Diastasis Rectus Abdominus (DRA)/Abdominal Separation
Victoria Women’s Health Physiotherapists Holly Mallari, Shannon Huff & Leah Taylor can help treat this medical condition. Abdominal separation or diastasis rectus abdominus (DRA) is the widening of the gap of the linea alba (the connective tissue) between the right and left rectus abdominus. DRA is a very common condition that many women don’t even know they have. It is not often brought up in prenatal education and is often missed in many pre or postpartum exercises classes. Some research states that 100% of women in pregnancy have some degree of separation1. Another body of research reported that 36% of women continue to have a separation at 5-7 weeks post-delivery2. Research also shows that left untreated, the gap at 8-weeks remains unchanged at 1-year postpartum3. Physiotherapy by a Pelvic Floor Physiotherapist can help alleviate these concerns.
It has also been shown that 66% of women with DRA also have some level of pelvic floor dysfunction4 (e.g. bladder or bowel control problems and/or pelvic organ prolapse). Improper training in attempting to correct the DRA can worsen the pelvic floor dysfunction, not to mention worsen the existing separation.
Even if women or men know they have a DRA, advice on how to resolve the separation varies dramatically. Promises of closing the gap and resolving the diastasis are often given. Unfortunately, these promises rarely deliver – there is often a degree of irreversible connective tissue stretch that does not completely recover. Abdominoplasty, or a Tummy Tuck, is a surgical procedure that closes the connective tissue component of DRA completely. This procedure is major surgery, and is not covered by basic health care. Does that mean that you cannot reduce the gap between the recti with exercise? No, often you can with proper training. You can also improve the tensile strength of this connective tissue, and the tone and strength of the deep abdominals (transversus abdominus). This improves the support and appearance of your abdominal wall as well as provide stability for your back and pelvis.
There is often an emotional component to the DRA for the postpartum mother. With more slack to the abdominal wall, the abdominal organs are not held in as well and protrude outwards when sitting or standing. This tends to get worse as the day progresses and the deep abdominals fatigue. A woman with DRA is often asked if she is pregnant, and this can be understandably upsetting to her. Expectations of our society to rebound right back to the pre-pregnancy state are everywhere – in the media as well as our own pre-conceived notions. Marketed programs for DRA promising to “close the gap” do not help the pressure either.
This video will show you how to check and measure for DRA. https://www.youtube.com/watch?v=PvybTZiLqRE
Proper training of the abdominals is necessary. There are many products and exercise regimens aimed at treating DRA on the market. But here is the thing: everyone’s body is different. The degree of the separation; the awareness and control of the deep abdominal muscles; the strength and endurance of the abdominal muscles; the existence of co-existing pelvic floor dysfunction – all of these is different from person to person. It is unrealistic to paint everyone with a DRA with the same brush. Treatment needs to be individualized.
I can show you how to find your deep abdominals (I promise, they are there!), and confirm this with Real-Time Ultrasound. I will also check to see if there is appropriate co-contraction of the deep abdominals with the pelvic floor, and vice versa. I will show you appropriate abdominal exercises, and show you a hard and fast rule to tell if an abdominal exercise is safe for you.
Treatment of DRA can begin during pregnancy, or in the postpartum period. It can be helpful to learn how to control your deep abdominals properly in pregnancy to prevent worsening the DRA more than it needs to for the pregnancy itself. Proper training may also maintain or improve deep abdominal support for the pelvis and back during pregnancy.
References
1 Gilleard and Brown (1996), Diane Lee (2013)
2 Boissonnault & Blaschak (1988)
DRA Research Articles
Physiotherapy. 2014 Dec;100(4):344-8. doi: 10.1016/j.physio.2013.11.006. Epub 2014 Jan 18.PMID: 24559692
Effects of specific exercise instructions on abdominal muscle activity during trunk curl exercises.
Stability, continence and breathing: the role of fascia following pregnancy and delivery.
[What is the best exercise for rehabilitation of abdominal diastasis rehabilitation?].
Rehabilitacion (Madr). 2019 Jul-Sep;53(3):198-210. doi: 10.1016/j.rh.2018.12.004. Epub 2019 Apr 11.PMID: 31370947 Review. Spanish.