Diastasis recti (DRA) or abdominal separation is a common occurrence during pregnancy. Research has found that between 27-100% of pregnant people experience DRA by the third trimester. Of that percentage, between 30-70% continue to struggle with abdominal separation after delivery. As a result of this common pregnancy issue, patients frequently seek help from physical therapy to minimize DRA during pregnancy or rehabilitate their abdominals after delivery. 

While seeing a pelvic floor physical therapist to address your diastasis recti is key, it is also important to understand the factors that contribute to diastasis recti in the first place. 

Before we dive into that, let’s do a quick review of diastasis recti. 

Diastasis rectus abdominis - also known as diastasis recti, DRA, or abdominal separation - is the separation of the rectus abdominis (RA) muscles at the linea alba (the connective tissue that brings together the right and left RA - seen below). 

A diastasis can occur above the belly button, at the belly button, below the belly button, or the entire length of the rectus muscles, as seen below.

When this abdominal separation occurs, you may observe coning or doming at the abdomen with an increase in intra-abdominal pressure such as lifting a heavy object, doing a crunch, coughing, laughing, or sneezing. It is also likely that you will see this with core exercises such as crunches, planks, dead bugs, or bird dogs. 

Okay so now, what causes diastasis recti in pregnancy?

1. Growing a Whole Human! 

As your baby grows, your uterus grows too, placing pressure on the abdomen resulting in an increased stretch on the rectus abdominis. You can help to minimize this by performing abdominal stretches (like cobra pose from our Top 9 Yoga Poses) as well as abdominal massage to help relieve tension and allow for stretching of the muscles and soft tissues. 

2. Increase in Hormones

While you experience many hormone changes during pregnancy, one of the most impactful hormones on the musculoskeletal system is relaxin. Relaxin is the hormone responsible for allowing the soft tissue in your body to loosen up so that your joints can shift to make room for your growing uterus. Imagine trying to fit a growing baby in your belly without your rib cage expanding to accommodate your lungs and abdominal organs as your uterus pushes up against the bottom of the diaphragm - ouch! Due to the laxity in the soft tissues from this hormone spike, we can see the soft tissue that connects the right and left rectus abdominis also stretch out - thus DRA.

3. Difficulty with Abdominal Pressure Management

Intra-abdominal pressure occurs within the abdominal cavity with things like bearing down, lifting heavy, or holding our breath. As the uterus grows, the abdominal cavity has less space available making the intra-abdominal pressure increase quicker with certain activities. When this increase occurs, the abdominals work to help to provide stability, however, this pressure will push against the area of least resistance - commonly the linea alba resulting in a diastasis. 

4. Muscle Weakness or Tightness

Much like the above point, if the abdominal muscles are weak or unable to coordinate to provide stability, increased pressure along the front abdominal wall can result in abdominal separation. Meanwhile, if the abdominal muscles are tight, instead of stretching lengthwise as the uterus grows, they may move towards the sides as the linea alba stretches and provides room for the growing uterus. 

5. Poor Posture

We’ve all seen pregnancy posture. As your body shifts to accommodate your center of gravity moving more forward, the abdominals start to work harder. Another component of pregnancy posture that can exacerbate an abdominal separation is the forward (anterior) tilt of the pelvis due to the baby's weight in the uterus. To help minimize this: shift your weight back into your heels, tuck your tailbone under, and engage your abdominals muscles as if to hug the baby. Doing this a few times per day can help as a posture reset and build the brain/body connection to the abdominal muscles. 

6. Multiple Pregnancies

Multiple pregnancies that are back to back (less than ~18 months between) can increase the risk of developing diastasis due to lack of time to work on recovery in the abdominals. For some pregnancy and postpartum safe exercises to help address an abdominal separation, especially if you are pregnant again within those 18 months, check out our post: Help Heal Your Abdominal Separation

7. Genetics

Finally, we have genetics - the one thing we truly have no control over. Some people are just predisposed to increased elasticity in our soft tissues or the number of muscle fiber types that can impact the strength of the muscles in our body. If you have genetics that tend towards increased elasticity or weakness, working with a pelvic floor therapist may be key in helping you address strength and stability during pregnancy as well as discussing outside supports to protect your abdominals as your baby grows. 

Fortunately, pelvic floor physical therapy has been found effective in helping to manage the above factors throughout pregnancy that influence the possibility of developing a diastasis recti. At pelvic floor therapy, we will work through lengthening, strengthening, and coordinating your abdominal muscles; guide you through safe movements and ways to modify movement to protect your abdomen while keeping you as active as possible. 

Ready to schedule? Reach out to us today!

Dr. Joy

@pelvicpride



Reference:

Fei, H., Liu, Y., Li, M., He, J., Liu, L., Li, J., Wan, Y., & Li, T. (2021). The Relationship of Severity in Diastasis Recti Abdominis and Pelvic Floor Dysfunction: A Retrospective Cohort Study. BMC Women's Health, 21, 68.