Preventing Diastasis Recti During Pregnancy
Diastasis Recti Abdominus (DRA) is a worrisome label for many women in pregnancy and postpartum.
It comes with a stigma. And when women research to understand more about what to expect there is still mixed information.
I would like to clear this up. We in the health and wellness field are still learning ourselves about what is known as DRA.
Here are some things we do know that every women who is or ever has been pregnant should know.
Abdominal separation does not equal DRA
The abdominal muscles technically are not completely attached to each other. They are connected through connective tissue called the linea alba (LA). The LA provides the abdominal muscles the ability to expand beyond regular length for multiple reasons, two very important being breathing and growing a baby. A study in 2009 found there are variations of normal separation even before you are pregnant, even up to 3.5 cm along the linea alba. And all these variations can be completely functional.
So even before you become pregnant you may have a functional separation and it is wise to check to see what your baseline is. If you are early in pregnancy (or are trying to conceive) you can perform the regular DRA test that I detail below. With the understanding the even if you show a separation there are many factors that may determine if that separation is functional or not, which is how a PT can help.
99% of all women have abdominal separation beyond “normal” in the 3rd trimester of pregnancy
In pregnancy your abdominal muscles lengthen and stretch to accommodate your growing uterus and baby. As I said above this is one of the purposes of the LA.
At the same time your growing belly shifts your center of gravity forward pulling your spine which is not as structural supported by your abdominals anymore altering your posture. This change adjusts how your body manages the pressures within your trunk and puts more strain on the linea alba. Over the 40ish weeks this posture shortens the low back muscles further exasperating the outward expansion to the front.
Even with all these changes the abdominal muscles are meant to stretch and continue to provide support in the newly lengthened state. So it’s not just the stretching that causes DRA, it’s posture and how your body adjusts to the pressures within it while moving and exerting effort.
There are many grades of DRA
Just like there are many degrees of normal separation there are multiple grades of DRA. Technically, a DRA is diagnosed at a 2 finger separation using the typical head lift test. A separation may measure as much as 8 or more fingers though.
However, as we understand abdominal function more, the tension in the LA plays a larger role in how the abs work and the different grades of DRA. What I mean by this is how soft the connection is between the two halves of the abdominal muscles during a head lift or functional task. When the body is able to produce proper tension in the LA it creates a solid foundation for the abdominal muscles to pull and contract from (much like a bone, but not that hard).
So the DRA test is not only looking at separation but how much tension you are able to produce in the LA. You may have a 4 finger separation and moderate soft LA or a 2 finger separation and very soft LA. It can vary a lot!
The severity of the grade does not equal dysfunction (i.e. symptoms or issues you may experience)
Since the grade DRA can vary immensely and separation is not the only variable in play for how the abs function, the symptoms may not equal the severity of the DRA. For example a person with a 2 finger separation and very soft LA may have severe back pain or gut issues. Where as a person with a 4 finger separation and ability to create proper LA tension may have no symptoms.
Healing a DRA is more than closing the separation
Since a DRA is also measured by the ability to produce tension in the LA, it should come as no surprise that healing a DRA is more than closing the separation. It’s about creating balance within the body to improve the ability to produce proper tension in the LA, which create a functional separation.
This balancing act involves many factors including:
Proper nutrition - more specifically a healthy amount of collagen
Good posture
Breathing properly
Modifying behaviors that don’t serve your body while it’s healing
Lengthening tight muscles that have been working double time to keep you stable while your pelvic core muscles have been at diminished capacity
Improving your pelvic core strength and applying the use of your pelvic core with activity to manage the pressures within your body
You can prevent a DRA with the right strategies and education during pregnancy
So by now hopefully you see where I’m going with this. That DRA is not inevitable as a birthing person. That it can be prevented with the right strategies and education during pregnancy. Many of these strategies are similar for every birthing person like learning how to breath properly, good posture and use your pelvic core. But your baseline ability is different from the next birthing person, so the strategies that work for you may not work for them.
This prevention starts with learning your baseline. If you are trying to conceive or are early in pregnancy you can perform the typical DRA test.
DRA TEST*
Lie on your back with your knees bent
Place your hand on your belly with your middle 3 fingers perpendicular to your midline (line from pubic bone to sternum)
You’ll test three areas: 1-2” below the belly button, at the belly button and 1-2” above the belly button
With an exhale lift your head off the floor
Explore what the three areas listed above feel like and how much separation there is
Anything 2+ fingers and soft to moderate soft you’ll want to seek guidance on how to manage
If you are later in pregnancy and you are unable to perform this test, you can watch for how your body manages pressure by looking for doming along the midline of your belly. This doming is the LA expanding outward because it cannot create enough tension against the inside pressures. It looks like a little hill or bulge between the two halves of your abdominal muscles and may occur with movement like sitting up in bed, getting up from a chair/couch, leaning back to wash your hair. This is more noticeable while holding your breath. So pay attention to any movement that causes this doming to happen and seek guidance on how to reverse it.
Once you know your baseline you can start to understand if behaviors need to be modified or certain exercises need to be implemented.
For many learning how to breath properly is the beginning of bringing balance to your body. Your body is designed to breath in a 360˚ manner with your ribs moving the most, especially into the back and side. Here’s why, your lungs are directly under your ribs with the largest portion in your back! So if you are inflating your lungs properly then your ribs should be expanding out and up and with that comes your breast bone sliding up, your belly rising and your pelvic floor blossoming outward. Give it a try and see how your body responds. If it’s challenging, that’s normal. Your body has created tight areas based on how it’s been used. Stretches, body work and practice will improve your ability to breath properly. Then as you do your spine will be less stiff, your pelvic core (which works with your respiratory diaphragm) will respond better, you’ll feel less bloated, your digestion will improve, you’ll feel taller and stronger and so on.
That is just the beginning stages of preventing (or healing) a DRA. The more you can learn and support your body through the changes that take place the better chance you have of setting yourself up for a thriving pregnancy, birth, postpartum and life.
*This is not medical treatment and you should seek medical care if you believe you have a DRA