Diastasis recti- Why do my belly still look pregnant after giving birth?

Why do I feel hard getting out of the bed even though it looks easy? Why do I always feel stiffness around my low back?

These might be diastasis recti that you are dealing with.

Who is prone to have diastasis recti?

Diastasis recti is defined as abdominal muscle separation greater than 2 cm. It is common in pregnant moms, postpartum women and obese people. It should be noted that there is a high rate of 70% diastasis recti is caused by pregnancy.

68% of muscle separation occurs above the belly button; 32% occurs below the belly button.

Why does abdominal muscles separate?

1. The abdominal muscles separate along with the growing fetus.
2. Changes in hormone levels during pregnancy thin out the connective tissues in order to accommodate the enlarging uterus.
3. Increased unwanted abdominal pressure during daily activities (holding your breath) can increase diastasis recti.

Do I have diastasis recti?

1. Lie on your back with legs bent.
2. Elevate your head and upper back in a crunch position.
3. Palpate the gap between the six packs above and under your belly button. The test is positive if the gap is wider than 2 cm.

Try not to repeat the test too many times in order prevent worsening of diastasis recti.

crunch position

palpate the gap between the red line

What problems will I face if I have diastasis recti?

1. Muscle weakness: abdominal muscles separating to both sides decrease the effectiveness of muscle pull.
2. Incontinence: pelvic floor muscle integrity and function is influenced by the intact of abdominal muscles, which work together to create intra-abdominal pressure. Separation of the abdominal walls will effect the strength of pelvic floor.
3. Low back pain: decreased muscle strength of the abdominal wall lead to additional pressure on the low back.
4. Additional bulge on the stomach: the bulge appears especially when you strain or contract your abdominal muscles.

Photo by Shane on Unsplash

What can I do to prevent it?

1. Avoid straining: especially during standing up from squat, carrying heavy objects and holding children.
2. Avoid sit up exercises during pregnant: this may increase unwanted pressure to the abdominal wall.
3. Core muscle exercises during early stages of pregnancy: according to the American College of Obstetricians and Gynecologist (ACOG), it is recommended to do light exercises such as abdominal breathing or pelvic floor muscle training to enhance your core muscles. Check out my previous article Physiotherapist’s guide on exercise do and don’ts during pregnancy for more information on exercise during pregnancy.
4. Aware of poor posture: to know about how poor postures lead to pain, please take a look at the article Pregnancy and posture alterations.

Will diastasis recti resolve over time?

According to statistics, diastasis recti will automatically resolve after 8 weeks of labour. However, 30% women still have the problem after 1 year of child birth.

Solution to diastasis recti?

1. Core muscle exercise: enhancing muscle strength is the first priority. Previous studies show that, exercise effect is the most significant in the first 45 days postpartum. Exercise recommendations are written in the article How to train your core.
2. Wear a corset: this may help regain abdominal muscle and fascia to an optimal tension. It is recommended to combine with core muscle exercise.
3. Prolotherapy: injection of small amounts of irritant solution which stimulate regenerative of injured tissues. A report showed a result of decreasing abdominal gap from 2.7 cm to 0.5 cm in a case after 7 prolotherapy sessions. The effects of prolotherapy to diastasis recti patients is still to be confirmed in future studies.

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References：

Benjamin DR, van de Water TM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. (2014) Physiotherapy, 100(1) 1–8.

Michalska A, Rokita W, Wolder D, Pogorzelska J, Kaczmarczyk K. Diastasis recti abdominis — a review of treatment methods. (2018) Ginekol Pol, 89(2):97–101.