If you have a bulging belly that still makes you look pregnant months after giving birth, you may have a Diastasis Recti. Once medically diagnosed, its treatment includes physiotherapy. Diastasis Recti is common for postpartum women, but it can affect anyone. Moms with Diastasis Recti need Physiotherapy, Not a "Mummy Tummy" exercise.
Diastasis Recti is a separation of the abdominal muscles after birth. Here's how to prevent, recognize, and treat this type of bulging belly.
Will my postpartum belly ever go away?
This is one of the most common questions asked by new mothers as well as expecting pregnant women, reports Dr Anuradha (PT) Certified Child-birth Educator who leads the prenatal and postnatal programs at ReLiva. And the answer is Yes! Chances are that this DR bulging belly could have been prevented completely if the pregnant mom has worked carefully with her pregnant self, doing prenatal exercises targeted at her core and pelvic floor, as those planned by FabMoms. [FabMoms is a dedicated prenatal and postnatal service for expecting and new moms, offered by ReLiva]
Abdominal muscles don’t always snap back into place after having a baby, and that belly bulge may be a sign of diastasis. A physiotherapist will help you with specific exercises to help knit those abs back together.
What can I do if I have Diastasis Recti?
Here is a list of Do’s and don’ts for you to follow if you have a bulging belly due to abdominal separation:
- Avoid all strenuous exercises that cause your abdominal wall to bulge out
- If you have to bend forward, activate your Deep Tummy Muscles before you do this
- Avoid heavy lifting or bending
- Avoid straining on the toilet
- Avoid aggressive abdominal exercises that would put strain on the midline of the abdominals such as sit ups or crunches or rising from a lying position by pulling up and twisting at the same time
- When getting out of bed, roll on to your side first before pushing up, avoiding the sit up motion
- Avoid holding baby on one hip
- Consult a physiotherapist to remedy your abdominal condition
- Continue exercises to strengthen your deep core muscles
What is Diastasis Recti?
During pregnancy, the growing uterus stretches the muscles in the abdomen (six-pack) to allow room for your baby to grow. This can cause the two large parallel bands of tummy muscles over-stretch during pregnancy and separate down the midline (rectus muscles) by an abnormal distance — a condition called Diastasis Recti or Diastasis Recti abdominis (DRA).
Who can be affected by Diastasis Recti?
Although Diastasis Recti can occur in both genders and across age groups, it is principally seen in pregnant women.
Diastasis Recti is common among women who are over 35, deliver a high birth weight baby or have a multiple pregnancy. It's usually most noticeable right after delivery. It also occurs in middle aged and older men with abdominal obesity.
How to know if I have Diastasis Recti?
So how do you know if your abs have parted ways and are reluctant to meet again? Diastasis isn’t painful and it is typically not obvious until the postpartum period. You will know if you have DRA by:
Self test to know if your bulging belly is due to Diastasis Recti:
There is a self-test that can be done. Always follow-up with a medical advice to confirm your discomfort.
Lie on your back with your knees bent and feet on the floor. Have your top rolled up so you can see your tummy. Tuck your chin in towards your chest and gently lift your head and shoulders up from the floor. If you have Diastasis Rectus, you will see doming down the middle of your tummy. This is your abdominal contents pushing through between your abdominal muscles.
A physiotherapist will examine to diagnose Diastasis Recti
Your physiotherapist will ask you to lie on your back and feel your tummy muscles while you are relaxed and then while you are activating your tummy muscles (physiotherapist will instruct you to do certain movements for it). They will measure the gap between your tummy muscles at your belly button and 2 inches above and below. You can also do this test on your own by measuring the gap with your fingers. What you want to feel is the edge of your abdominal muscles hugging or squeezing your fingers. If you don’t feel it with two or three fingers there, add more fingers until you feel a hug.
A gap of one or two fingers is normal and doesn’t require treatment; the gap may or may not close, but it’s unlikely to inhibit healthy function, unless it’s accompanied by other issues, like incontinence or low-back pain. In that case, or if the gap is larger than two fingers, it’s time to see a physiotherapist especially if you plan to have more children. A stronger core will make subsequent pregnancies and postpartum recovery easier.
Watch physiotherapist Dr Fizzia talk about diastasis Recti and how to fix diastasis Recti
What are the symptoms of Diastasis Recti?
The most common symptom of Diastasis Recti is a pooch or bulge in your stomach, especially when you strain or contract your abdominal muscles. Additional symptoms include:
- lower back pain
- poor posture
Here is a picture that shows how a belly with Diastasis Recti may look like.
Symptoms of DRA during Pregnancy:
During pregnancy, you might not have any noticeable symptoms as your abdominal muscles separate. But during the second or third trimester, you might see a bulge or ridge developing on your belly. It can appear above and below the bellybutton. It might be most noticeable when you’re trying to use your ab muscles to stand, sit up, or lie down.
Symptoms of DRA after delivery (Postpartum):
After delivery, the most noticeable symptom is a bulge or “pooch” in your belly area. Even though you’re no longer pregnant, it might look like you still are.
Why did I get Diastasis Recti?
Pregnancy is the leading cause of DRA :
- Due to stretching of the abdominal muscles
- Due to weight fluctuation during pregnancy
- Hormonal changes combined with uterine growth also can lead to this condition.
- Caesarean section (possibly due to changes in anatomical morphology of the abdominal wall after caesarean section) is another pregnancy related cause.
Other causative factors that could lead to DRA are:
- There is an increased risk with twin or IVF pregnancy due to increased bump size/tissue elasticity.
- Many years of abdominal loading/lifting with poor technique can also cause diastasis recti.
- Chronic straining, obesity, hypermobility, previous abdominal surgery and multiple pregnancies are the other causes.
What should be done if I have Diastasis Recti during Pregnancy?
Most women will experience some abdominal separation during pregnancy. This can weaken your core and lead to back or pelvic pain. Physiotherapy guided exercises are considered to be the only treatment method that may potentially result in the decrease of inter-recti distance causing DRA1.
You may need to wear a binder or tubigrip for support during the day. Also, take care to do the following:
- Avoid any heavy lifting or further straining of your abdominal muscles until after you deliver.
- Practice good posture.
- Support your lower back when sitting with a towel or pillow placed behind you.
- Bend your knees, roll, and support yourself with your arm when getting in or out of bed, or standing up off the floor.
During pregnancy, you can continue to strengthen your core, but in consultation with a physiotherapist. A ReLiva physiotherapist will design a prenatal regimen to include modified, pregnancy-safe exercises for diastasis recti after a thorough assessment of your pregnancy condition.
What to do to treat Diastasis Recti?
For some women, Diastasis Recti may correct itself after delivery as the ab muscles regain strength. If you’re still experiencing symptoms or separation eight weeks postpartum, specific exercises may help. You can consult a women’s health physiotherapist such as those at ReLiva Physiotherapy.
Postpartum treatment for Diastasis Recti usually involves exercises targeted at:
- pelvic floor and
- deep stomach muscle
Always check with your doctor and physiotherapist and get their approval before you start exercising after delivery. At ReLiva, physiotherapist will teach you progressive exercises to help improve Diastasis Recti symptoms. They will also teach you exercises to do at home to maintain your recovery and abdominal strength. [Scroll further to understand how physiotherapy helps healing in Diastasis Recti]
If pain from Diastasis Recti is interfering with your ability to perform day-to-day activities, surgery is an option. Some women also elect for surgery for cosmetic reasons.
Does binding help Diastasis Recti?
It is a highly discussed issue if a Splint, belly Binder or Abdominal Wrap should be used postnatally?
Postpartum abdominal binding has been traditional practiced in many parts of the world for generations. Supporting the abdomen during and immediately after pregnancy may be helpful in some cases, and, used correctly, can help with awareness of the abs and for lower back support.
However, wrapping it up tight, pulling the two sides together won’t make them heal or stay there. Don’t use a wrap or splint as a substitute for actually engaging the right muscles. Otherwise you’re going to be wearing that splint for a very long time.
Remember the diastasis is caused by excess loading and pressure within the abdominal and pelvic muscles - a pressure that your body can’t withstand as it should. Wrapping it up in itself won’t fix it, it will just squidge your abdominal mass in a different direction. You need to correct alignment and re-engage an entire system of muscles and fascia to put your tummy back where you want it for the long term.
Can you fix Diastasis Recti without surgery?
Physiotherapy guided exercises are considered to be the only treatment method that may potentially result in the decrease of inter-recti distance causing DRA1.
If your condition is severe, or not improving to your satisfaction after exercise, you may consider going under the knife to correct your diastasis recti. In most cases surgery is an extreme case option if conservative treatment of therapeutic exercise and physiotherapy has failed.
How long does it take for Diastasis Recti to heal?
If exercises are done as prescribed and a splint is worn (if and as advised), in most cases Diastasis Recti heals over a postpartum period of 6 weeks to 3 months. If the condition is severe, it may take as long as 6 months to a year altogether.
How does Physiotherapy help in Diastasis Recti?
Diastasis Recti is conventionally treated through targeted exercise therapy, specifically abdominal exercise. Clinical studies do show promise for both preventing and reducing Diastasis Recti with targeted exercises.
At ReLiva, physiotherapists help patients suffering from Diastasis Recti by creating an exercise program that focuses on improving pelvic alignment and toning and flattening the abdominal wall. Effective physiotherapy works to shorten muscle fibers and develop dynamic stability which can improve the function between the external and internal layers of the abdominal wall.
For separations that are smaller than 4 finger widths, corrective exercise is the best first line approach in order to help draw the two bellies of the rectus abdominus together. Exercise is typically done for 2 to 6 weeks until the separation is closed or less than 2 finger widths.
It is important that corrective exercise include strengthening of the muscles of your inner core, your support muscles.
Basic physiotherapy protocol for DRA will include:
- Abdominal exercise program which includes strengthening of transverse abdominis and rectus abdominis muscles
- Postural training, strengthening of postural muscle and stretching of tight muscles should not be ignored
- Pelvic floor muscle strengthening. More than 70% of women cannot create a pelvic floor contraction in the presence of a rectus diastasis, and as a result are more likely to experience incontinence, prolapse and pelvic pain
- Abdominal bracing and taping
- Breathing exercises for diaphragm efficiency
For larger separations that are 4 finger widths or more, a corset or binder is typically recommended in conjunction with exercise. This is typically worn 24 hours of the day and taken off for bathing and exercises.
Incorrect exercises or exercises incorrectly performed can be ineffective, or at worst, counterproductive and harmful.
Hence, it is very essential to seek the guidance of your physiotherapist for your treatment.
What happens if Diastasis Recti is left untreated?
In the light of few studies2, one cannot deﬁnitely conﬁrm the link between DRA and such conditions as the pelvic ﬂoor dysfunction or lumbo-pelvic pain. However, complications can arise if the rectus muscle continues to separate.
- Low back pain: A common complication associated with Diastasis Recti is lower back pain. Abdominal muscles support the back so separated or weakened muscles jeopardizes trunk mobility and stability leading to chronic pain
- Hernia: A serious complication associated with Diastasis Recti is hernia. Pregnant women with Diastasis Recti may experience umbilical hernia when extra pressure placed on the abdominal wall during the second and third trimester of pregnancy causes the pregnant uterus to bulge through the wall. In addition, premature newborns with Diastasis Recti may develop hernia when separated abdominal muscles allow part of the intestine to protrude through a weakened or poorly formed abdominal wall. Diastasis Recti usually disappears as the infant grows and the abdominal muscles close. In most cases, the hernia usually heals without medical intervention, but in some cases, surgery may be needed to decrease pain and close the gap in between the abdominal muscles
- Poor posture: People who have Diastasis Recti may experience poor posture due to weakened abdominal muscles leading to secondary postural problems
- Pelvic floor dysfunction
If you or a loved one are facing post natal bulging belly, contact us right away at 9920991584 and we will connect you with a ReLiva physiotherapist near you. They will help you identify the condition and learn exercises to heal and strengthen the abdominal muscles for correction.
This article is based on the inputs from Dr Swapnaja Joshi (PT). She is a senior physiotherapist with experience in recoveries related to prenatal and postnatal care, back pain, spine, shoulder and hip joints as well as neuro issues.
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