Diastasis rectus abdominis (DRA) is a condition in which the 2 sides of the abdominal muscle separate, as the tissue connecting them stretches. This typically happens in women during and following pregnancy due to the stretching of the abdominal wall, as the uterus expands. Physical therapy has been shown to be a highly effective approach to both the prevention and treatment of diastasis rectus abdominis.
DRA is a common condition that affects many women during the childbearing years. As a fetus grows within the uterus, the uterus expands, which places stress across the structures surrounding it, specifically the muscles. The primary abdominal muscle on the front side of the body is called the rectus abdominis. This muscle is divided into a left and right half by a thick band of connective tissue called the linea alba. You may hear people talk about “6-pack abs”; this is referring to the rectus abdominis. As the uterus expands, stretching across the rectus abdominis potentially could occur. In some cases, the weakening and stretching of the linea alba connective tissue creates a separation between the right and left sides of the muscle, or diastasis.
DRA may affect women during and after pregnancy. Typically, DRA develops in the second or third trimester. It is during this time that the fetus is growing most rapidly and can result in the greatest increase in distance between the 2 sides of the muscle.
There are several factors that may make a woman more susceptible to developing DRA. These include age, being pregnant with multiple children (multiparity), and having many pregnancies. The abdominal muscles have many important functions within the body, including postural support, movement, breathing, and protection of the internal organs. Therefore, if their structure is affected by DRA, a woman may have difficulty controlling her posture, which may put her at an increased risk for injury. Additionally, for a woman juggling the many stresses of having a new baby, the discomfort, weakness, and changes to postural control that may result from DRA can negatively affect her quality of life.
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Symptoms of DRA typically develop gradually over the course of a woman’s pregnancy and may linger following labor and delivery. Separated abdominal muscles themselves are not always painful, but the effects of DRA can cause pain.
A woman with DRA may experience any number of the following symptoms:
• A visible and palpable (detected by touch) separation of the rectus abdominis muscle.
• Feelings of “flabbiness” in the abdominal muscles.
• Pelvic-floor muscle dysfunction that causes urinary or bowel problems (incontinence, leakage, constipation, etc).
• Low back or pelvic or hip pain.
• Poor posture.
• Feeling weak through the midsection.
• Sexual pain.
Following a cesarean section (C-section), scarring of the incision may accentuate the symptoms associated with DRA.
Your physical therapist will review your medical history and conduct a thorough interview about your condition. This may include specific questions regarding your pregnancy, labor and delivery, type of delivery (C-section or vaginal), presence of pelvic pain, and information related to your physical recovery, including your breastfeeding habits. Your physical therapist will also ask you when your symptoms began, and how they are impacting your daily life.
The primary diagnostic test for DRA is to perform a gentle abdominal examination to note the degree of separation of the abdominal muscle. Your physical therapist will also assess factors, such as your posture, back, and hip movement (range of motion), and muscle strength.
Physical therapy is a very effective way to manage symptoms and improve functional capacity when DRA is diagnosed. Your physical therapist may help you with:
Postural Training- Improving postural control is one of the most important components of treatment for women who are dealing with DRA. Your physical therapist will help you learn how to stabilize your core, without overuse of the rectus abdominis muscle. This will involve training your other core muscles, such as your transverse abdominis (a deep abdominal muscle), and your pelvic floor muscles. Your physical therapist will show you how to perform daily activities, such as lifting and carrying your baby, while using proper posture.
Stretching- When certain muscles become weak and overstretched, other muscles may become overactive and tight. Your physical therapist will help you learn which of your muscles needs to be gently stretched to improve your strength and posture.
Bracing- Sometimes taping or bracing of the low back and abdominal region can provide soothing external support for women with DRA in the early phases of rehabilitation. It can also help teach you the proper position for your midsection, as it provides support and decreases any pain you may be feeling.
Education- There are factors that you may not even know about relating to your pain or movement challenges that your physical therapist can help resolve. Your physical therapist can help you understand the movements or activities that are best to avoid, as you recover from DRA. (For example, women suffering from DRA should not perform traditional sit-ups or crunches.) Your physical therapist will be able to teach you safe and effective ways to regain your full function.