Diastasis Recti | Donna Sarna

What is Diastasis Recti?

Diastasis recti is a separation of the rectus abdominus (6-pack) muscle at the midline. Separation occurs as a result of the widening and thinning of the fascia, known as the linea alba. During pregnancy, diastasis recti occurs in response to the force of the uterus pushing against the abdominal wall as the baby grows as well as with the release of hormones softening the connective tissue to prepare for the birthing process. Diastatsis recti reduces the integrity of the abdominal wall, as well as the functional strength of the torso (the abdominal wall and the back). Diastasis recti can occur anytime during pregnancy but is more common in the later stages. It is most problematic post-partum, when the weakened abdominal wall does not provide adequate support for the torso and internal organs. This can lead to lower back pain, pelvic instability, as well as problems with the pelvic floor including pelvic organ prolapse and incontinence.

How do you Test for Diastasis Recti?

Lie on your back with knees bent

Place your fingers directly under your belly button so your palm is facing your head

Gently lift your head and shoulders off of the floor

You will feel a separation between your finger tips

Measure the number of finger tips if a separation is present

How Can Donna Sarna Physiotherapy Help?

The physiotherapists at Donna Sarna Physiotherapy & Rehabilitation can help in determining the extent of your diastasis recti and advise you on exercises and techniques that can lessen the separation in a safe and effective manner. Not all abdominal exercises are safe to perform after pregnancy if you have diastasis recti, and some exercises can make the separation worse. Strengthening of specific muscles that stabilize the core is the first step and is necessary to reduce the separation. Muscles that comprise the inner core include the diaphragm, as well as a specific stomach muscle known as the transverse abdominus, specific back muscles known as the multifidi, and muscles of the pelvic floor. A pelvic floor evaluation is performed as a component of the assessment to ensure that you are activating the core muscles correctly and in the right order. It is an important component of the assessment as often women experience other postpartum pelvic floor issues such as prolapse, pain, and incontinence.

The assessment is a two-part process with a global approach incorporating not just the abdomen and pelvic floor, but also assessment of posture, breathing, range of motion, strength and stability of the torso, back, hips, pelvis and extremities. The associated musculature and fascia as well as the nerves and joints are also evaluated. The pelvic floor component will include an external evaluation of the skin and connective tissue in the perineal and genital area as well as an internal examination of the vagina and possibly the anal canal if indicated. The pelvic floor muscles and sphincters are tested for muscle tone and tightness, strength, endurance, trigger points, and tissue integrity. Position of the pelvic organs and integrity of their supporting ligaments and fasciae are also evaluated. You are always welcome to have a trusted individual present during assessment or treatment.

An individual treatment plan is developed based on the assessment findings. Manual therapy techniques including myofascial release and visceral manipulation is performed to decrease the tension in the abdomen that contributes to the pull on the fascia and subsequent separation of the abdomen. Your physiotherapist will also guide you through a safe and effective exercise program to restore your core and regain your function.