What is Rectus Diastasis?
Rectus diastasis, also known as abdominal separation, is a widening of the gap between the muscle bellies of the rectus abdominis muscle (or 6 pack). The rectus diastasis is a series of muscles separated by fascia, and the middle is termed the linea alba. The linea alba commonly widens and becomes thinner in pregnancy, occurring in 33% of women in the first trimester (Sperstad, Tennfjord and Hilde 2016).
This is common to occur, as the muscles are adapting to the size of the growing baby. It is not known why some women are more at risk than others of having a separation.
In one study it was found that 52% of women had a separation immediately post-natal, with this naturally decreasing over the subsequent 2 months (Mota et al 2014). At 6 months post-natal, 39% of women still had some degree of separation.
But does this matter?
It has been found that the size of the separation likely doesn’t matter. It is not linked to low back pain, pelvic floor weakness or urinary incontinence (Sperstad, Tennfjord and Hilde 2016, Mota et al. 2015, Bo et al. 2017). It may be weakly associated to pelvic organ prolapse (Benjamin et al. 2018). It is however associated with poorer quality of life, and body image issues (Joueidi et al 2019, Keshwani et al. 2017).
What might matter is the tension that can be generated across this gap (Lee and Hodges 2016). This can be seen as a bulging or indented valley occurring across the separation when the abdominals are loaded. It has been shown that specific abdominal exercises can improve the tension, and therefore the function of the abdominals. This can also improve the look and how women feel about their body. A physiotherapist with a special interest in women’s health can help you with this.
Do you need surgery?
As there are no particular complications due to abdominal separation, the answer is technically no. Some women decide on surgery though for cosmetic reasons. As any surgery has some risk of complications, the best course of action is to start conservatively – with appropriate exercises – before looking at this as an option.
If you are concerned or want to learn more about your abdominals during pregnancy or after having your baby, then please feel free to call us for a Free Initial Assessment.
Fiona Burford | Physiotherapist In recent years Fiona has been strengthening skills in Women’s Health and is particularly passionate about this area of physiotherapy and is currently studying her Masters in Pelvic Floor Health. She is also interested in chronic pain and is DMA level 1 certified in Clinical Exercise.References
Bø, K., Hilde, G., Tennfjord, M. K., Sperstad, J. B., & Engh, M. E. (2017). Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourology and urodynamics, 36(3), 716–721. https://doi.org/10.1002/nau.23005. Fernandes da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002. Epub 2014 Sep 19. PMID: 25282439. Joueidi, Y., Vieillefosse, S., Cardaillac, C., Mortier, A., Oppenheimer, A., Deffieux, X., & Thubert, T. (2019). Impact du diastasis des muscles droits de l’abdomen sur les symptômes pelvi-périnéaux : revue de la littérature [Impact of the diastasis of the rectus abdominis muscles on the pelvic-perineal symptoms: Review of the literature]. Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie, 29(11), 544–559. https://doi.org/10.1016/j.purol.2019.05.002 Keshwani N, Mathur S, Mclean L. Relationship Between Interrectus Distance and Symptom Severity in Women With Diastasis Recti Abdominis in the Early Postpartum Period. Physical Therapy. 2017 Apr;98(3):182–90. Lee, D. and P. W. Hodges (2016). “Behavior of the Linea Alba During a Curl‐up Task in Diastasis Rectus Abdominis: An Observational Study.” J Orthop Sports Phys Ther 46(7): 580‐589. Mommers, E. H. H., J. E. H. Ponten, A. K. Al Omar, T. S. de Vries Reilingh, N. D. Bouvy and S. W. Nienhuijs (2017). “The general surgeon's perspective of rectus diastasis. A systematic review of treatment options.” Surg Endosc 31(12): 4934‐4949. Mota, P. G., A. G. Pascoal, A. I. Carita and K. Bo (2015). “Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo‐pelvic pain.” Man Ther 20(1): 200‐205.Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain British Journal of Sports Medicine 2016;50:1092-1096.
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