our babies, despite having diastasis recti so it’s important not to avoid with a fear of making it worse. If in doubt though always check with a professional.
SPECIAL NOTE:
I notice their will be a smaller percentage of women that stretch significantly( this is individually assessed to diagnosis severity), and this may be to do with their connective tissue type ( some of have more of some collagen than others than makes our tissue more prone to stretch and this is demonstrated with stretch marks too). They may have abdominals that find it very difficult to come back to their original length and the gap created by the division at the central line alba may not be recovering well. Some women will need intensive physiotherapy and in some cases surgery to recover the stomach muscles. This is a very big operation and it is always worth talking to your women’s health physio first before worrying about anything like that. If you think this might be you please do reach out for support.
Will my diastasis recti affect my pelvic floor?
Most recent research in this area looking at women up to one year postnatal has not found a connection with diastasis recti and incontinence ( Bo et al 2016). However, anecdotally and with experience the abdominals do serve an important role in managing pressures downwards onto the bladder and pelvic floor, and in my opinion may play a role in incontinence later in life. There has been connection between diastasis recti and low back pain which makes sense too as the core helps support our posture and offers our low back support.
Can collagen supplements help recovery?
The research is not there to support taking collagen supplements for recovery of diastasis recti just yet. However it makes sense to eat protein rich and college rich foods, soups and smoothies postnatally to aid overall recovery. If your body is giving to your baby it has less energy for recovery so make sure to account for this, especially when breastfeeding.
In a nutshell your women’s health physiotherapist is ideally positioned and specialist in this area. Don’t fear as help is here and if in doubt book your pre and postnatal checks as part of your pregnancy care.
