A common and often missed post-partum issue is diastasis recti. This is where the abdominal muscles do not come back together as well as they should after adapting for pregnancy. It can also occur in obesity, but we will focus on post-partum in this post.
Adaption in Pregnancy
From mid to late pregnancy, the abdominal muscles begin to stretch apart to make space for the growing uterus. This is normal, and is facilitated by the linea alba: a line of tissue that runs down the centre of the abdomen, connecting the left and right rectus abdominis (“6-pack” muscles). Once the uterus shrinks back down, these muscles should come back together. If there is a significant gap (in terms of width or depth) a few months after pregnancy, there may be cause for a diagnosis of diastasis recti.
Testing for Diastasis Recti
Unfortunately, despite being a common condition, it is not always screened for in post-partum checks. The diagnostic criteria are lacking, but it makes sense that diagnosis should not be made before 6-12 weeks post-partum, in order to give the body a chance to heal. After this time, your osteopath can check for a gap during your treatment. The process is quick and non-invasive.
You will be asked to lay on your back with your tummy exposed and knees bent
Your osteopath will feel along the length of the linea alba for any areas that seem particularly lax
With their fingers on the linea alba, they will ask you to raise your head from the plinth. This engages the muscles of the abdomen
They will use their fingers to gauge the width and depth of any potential gaps
A gap that is more than 2cm wide and/or 2cm deep could be given the diagnosis.
Anatomy of the Area
A diastasis can occur anywhere along the linea alba, which runs from the bottom of the sternum (breast bone) to the top of the pubis (front of the pelvis). Cases are more likely around the area that was most stretched during pregnancy, typically around the belly button.
Managing Diastasis Recti
Not all cases can be managed conservatively, but exercise is the first line of treatment. Ensuring the abdominal muscles are strong is key, and over time can support the reduction of a diastasis. We can support you with prescribing and reviewing exercises focused specifically to your case. There is a possibility that lower back pain is related to some cases, and if this affects the exercises you can do, we can help to manage the back pain and adapt the exercises. Similarly, it is unclear whether pelvic floor issues are more common with diastasis recti than the general post-partum population. If you are struggling with continence issues or organ prolapse, we can support you in getting the right help.
Where exercises are not enough, surgery may be the most appropriate route. It is worth noting that a mild diastasis can be totally functional, and it may be that the demands you place on your body are well within your ability. However, if treatment does not give you the desired results, we can support you in the next step and advise you of a suitable exercise routine in the meantime.