What is Diastasis Recti Abdominis?
Diastasis means ‘separation’.
‘Rectus Abdominis’ are the muscles at the front of your belly, also known as the ‘six pack’ muscles.
‘Diastasis Recti’ simply means separation of the six pack muscles.
More specifically, this separation is a result of over-stretching the ‘linea alba’ fascia (tissues) that would usually hold the two rectus abdominis muscles together.
The muscles can separate above, below or just around the belly button, or throughout the length of the muscle. Due to these differences within the condition, one person’s diastasis recti may be manageable, while for someone else, it is highly problematic.
How does it happen?
The most common cause of this muscle separation is pregnancy. The body stretches to allow the baby to grow, and in doing so the linea alba stretches and the six pack muscles separate. For about 70% of women, the linea alba ‘bounces back’ as the uterus contracts after birth. For about 30% of women, the fascia never ‘bounce back’, but remain separated. For multiple births, as high as 60% of women remain with separated muscles a year after birth.
Pregnancy is not the only cause. Any major increase in abdominal pressure can cause stretching of the tissues. Men can suffer this condition. Women who have never been pregnant can suffer this condition. Risk factors include weight gain, diabetes and exercise, especially weight lifting. Finally, infants and children can also have separated abdominal muscles. In these cases it is usually something they are born with.
So what’s the problem?
For many people with this condition, there are no problems. The gap may be small. It may not cause them any pain. It may all be fine.
But there are many people for whom this condition is distressing and painful. Current research into the condition is limited, but complaints commonly associated with this condition are:
Back pain
Belly pain
Incontinence
Constipation
Pelvic pain
Low energy
Difficulty with day to day tasks, such as pushing a shopping trolley, participating in sports, or carrying children
Difficulty finding clothes that fit, or struggling to move on from maternity wear
Pain when wearing waistbands or constrictions around the waist
Aesthetics of suddenly having a round belly and no waist.
Deterioration of mental health due to limitations on activity and/or frequent or constant pain.
Will losing weight help reduce my diastasis?
Yes and no.
Your abdomen skin, fat and fascial tissue act as a ‘hold all’ or bag for your internal organs. The fascia encase the muscles holding them in the right place and allowing them to function efficiently and together.
Imagine your torso like a hold-all bag with a zip along the top. In Diastasis Recti, the zip is coming undone to some degree. Yes, taking stuff out of the bag (losing weight) will help to some degree by taking the pressure off the dodgy zip. But once the elastic limit of the fascia has been reached, the bag (skin and fascia) is still going to flop a bit, even if the bag is empty.
When the abdomen stretches, whether through pregnancy, weight gain or mis-aligned sporting activity, it is the fascia that provides the elasticity to allow this stretch. Like a balloon, the fascia tolerates a certain amount of stretch while still being able to regain its previous form. Again, like a balloon, the larger the stretch and the longer the stretch is maintained the less able the fascia is to recover from, to ‘bounce back’. Once it is stretched beyond recovery, the fascia has the texture and elasticity of a deflating balloon.
So what about exercise with diastasis recti?
Unfortunately, exercise can be both good and bad for those with diastasis recti. There are some, specific, exercises and programs that can help engage your whole suite of core muscles and build co-ordination and strength. However, exercises that put additional load on the core can aggravate the condition and further stretch the linea alba.
When a diastasis recti specific exercise program is diligently followed, the gap between the muscles can reduce. The better alignment of the muscles will improve core function and stability. For many, this is an effective way of regaining core function. Results will depend on the severity of the condition, the knowledge of your physio, and the suitability of the exercises for your specific situation.
It is also worth bearing in mind that until the body can bring the two rectus muscles close enough for long enough to knit them back together, the benefits of the exercise will last only as long as the diastasis specific exercise regime is followed. There will be more information on which exercises help and which exercise harm in treatment options.
Excercise is good for muscles though?
The separation is not only a muscle problem. The fascia and ligaments of the abdomen provide 'passive’ support to all the muscles and internal organs in the belly. Without a tight ‘corset’ of fascia, due to stretching of the linea alba, the muscles of the abdomen and back must ‘actively’ support the core, and bear the weight of the rib cage and head.
Think about a cylinder.
The abdomen is essentially a cylinder. The internal pressure of organs, intestines, muscles and fat are all held in place by the fascia and then the skin. An intact cylinder is extremely strong. We use cylinders, in the form of columns, to hold up buildings. We use cylinders to transport liquids. But when a weakness is found in a cylinder, all the pressure that was evenly spread across it, starts to converge at the weak point.
If you take a sheet of paper or thin card and try to stand it up and balance a weight on the top, it is impossible. It keeps falling over. But put an elastic band around it, and it holds it’s shape in a cylinder. A solid, balanced, stable cylinder that will support weight. It is the same card. It is only its shape that has strengthened and stabilised it.
Due to the tightness of the band, all the internal pressure is contained and the insides stay inside.
However, when the band supporting the shape is weaker, or stretched, the whole cylinder becomes weaker. It begins to bulge. This loosening of the belly fascia means that the shape of the abdomen bows outwards, creating the round belly that is indicative of the condition.
Because of the loosening of the fascia, the ability of the abdominal wall to retain all its internal organs inside is weakened. As the body moves, the muscles move. The wall moves. Fat and intestines can work their way between the rectus abdominis (six pack) muscles.
At this point, engaging the muscles or wearing slightly constricting clothing can squeeze on those parts that are caught between the muscles.
If there is a hole in the fascia, then fat and intestines can be caught in the hole. These are known as umbilical and epigastric hernias. These can occur in narrow gaps or in wider gaps.
Even without a hole in the tissues, the intestines can still bulge outwards between the muscles, potentially being trapped during movements, but they are able to retreat back inside when lying on your back.
Where the muscles are very wide, there is almost no passive support for the head and rib cage. The fascia remains in a state of constant stretch. The body is not passively stable. The only way to maintain the upright position is for the other core muscles to engage and to continuously compensate and balance the body.
Some internal processes depend on pressure, such as bowel and bladder function. A reduction in the internal pressure, due to the extra flex in the abdominal wall, may contribute to improper function of these processes.
