There is a silent epidemic hitting postpartum women all over the U.S. It’s called Diastasis Recti, a condition where the front surface muscles of your belly seperate. I called upon renowned expert Melissa McElroy, PT, DPT, a trained Physcial Therapist from Bellarmine University who specializes in Women’s Health and Male/Female Pelvic Dysfunction to fill us in on how to prevent a Diastasis Recti, how to tell if you have it, and what to do if you suspect it.
So what exactly is Diastasis Recti and what causes it?
Diastasis Recti (DR) is a separation of the rectus abdominis muscle (think 6-pack muscle) midline down your abdomen, causing stretching and compromise to the connective tissue surrounding it. In general, this stretch and separation is caused by continuous or chronic repetitive pressure or force on the structures/ increased tension on the abdominal wall. This occurs in pregnancy, with increased incidence into the 3rd trimester when prolonged forces against the abdomen are greater.
What problems can occur if left untreated?
One of the primary functions of the rectus abdominis muscle and its associated connective tissue is support and compression of the abdominal organs as well as counter-balancing the muscles of the back. If left untreated, a DR can lead to chronic low back pain, pelvic organ prolapse (bladder falling, uterus falling), incontinence and hernias, as well as pelvic instability and increased incidence of pain with subsequent pregnancies.
How often do you see it in your practice and why do you think it has become so common?
Almost everyone who comes into our clinic (male or female) is tested for a DR because it is extremely common. I don’t think that there is necessarily an increased incidence of DR compared to 5/10/20 years ago, but I do think that it’s finally being given the attention that it desperately deserves.
So you are saying it has always been an issue for women, but that we have lagged in addressing it postpartum?
Yes. This is one reason why I’m seeing women who’s children are older/grown who come in due to prolapse issues; because their DR was never properly addressed.
Why is there such a massive gap in screening for it postpartum?
I feel that post-partum care as a whole is lacking in the US. As a society (medical and otherwise) we shift our focus to baby as soon as he/she arrives, often forgetting that the mother’s body went through a wonderful but traumatic event to bring baby into the world.
How do you know if you have it?
There is a simple test that can be easily performed at home. It can be done on your own, but it’s highly recommended that you have a friend or significant other perform the testing instead.
The patient lies on her back with knees bent and feet resting on the ground. The tester (friend/family member) places his/her fingertips into the belly button with their hand perpendicular to the abdomen. Then the patient is asked to raise her head off the ground while reaching with her hands towards her toes. A measurement is given based on how many fingers fit between the ridges that the abdomen makes when the patient raises her head. The test should be repeated above and below the belly button as well.
A positive DR is a measurement more than one fingertip’s width. Research is varying when determining how many finger widths should be considered “significant”. My thought is, if you’re worried enough to be testing yourself then you may just want to get things checked out by a professional.
If a woman suspects it, what should her next step be?
First and foremost, DO NOT TRY TO DO CRUNCHES. This will NOT, I repeat, will NOT help. It will most likely make it worse. If you suspect that you have a DR then find a physical therapist that treats it and go in for an evaluation.
What are some of the things that a woman should do, or more importantly, should NOT do, day to day?
Like I said before, your typical ab exercises (crunches, sit-ups, leg raises) could make your DR worse, so please don’t do them! (Obviously, if you are under the care of a licensed medical provider who is familiar and experienced treating DR and they have you performing a plank or leg lifts then maybe you’ve advanced to where its appropriate. For most of us, however, just stay away). Other day-to-day activities that you should be paying attention to are getting in and out of bed, getting in and out of a car, throwing laundry in the dryer, lifting the kids, lifting anything with weight to it. No forceful bending, raising up (like out of a recliner) or rotation. The general rule of thumb is, if your belly bulges when performing the activity then it needs to be stopped or modified so that there is no belly bulge with activity.
Is there anything a woman can do to prevent DR while she is pregnant?
Gernerally, the better core control/core strength you have prior to pregnancy and the more you work your core muscles (with appropriate exercise) during pregnancy the better off you will be. Does this mean that if you have a 6-pack before pregnancy that you won’t develop a DR? NO. Does this mean that you won’t get a DR if you work out daily during your pregnancy? Sorry, No. But you will be more apt to better rehab and recovery.
Is there an online resource a woman can use to locate therapists who specialize in treating Diastasis Recti in her area?
The American Physical Therapy Association’s Website: www.apta.org has a “Find a PT” page that you could search for a PT who specializes in Women’s Health. That would be my first recommendation. However, there are a lot of PTs who aren’t listed in that database, so my next recommendation would be to talk with your OB/Gyn or local general PT to see if there is anyone that he/she recommends.
Thank you so much for sharing your wisdom with us Melissa! If you are in the Louisville, KY area and would like to make an appointment with Melissa you can find her at Dunn Physical Therapy.
For more information and some visuals on how to test and what it looks like check out: www.Fit2B.com.
So ladies lets spread the awareness! Post this to your FB page through the link below and make sure all your girlfriends read it!
I want to know from you! Had you heard of DR before and did your ob or midwife check you for it postpartum?
Hugs and kisses to you all!