Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.
Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.
What is a DRA?
DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue). The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone). Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well. They are also maintain pelvis stability during walking, lifting, bending and squatting.
What are the symptoms of DRA?
Symptoms may include:
Noticeable small or large bulge in the center abdomen
Sharp or burning abdominal pain during bending, lifting, standing and walking
Lower back pain
Feeling like the intestines or stomach may fall out
Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.
How To Measure for a DRA?
The best way to measure is a finger width measurement. Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort. Now raise your head and shoulders slightly upward. If your fingers descend inbetween the parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward. If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!). A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width) that lower. We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width
What to Do if you have a DRA?
Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).
Here are some tips that you can do immediately:
Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements. Avoid being on "all fours" or on hands and knees for too long during exercise classes. Assuming the yoga, "cow position" where your belly drops down as your head and hips arch upwards, puts too much pressure on the already stretched linea alba. Plus, the yoga position of "Up dog" and extensive backward bends are not recommended.
Stand and sit symmetrically in good posture (don't stand on one leg or sit with crossed legs leaning on one hip for too long)
When you are standing, gently unlock your knees and pull your stomach inward while breathing normally to give abdominal support and prevent "hanging out" on your ligaments
When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing
Wear a pelvic and/or abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.
By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.