It happened to me. The thing no mom ever wants to happen. I heard those words:
“I didn’t know you were expecting!”
Then the uncomfortable silence and a quick mumbled response, “I’m not.”
I was at the orthodontist for my oldest (trying to help her with mouth breathing!). That sure started the appointment awkwardly! And as someone that has dealt with the pain of both infertility and loss, those words really stung.
I felt like saying, “Do you know what my body has been through?”
Of course, I didn’t. But in my head, I was going over my years of digestive issues putting pressure on my abdomen, my major colon surgery, and three c-sections (that’s four abdominal incisions…with one more to come a few years later). Plus a large third baby (she was not even one at the time – she was nine pounds at birth) in my small five-foot three-inch body. That is a recipe for one thing – diastasis recti.
On top of all that we were struggling with my daughter being malnourished due to some health issues, so I was under a ton of stress and underweight myself. This leads to adrenal fatigue and storing fat in the abdomen. So my underweight body had a protruding belly.
When I was pregnant with my daughter I could feel my abdominal muscles tearing apart. It was painful. Every doctor I asked simply said it was my muscles. They were right. But they didn’t give me any solutions. After she was born I stumbled upon the term diastasis recti. I learned about it and knew I had it.
But it wasn’t until my fourth was about one-year old that I decided to do something about it. I didn’t care what I looked like. But it was impacting my life. My diastasis recti was making it hard for me to sit up straight. My digestion was suffering immensely. I felt like my back was getting weaker by the day.
I tried some online programs, but they weren’t enough. I finally turned to physical therapy to get assessed and get help. I am honored to share with you today some insight from my pelvic floor physical therapist, Emilee Van Hoven, and a little bit about my journey to lessen my diastasis recti. I hope you learn a lot from her!
What is Diastasis Recti?
Diastasis recti (DR) is separation between the two bellies of the rectus abdominis muscle – our “six pack” muscle; the separation occurs at a structure called the linea alba which is a band of connective tissue.
What Causes Diastasis Recti?
Diastasis recti can be caused by anything that takes up space within the abdominal cavity. Most commonly, we hear about it in relation to pregnancy – as the uterus and baby grow, the tissue must stretch and separate to accommodate. DR can also occur due to excess abdominal adipose tissue, including in men. For the purpose of this interview, I’ll focus on DR associated with pregnancy.
How Do You Diagnose Diastasis Recti?
Research is mixed about diastasis recti diagnosis, however the most common standard is via a “finger-width” measurement that occurs 2” above the belly button, at the belly button, and 2” below the belly button. Diagnostic ultrasound can also be used to visualize DR and assess muscle separation and activation.
Is Diastasis Recti “Curable?”
Yes! But usually not without some hard work! Some women are fortunate and have good recovery of their abdominal wall with minimal lingering connective tissue effects after pregnancy. This is likely due to genetics – some people just heal better than others. For most women, it requires some intention – intentional modification of daily tasks and exercises, intentional re-building of the core and abdominal wall, and continued intention with these throughout a lifetime.
It’s also important to remember that the goal of DR recovery isn’t closure of the gap. Research tells us that it’s more important to help establish functional tissue tension across the gap than to eliminate the gap all together. This takes place through intentional training of the transverse abdominus (TA) – our deepest abdominal muscle whose fibers run side to side across the abdomen. A physical therapist can help you to do that!
What Exercises are Unsafe for Someone with Diastasis Recti?
It is common to see lists of exercises that “aren’t safe” for individuals with DR. Exercises on these lists often include crunches, sit ups, and planks. I personally don’t agree with an umbrella list, as everyone is different! Rather than a list, I like to educate patients on how to assess if an exercise is appropriate for them.
I encourage patients to consider 3 factors:
- Does my abdomen press outward during the exercise? – this can look like an outward rounding of the entire abdomen or what many refer to as “coning” or “tenting” which is an outward press that is more prevalent at the DR and therefore, creates a pointed look to the abdomen.
- Do I feel like I want to hold my breath at any point during this exercise? If so, that likely indicates that your abdominal wall isn’t quite strong enough and your body feels it needs to do this for extra stability.
- Do I feel good doing the exercise?
If for one or all of these reasons, someone feels like an exercise isn’t appropriate, I encourage modification of that exercise until no compensation is observed. If I did have to list one exercise I’m not a fan of, it would be straight leg lowers – those aren’t often performed by anyone without compensation!
Can Diastasis Recti be Fixed Surgically?
DR can be addressed surgically, however it is best performed by a plastic surgeon and therefore, is not typically covered by insurance, even for women with large separations who would benefit functionally, not just aesthetically, from repair.
Can You Do Yoga With Diastasis Recti?
Yes! But just like with my answer above, during your practice, you should observe the behavior of your abdominal wall. One yoga pose that may not trigger as inappropriate, but can create a lot of additional stress on the linea alba is upward facing dog. It may be wise to modify this with cobra instead.
Does Babywearing Impact Diastasis Recti?
Yes! Babywearing is a major core workout – yes?! And just like with abdominal exercises that are challenging, functional activities that are challenging, like babywearing, can have the same result – abdominal bulging and breath holding, both of which create unnecessary stress on DR. Things you can do to help with this include:
- Ensure you are babywearing correctly to minimize unnecessary stress on your trunk. Work with an expert if you need help finding the right fit!
- Monitor the amount of time you babywear – i.e. you may do just fine for 45 minutes, but by an hour, you’re compensating due to fatigue
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Do Hormones Affect Diastasis Recti?
Yes. In the post-partum period, particularly in someone who is breastfeeding, decreased estrogen and progesterone levels in combination with continued secretion of relaxin creates an environment that promotes connective tissue laxity more than connective tissue healing.
Now this doesn’t mean you shouldn’t address DR because of this, but you should set your expectations appropriately, knowing that your hormones are making recovery a bit more challenging. Hormonal changes can remain up to 4-6 months after completion of breastfeeding, so keep that in mind as you work on your recovery!
What are Some Simple Steps to Take to Work on Diastasis Recti?
A great place to start is:
- Monitoring every day functional tasks for abdominal outward pressing and breath holding, ie. lifting and carrying the car seat, lifting children
- Monitoring exercise for abdominal outward pressing and breath holding
- Begin to work on transverse abdominal activation by relaxing your belly with your inhale and gently drawing your belly button inward with your exhale. Try a few rounds of this for a minute everyday.
- Think about engaging your TA with activities you find challenging or notice your body compensating during.
- Schedule with a physical therapist!
When Should You See a Therapist for Diastasis Recti?
I’m, of course, quite biased, but ASAP! A physical therapist who specializes in postpartum recovery can provide support for healing in several ways:
- Assessment of surrounding structures that can impact DR (diaphragm, pelvic floor, abdominal wall, back, hip, and shoulder)
- Breathing techniques that assist in recovery of the entire core
- Manual therapy or massage techniques that help with decreasing the diastasis distance
- Intentional, personalized exercise progression that gradually loads the muscles and connective tissue appropriately (not too much, but not too little, either!)
- Recommendations for progressive return to general exercise
- Recommendations for abdominal binding or support if indicated
Even if it’s just for one or two visits for some education, working with a physical therapist to help guide your recovery can make all the difference! Also worth noting, early intervention is best, but it’s never too late to address DR!
Physical Therapy for Diastasis Recti
Hindsight is always 20/20, right? I wish I had known all of this well before I even had kids! Honestly, I could have used this in high school when I was struggling with digestive issues plus doing crunches like crazy to try to get a flat belly. But, as Emilee said, it’s never too late to work on repairing diastasis recti.
I’m so thankful I took that step to see a physical therapist instead of trying to do this alone. It gave me a great starting point and the direction I needed to continue.
I wish I had some amazing before and after pictures for you. But I don’t (I’ll share some progress, though!).
After so many years of separation, my diastasis is very deep and it will take quite a bit of work to get my core fully functional again.
Actually my diastasis is really high, which is what I struggle with. Given my short stature and short torso, having a bulge well above my belly button is what bothers me. It makes it hard to find shirts that fit right and are flattering. Not to mention it makes it hard to do just about everything! We use our upper abs for so much.
I also have an umbilical hernia because of my diastasis recti. I’m hoping that as my DR gets smaller the hernia will resolve. It will be nice to have a normal belly button again!
I also still have digestive issues to work through that compound the problem. When I am having a bad stomach day, it’s hard for me to do my diastasis exercises as it can be very uncomfortable. I’m thankful Emilee not only helped me with my diastasis, but also showed me how to do abdominal massage to help with digestion.
After just a few sessions of physical therapy, I could definitely feel a difference in my DR. The gap had already narrowed quite a bit, especially at and below my belly button. I loved how Emilee helped break up connective tissue to mobilize my muscles and to help with my deep abdominal scar.
I also loved all of the at-home exercises. We started with really simple moves like mini marches while laying on my back and gradually added more as I was able.
Although I would love to work with a physical therapist for the next year, time and finances don’t allow it. I did about ten sessions with Emilee. She was so helpful to get me started with the healing process and educate me on how to keep it going.
At-Home Exercises for Diastasis Recti
The hardest part of the healing process for me is self-motivation. Now that I am on my own I really have to make a point to set aside time for my exercises. It’s easy to get out of the habit!
I want to encourage anyone struggling with diastasis recti to make therapy a self-care top priority. Even if you can only afford one or two visits with a pelvic floor physical therapist, it’s worth it! I’m ready to put myself first for once.
Then when you have exercises and understand how to engage your core, put it on your to-do list at least a few times a week. Even setting aside 15 minutes during the day can go a long way. If necessary, get child care or have your spouse watch the kids to give yourself the time to work on your health.
The strength of your core impacts how you move and even how your body functions. A weak core leads to poor posture, which the body views as a constant source of stress.
My biggest takeaway from my work with Emilee was that it’s not about doing the right or wrong exercises. It’s about properly engaging your core no matter what you’re doing. That is something I have carried with me into my everyday life.
If I am lifting my toddler, I pause to breathe and engage before I pick him up. When I’m driving, I sit up straight and focus on breathing and engaging my core to sit up.
It is my goal to continue to work on strengthening my abdomen. I especially want to gain the functional tissue tension above my belly button. That is the spot that basically ripped apart while pregnant with my third child over five years ago. Doing my DR exercises that cross the mid-line of my body are the most helpful for it, which is why they are also the most challenging!
I have also noticed how much of a difference footwear makes! When I make sure to wear minimalist shoes it really helps reduce the stress on my spine and maintain good posture. This, in turn, helps my abdominal muscles to engage properly.
Diastasis recti is so common. Yet I never even heard of it until after my third child was born. My hope is that more and more doctors become knowledgeable about it and educate and support women before, during, and after pregnancy. When it comes to diastasis recti, a little awareness and work can go a long way!
And, yes, it is still awkward every single time I take my daughter to the orthodontist! But if it ever happens again, I think I’ll speak up. Everyone should know about diastasis recti!