What is Diastasis Recti?

Diastasis recti is a condition characterized by the separation of the rectus abdominis muscles (the six-pack in the front of your abdomen), which are the two parallel bands of muscles that run vertically along the front of the abdomen. This separation occurs when the connective tissue, known as the linea alba, that holds these muscles together becomes stretched and weakened, often due to the pressure and strain of pregnancy, although it can also affect men and non-pregnant women. 

However, pregnancy is the most typical cause. By the 36th week of pregnancy, nearly every woman experiences some degree of this condition as the expanding uterus exerts pressure on the abdominal wall, causing the rectus abdominis muscles to stretch and separate. This natural adaptation allows for the necessary space for the baby but can lead to a noticeable gap in the abdominal muscles postpartum. While this separation is a normal part of pregnancy, it can sometimes cause symptoms such as a weakened core, back pain, protruding belly, and pelvic floor issues. 

Do I need treatment if I have a separation?

The need for treatment of diastasis recti postpartum largely depends on the severity of symptoms and the degree of muscle separation. For many women, the condition may resolve naturally over time as the body heals and the abdominal muscles gradually come back together. However, if the separation is significant or accompanied by persistent symptoms such as lower back pain, core instability, or a noticeable bulge in the abdomen, medical intervention may be necessary. Treatment options can range from physical therapy, which focuses on strengthening the core and pelvic floor muscles, to surgical procedures in more severe cases. 

It's important to understand that healing from diastasis recti is not an overnight process. The journey to recovery can span several years postpartum, as the body gradually works to restore the integrity of the abdominal muscles and connective tissue. In the initial weeks postpartum, the body begins its natural healing process, with the first six to eight weeks being crucial for the initial recovery of the abdominal muscles and connective tissue. During this period, the uterus contracts back to its pre-pregnancy size, and the hormone relaxin, which was elevated during pregnancy to allow for the stretching of tissues, gradually decreases. This hormonal shift aids in the initial tightening of the linea alba, the connective tissue between the rectus abdominis muscles. By three months postpartum, many women notice a reduction in the gap between their abdominal muscles, although complete closure may not occur and based on studies, may never occur.  Six months to a year postpartum, consistent engagement in core-strengthening exercises and appropriate pressure management, can significantly enhance muscle tone and connective tissue resilience to further reduce the gap. The main point is that it's crucial to set realistic expectations and recognize that progress may be slow and incremental. Remember, every body is unique, and the timeline for healing will vary from person to person. The true goal is to become asymptomatic in regards to pain and have no functional limitations due to the diastasis recti.

How do I know what exercises are helpful?

Recent studies have provided some clarity on the role of exercise in managing diastasis recti. Interestingly, these studies indicate that there are no specific exercises proven to significantly improve the condition. This might come as a surprise to those seeking a targeted workout regimen to address the separation. However, the silver lining is that there are also no exercises that need to be strictly avoided due to the risk of exacerbating the separation. This means that individuals with diastasis recti can engage in a variety of physical activities without the fear of making the condition worse. However, a crucial aspect of exercising with diastasis recti is learning to control abdominal core pressure during workouts to encourage optimal healing, strengthen the muscles, and prevent pelvic floor issues or other pain symptoms.  The focus while exercising should be on maintaining overall core strength and stability, as well as pressure management which can support the healing process and improve functional outcomes.

In summary, treatment can be beneficial for individuals experiencing lower back or hip pain, pelvic floor problems, or functional limitations due to diastasis recti. Furthermore, treatment can assist you in understanding pressure management and properly engaging your core during exercises to prevent symptoms. Finally, if you're uncertain about where to begin and need more guidance on your postpartum recovery, consider consulting a pelvic floor physical therapist for tailored treatment advice.