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Diastasis Recti

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Introduction

Diastasis Recti (DR) is a widening of the Recuts Abdominis muscle. The abdominal wall has four layers of muscle, from superficial to deep: Rectus Abdominis, External Oblique, Internal Oblique and, the deepest layer, the Transversus Abdominis. The abdominal muscles in most cases, are still connected by the thin sheath of tissue called the Linea Alba.

 

Signs & Symptoms

DR can be identified by checking the abdominal muscles but also if you see a doming when performing tasks which place pressure on the abdominal muscles, i.e: getting in and out of bed, standing up from sitting in a chair. This is not dangerous however adding strain to this area is not ideal. Lie on your back on the floor and bend your knees. Then, place your fingers together on the centre of your stomach (just above your belly button). Press down with your fingertips and then lift your head and neck off the floor leaving your shoulders down. Feel with your fingertips to see if there is a gap between the muscles on contraction. This can be repeated below the belly button also.

 

DR can have a number of implications which effect the stability of the trunk and may contribute to pelvic floor dysfunction for males or females (66% of patients with DR have reported to have pelvic floor dysfunction), back and pelvic girdle pain, and hernias. This may be a factor in persistent postnatal lumbar, Pubic Symphysis and Sacroiliac pain, and even incontinence, due to the interaction of the pelvic floor and abdominal musculature as a stabilising unit.

Prevalence

Diastasis Recti is very common after pregnancy, it is believed that 98-100% of woman experience some degree of a DR in the end stages of pregnancy (Lee, 2013). A large percent of these cases will be accompanied by a pelvic floor dysfunction. The pelvic floor muscles should not be ignored in this process, click here to find out how to activate your pelvic floor. DR is not limited to postpartum women; it is a condition also seen in men, athletes of both genders and children.

Causes

Diastasis Recti is common during pregnancy or with consistent, inappropriate strain on the abdominals. This tissue can become over stretched and lose tension, leading to a widening of the Rectus Abdominis – rarely does the Linea Alba completely separate.

Assessment & Diagnosis

You can seek advice from a Physiotherapist for DR if the separation is significant – more than 4 fingers, or if you have any pain, it would be wise to seek advice with a First Contact Practitioner at your surgery, GP or Physiotherapist to discuss management. An accurate diagnosis will ensure the most effective treatment and management can be implemented. Your Physiotherapist can work with you to help achieve your goals and will offer ongoing support and input.

Self-Management

You Physiotherapist will explain the condition and will suggest useful strategies for adapting your technique during everyday tasks to avoid making your symptoms worse. This may include safe lifting techniques such as:

 

  • Bending your knees, keeping your back straight and always tighten your pelvic floor and abdominal muscles as above when lifting, do not hold your breath. Hold the object firmly and bring it in close to your body.
  • Avoid sudden and repetitive bending, and, twisting movements.
  • Make sure your working surfaces are at waist height (e.g. for bathing & changing the baby).
  • Create a supportive position for feeding. Place your bottom back in the chair, make sure your feet are flat on the floor and use support to help lift the baby up to your breast. feeding pillows etc.

 

Your Physiotherapist will also support you with your return to exercise and will educate you on how your activity can be progressively increased. Some useful tips include:

 

  • Start with gentle walking when your pain and discomfort allows.
  • Gradually increase your walking distance and speed (at your own pace).
  • A 30 minute walk each day has been shown to improve your general health and well-being.
  • Avoid other strenuous and high impact exercises during the first 12 weeks (such as weights, sit-ups or running, if you find your DR is still present seek advice from a physiotherapist before starting these.)
  • If your baby is more than three months old and you have urine leakage, you may need some further advice from a continence team or a GP, although common it is not normal and this it can be helped with correct management.

Physiotherapy

Surgical closure of a DR is not also an essential requirement to restore optimal function and performance. What appears to be essential is the ability to generate tension and minimize distortion between the left and right Rectus Abdominis and thus, fulfill the requirements for control and function of the trunk. Physiotherapists can help you with this and guide you through management.

 

 

Suggested Exercises 

You can try the following exercises to get going with management. However, if you feel any pain or increase in symptoms, seek advice from a Physiotherapist.

 

Exercise 1

This exercise is to activate the deep abdominal muscles and whilst not putting strain on the DR.

  1. Lie on your back with your knees bent and feet supported on the ground. Or sitting in a chair.
  2. Breathe in, then breathe out and as you do so gently tighten your lower abdominal muscles by pulling your lower belly in towards your spine (just below your belly button). Try to keep your upper abdominal muscles relaxed throughout the exercise. Try not to let you ribs stick out and don’t hold your breath.
  3. Hold for three to five seconds as you breathe normally.
  4. Repeat six to ten times, four times a day.

 

Exercise 2

Draw the pelvic floor muscle upwards and forwards – as if your reaching them to the tip of your chin. Imagine that you are trying to stop yourself from passing wind and urine at the same time. (do not attempt to stop yourself from passing urine when going to the toilet, as this can lead to urinary tract infections). Breath freely do not hold your breath or squeeze your buttocks or legs together.

 

How repeat exercise 1 with exercise 2

Hold your lower abdominals in and breath as above and recruit your pelvic floor muscles at the same time. This can be done throughout the day, when performing functional tasks, or just in sitting. Try and hold these muscles contracted for longer periods each day, it is important to practice pelvic floor squeezes and long holds.

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