What Is This Mommy Pooch?
A Guide to Understanding Diastasis Recti
Despite being one of the most common conditions women endure in relation to pregnancy, not only are resources and information scarce but even the pronunciation is tough! Fear not, I will break down all things DR below in a simple and easy-to-understand format.
What is diastasis recti?
Ever made those Pillsbury biscuits? The ones that come in a cylinder roll? You know, the ones where you have to poke it in the middle and it pops? Imagine the entire center, vertical portion being the core unit, for the most part. The top being the diaphragm, the bottom being the pelvic floor and the sides being the transverse abdominis (this is a corset like muscle group that wraps around). The middle muscles are separated by the left and side and they are all rectus abdominis (your “6-pack” muscles). Obviously, there is more to the story, but overall – if you put too much pressure in the can (imagine poking the can at this point), it pops, right? This is similar to your core unit. If you put too much pressure in a can it, it pops. If you apply consistent intra-abdominal pressure to your core unit for a period of time, like pregnancy, you can end up with abdominal separation, just like dough separates.
The word “diastasis” means separation, and “recti” refers to the rectus abdominis muscle. When there is too much pressure applied to the core unit, this linea alba ends up getting weaker and thus, not able to do its job of keeping the two sides together! In short, diastasis recti (DR) is when the right and left sides of the rectus abdominis muscle (your “6-pack” muscles) move wider apart due to a thinning and weakening of a connective tissue called the linea alba. This holds the two sides together. A small separation is normal and expected, but a separation greater than about 2 finger-widths and greater is considered diastasis. Typically, it’s due to the fascia in the abdominal wall being too weak or tight in the wrong places.
Sometimes DR is confused with a hernia. However, DR is just a thinning and weakening of the linea alba tissue; whereas a hernia is when the internal contents (intestines or organs) actually protrude through a weak point in the abdominal cavity (or other cavity).
What causes this?
It all comes down to one thing: excess intra-abdominal pressure. In other words, think of your growing belly like an expanding balloon. As you blow air into the balloon, the pressure continues to build inside it. After a certain point, if you continue to force air into that balloon, it will eventually pop. Just like the biscuit can-analogy! This same general idea can be applied to your abdominal muscles. All your abdominal muscle layers are connected at the front midline of your body by the linea alba. Think of the linea alba tissue like “silly putty;” it’s strong, but flexible. If consistent and excessive outward pressure is placed on that tissue (like from a growing belly during pregnancy), then it eventually thins and stretches out so much that its consistency becomes more like cellophane, and it loses its ability to hold anything together. When this happens, your outermost muscle layer – rectus abdominis – begins to drift apart.
How can this affect me?
From an aesthetic perspective, DR leads to a “pooch” appearance in your belly. What you see are abdominal contents protruding through the separation caused by the thin and weakened linea alba aka “silly putty.”
There are other implications that are extremely important beyond the appearance For instance, DR may indicate a weak and ineffective core. This can lead to a several problems including constipation, low back pain, pelvic or hip pain, incontinence, bladder or rectal prolapse. It can also put you at greater risk for developing a hernia, which requires surgery to fix. So you see, correcting and preventing DR is beyond appearance, it’s to help you feel better, and prevent injury and other complications.
Why is this so common?
Well, for one, it is often not discussed in your typical appointment with your provider. Not all trainers are created equal and equipped to understanding how to prevent it to some degree nor do they understand the means to work towards resolving it. For instance, it can be brought on by doing crunches or other inappropriate core/ab exercises. If over the years, you’ve done a lot of crunches or abdominal exercises that are super intense that were taught in that traditional crunch style, this can lead to stress in the abdomen which puts stress toward the pelvic floor. Also, if you are not aware of what can exacerbate it or how to adapt simple techniques to prevent it, it is quite inevitable.
Why does it matter if I have diastasis recti?
Understanding why it matters can help you to see the purpose in why you should care, why others should care, why it is imperative for other fitness professionals and doctors to bring awareness and why this needs to be addressed. It’s not just about the abdominal separation itself. I know I already mentioned doing lots of crunches and how it can lead to putting unnecessary pressure on your pelvic floor, on your lower back, your lumbar spine and preventing you from creating an optimal fascial connection through your core and entire body.
Long story short, having diastasis recti (or a deep core that does not function optimally) can lead to aches and pains and issues within the body that you don’t need to be experiencing.
Take a few steps back and re-evaluate the foundation and ask yourself these questions as you’re going throughout your workouts:
If there’s any incontinence, that is a strong indicator that this exercise is not appropriate for you.
Does this cause me pain in my low back?
Do I feel pressure on my pelvic floor?
Do I feel like my abs are bulging out instead of zipping up?
These fundamentals apply to everybody, even if you don’t have separation.
I challenge you to begin to shift your mindset. It’s not just about preventing or healing diastasis recti. It’s about what it means for your entire body.
What factors make someone more susceptible to getting diastasis recti?
DR can occur in anyone at any time – men and women! Any factor that causes consistent and excessive intra-abdominal pressure can cause it. Imagine that balloon or can again! However, you can see why it’s so common during pregnancy due to the excess pressure that an expanding belly creates.
In fact, it’s important to note that every woman experiences at least some degree of DR during the third trimester of pregnancy. If managed properly during pregnancy and if the appropriate measures and rehab is performed post partum, it can resolve within a short time period after delivery. However, excessive intra-abdominal pressure and not performing the correct movements can cause the diastasis to remain in the postpartum period, and long beyond. Factors that increase a woman’s likelihood of getting it include:
Forceful “bearing down” during strenuous activity (constipation, vomiting, etc)
Weak deep core muscles
Being pregnant with multiples
Having a shorter torso (baby has less room to grow up and down, so it forces belly out more)
Failure to rehab core and pelvic floor appropriately post partum (you don’t need to wait 6 weeks to adapt low impact breathing techniques)
Rapid or excessive weight gain (the larger the belly, the more pressure)
Performing improper core exercises during pregnancy
Can I prevent diastasis recti?
There can be some abdominal separation during pregnancy, but yes, it can be highly prevented to some degree! The reason I say that is because obviously all bodies are different. During pregnancy and postpartum, it is not 100% preventable, BUT you can work to prevent the severity of diastasis recti – which is, huge.
If you do nothing, the severity of the abdominal separation that you could get from having babies could be severe. The tissue could become extremely weak and your recovery could be much more challenging.
When you learn how to properly activate your deep core, and how to release/relax (especially during pregnancy), you can start waking up the fascial connections of your body. Pregnancy is the best time to learn about your core and engage it appropriately. Don’t tune your core out during this opportune time, in fact – pregnancy is an ideal time to activate these muscles.
Between biscuits and silly putty, it is safe to say we can see diastasis recti in our day to day lives…. (or im just craving biscuits?) Stay tuned for my second post next week on how to prevent Diastasis Recti.