Let’s talk about diastasis rectus abdominus or DRA. This occurs in almost 100% of all pregnancies during the third trimester. It happens as the linea alba, a line of connective tissue that lies between the two rectus abdominus muscles is stretched. For about 60% of women, the DRA will close within the first 3 months after delivery. For the other 40% of women, it may not naturally close, and they may need some muscle training to improve the function of the abdominal wall. If the DRA is not resolved within the first 3 months, it often will not improve on its own.
A DRA is not a hole or a hernia. It is the change in the pull of the abdominal wall muscles across the linea alba. If a DRA continues after the fourth trimester, you might notice a valley or a bulge that lays just above or below your belly button. If you push along that line, you may notice that the tissue feels soft or that you can push into the tissue differently than you can other places on your stomach. To check for yourself, lay on the floor and bend your knees. Lift your head up like a you are doing a crunch. Then feel along that line above and below your belly button. Is it soft? Do you feel like you can sink into that tissue? Or do you feel like there is a lot of pressure pushing your fingers away? Those can be signs of a DRA.
The weakness in the tissue of the linea alba creates a difficulty transferring load from one side of your body to the other. Think about a hole in the side of a pop can. It is difficult to hold pressure with a hole. It is the same with our core system. We have to maintain pressure in the abdominal cavity to provide stability. If we cannot create tension across the linea alba due to a DRA, it is hard to activate our deep core or pelvic floor. We lose stability in he trunk and pelvis, and daily tasks become difficult. Women with DRA have a higher risk of leaking urine or having a prolapse due to the difficulty to activate our deep core and transfer load from one side of the body to the other.
Pelvic floor physical therapy plays a huge role in the treatment of DRA. We will look at the whole abdominal wall, spine, hips and pelvic floor and see where the system is breaking down. A pelvic floor PT with teach you how to improve activation across the linea alba to improve your pressure control and stability. Every patient is different.. Sometimes this involves getting the deep core to turn on symmetrically. It can mean improving your pelvic floor activity. It is common that we have to improve your ability coordinate the deep core with the pelvic floor and diaphragm.
If you are struggling to get your deep core to turn on after baby and you feel like you have a DRA, please reach out to a pelvic floor PT. We can help you return to exercise safely, improve your abdominal strength and function and prevent or stop urine leakage or pelvic organ prolapse. We offer a free 15 minute consultation to answer any questions you may have about how we can help!