Diastasis of the rectus abdominis muscles

If you still look like you were pregnant after giving birth, you may have diastasis recti, a condition in which the rectus abdominis muscles are spread farther apart than normal to the point that the abdomen continues to appear lumpy. Let’s see better what it is:

1. diastasis, in medicine is the removal of body parts that are normally in contact;
2. the rectus abdominis muscle, or simply the rectus abdominis, is an even muscle (i.e. present on the 2 sides of the body) that extends vertically in the center of the abdomen.

Abdominal diastasis, also called rectus abdominis diastasis , affects precisely the rectus abdominis muscle (commonly, just the rectus abdominis) formed by the right and left rectus abdominis separated by a connective tissue about 1 centimeter wide: the so-called “linea alba”.

When the right rectus abdominis separates from the left rectus abdominis, diastasis occurs.

How distasis is formed

The abdominal wall is made up of a set of supportive and ligament connective tissues, formed by collagen fibers that surround the rectus abdominis and fuse in the midline. These connective tissues form a particularly robust and poorly vascularised structure: the linea alba.

In order to make room for the growing baby, pregnancy hormones lead to a decrease in the tension of these fibers and to a lengthening of the abdominal muscles of the pregnant woman.

When the connective tissue between the right and left fascia of the rectus abdominis (the linea alba) has a separation greater than 2.5 centimeters, it is in the presence of abdominal diastasis.

Since this line (alba) extends from the bottom of the sternum to the top of the pubic bone, diastasis recti can occur in the midline from top to bottom anywhere. Three out of ten women will be affected by a mild form of diastasis recti after their first pregnancy.

The chances of diastasis recti in pregnancy tend to increase,

• more or less proportional to the woman’s weight gain;
• in the case of twin pregnancies
• in the case of a fetus with a heavy weight;
• after multiple pregnancies (including in terms of their severity). 

However, diastasis rectus abdominis is not only linked to pregnancy. It can affect everyone, including babies and men. In some cases, it may be due to lifting excessive weights incorrectly, or performing inappropriate or too intense abdominal exercises.

Symptoms and diagnoses

The most common symptom of a rectus abdominis diastasis is a bulge in the stomach: it is especially noticeable when the abdominal muscles are strained or contracted.

Its other symptoms may consist of :

• from lumbar pain (sciatica or low back pain),
• from being forced to hold incorrect postures,
• from constipation (constipation) and nausea,
• from abdominal swelling.

your symptoms during pregnancy

In early pregnancy, when the abdominal muscles are separating, there may not be any obvious symptoms. During the second or third trimester, you may see a bulge or ridge developing on your belly.

This rectus abdominis diastasis is evident in 66% of women, can appear above and below the navel, and may be more evident when the woman is trying to stand, sit, or lie down.

If you experience severe abdominal, back or pelvic pain, see your doctor immediately.

her symptoms and diagnoses in the postpartum period

The collagen fibers normally regain their tensile strength after delivery, and the diastasis resolves spontaneously.

Sometimes however, due to prolonged stretching or due to a tear in the fibers, the binding tissue fails to fully recover and the two halves of the abdominal wall remain separate.

In 30-60% of women, diastasis persists even after childbirth: the most evident symptom is a swelling in the belly area, so even if they are no longer pregnant, they could appear pregnant.

Self-diagnosis . As for self-diagnosing this postpartum condition, here’s how you can detect the existence of any diastasis rectus abdominis.

1. Lie on your back, legs bent, feet flat on the floor.
2. Raise your shoulders slightly off the floor, supporting your head with one hand and looking down at your belly.
3. Move your other hand above and below your belly button and along your midline abdominal muscles. See if you can fit your fingers into the spaces between the muscles.
4. If you feel a gap or separation of a finger length or two, you probably have moderate diastasis rectus abdominis.
5. A few weeks after giving birth, the gap will begin to narrow as the muscles regain strength.

Precise diagnosis . To get a precise diagnosis, contact a doctor who can prescribe you an ultrasound, a CT scan or an electromagnetic resonance.

• An ultrasound scan is useful to highlight the existence (if any) of midline distension, and if this is greater than 2 cm.
• A CAT or an MRI: these are two techniques capable of generating much more precise and detailed images than an ultrasound, but they also have some more contraindications.

What are the causes of a diastasis

It is usually excessive internal-abdominal pressure that causes a diastasis. Pressure that can occur both during pregnancy and during childbirth.

• During pregnancy: the uterus is in an expanding phase due to the growth of the fetus, and the abdominal muscles and connective tissues relax due to the activity of pregnancy hormones (which relax the muscles themselves).
• During childbirth:  this bundle of abdominal muscles is put under strain (during the thrusts of childbirth) or is weakened (for example due to an episiotomy, the cutting of the perineum during childbirth).

In the past, the body mass index (BMI), weight gain during pregnancy, the weight of the child and the maternal age were considered risk factors: however, according to a 2015 study, these are not  connectable  , and each woman is more or less likely to experience this condition during pregnancy.

Sometimes newborns , especially premature ones, are born with a diastasis. This is because their abdominal muscles are not fully developed and connected. This condition usually corrects itself over time.

The risk factors

A physiological diastasis during the third trimester is completely normal. However, there are a number of factors that could increase the chance of a diastasis with a reduced rate of recovery of fitness after childbirth :

• the fact of being in the second or third pregnancy;
• a previous caesarean section
• a prolonged increase in abdominal pressure due, for example, to a shallow way of breathing;
• being pregnant with twins
• the fact that you are expecting an excessively large baby, or that you have a lot of amniotic fluid
• the fact of having an incorrect load on the linea alba during pregnancy which increases the extent of effort;

• a constipation;
• during or after pregnancy, excessive physical activity (strength) is capable of producing an increase in tension on the linea alba;
• those diseases that cause intense retching;
• a chronic cough.

How can it be treated

Most pregnant women have some abdominal separation. The distance between the right and left rectus abdominis less than 2 cm. is considered physiological.

Rectus abdominis diastasis can weaken the coxo-lumbo-pelvic (core) muscle complex and lead to back pain or pelvic pain. It may therefore be necessary to wear a binder or tubigrip during the day, a functional bandage to support tendons, muscles and ligaments.

things to watch out for

During her pregnancy, a woman should take the following precautions:

• avoid heavy lifting or straining the abdominal muscles until after delivery;
• try to maintain correct posture;
• when sitting, try to support her lower back with a towel or pillow placed behind you;
• when getting in or out of bed or when getting off the floor, bend your knees, roll over and support yourself with your arm.
• All of this could decrease the risk of non-physiological rectus abdominis diastasis.

things you can do

During pregnancy, the woman should continue to strengthen her coxo-lumbo-pelvic muscle complex through suitable and “safe” exercises during this period.

After giving birth , diastasis recti can “correct” itself in some women when their abdominal muscles regain strength: in the event that eight weeks after giving birth a woman still experiences symptoms or a separation, some can help. (special) physical exercises.

• You can do these exercises at home or under the supervision of a physical therapist or postpartum fitness specialist.
• Postpartum treatments for diastasis recti usually involve exercises for the pelvic floor (a set of muscles, bands, and ligaments in the lower abdomen) and the deep stomach muscles.

things to avoid

It is good to avoid doing the following physical exercises which can worsen this condition.

• the abdominal crunch
• il crossover/bicycle crunches
• the standard situps
• i double leg raises
• push-ups on the arms
• he plans
• swimming
• golf
• he tennis.

You should also avoid

• to do any intense exercise that works the abs;
• to hold the child on its side, if this causes pain;
• to lift or carry heavy loads;
• to cough without supporting the abdominal muscles.

Its possible complications

Diastasis can lead to the following complications :

• an impairment of the stability and mobility of the trunk
• backache,
• pelvic pain,
• a worsening of your posture,
• pelvic floor dysfunction,
• a hernia, in extreme cases.

The treatments

A conservative path is possible through a physiotherapeutic or surgical approach.