Diastasis Recti Abdominis (DRA)

During pregnancy, abdominal muscles stretch to allow the baby room to grow ⁽¹²⁾. Diastasis recti is a condition in which the abdominal muscles overstretch causing a separation in the rectus abdominus (the 6-pack muscles) which are connected by the linea alba (a thin connective tissue) ⁽¹²⁾. Commonly separation occurs at the belly button region but it can be anywhere between the xyphoid process (bottom of chest plate) to the pubic bone ⁽¹⁰⁾. Usually, there is no pain present in the abdominals. However, as a result, women often report weakness, a mound or ‘flabbiness’ in the affected area ⁽¹¹⁾. Secondary problems can arise such as the low back, hip and pelvic pain ⁽¹⁰⁾. Sometimes the condition is referred to as DRAM (divarication of rectus abdominis muscle).

It can also occur in males with links to increasing age, activities and genetic factors. In infants or newborns, it can be inherited or due to the under-development of the muscles in babies born prematurely ⁽¹⁾.

In the past, it was thought that body mass index (BMI), weight gain during pregnancy, the weight of the baby and maternal age were considered risk factors. However, a recent study in 2015, found no significant correlation between these factors and developing the condition ⁽¹⁾.

During pregnancy, diastasis recti usually resolves spontaneously but can persist postpartum, in some cases for 6 months. In some case where the separation has been significant (6 fingers and above), it may take slightly longer. Assistance with physiotherapy exercises can aid the recovery of the abdominal muscles ⁽¹⁰⁾.

Diastasis recti is a very common condition following pregnancy. It has been reported to affect between 27%-100% in late pregnancy and 30%-60% of women postpartum ⁽⁸⁾. Another study has estimated that it occurs in 52% of first pregnancies at 4-6 weeks postpartum and 39% at 6 months ⁽¹⁾. Umbilical hernias are less common and it has been found that the incidence is less than 0.1% in pregnant women ⁽⁹⁾.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate accurate diagnosis.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment.

Real-time ultrasound imaging can be an accurate way of measuring the gap between abdominal muscles. However, often a healthcare professional can conduct reliable tests in the clinic without the need for a scan ⁽⁷⁾. Diastasis recti is likely to be confirmed if there is evidence of the following:

• A palpable gap of more than two and a half finger-widths when performing a curl up.
• Gapping that does not shrink as abdominals are tightened by the patient.
• Presence of a small protruding mound at the midline.
• On lying, a dip in the abdominals/or doming on exertion/stress of the abdominals.

As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your diastasis recti. This will include activity modification strategies, as well as other useful treatments aimed at reducing complications. Regular adherence to a condition-specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix, but if adhered to on a consistent basis, weeks to months, over time they have been shown to yield positive outcomes ⁽¹⁰⁾.

How to check your ‘DRAM’

Lying on your back with knees bent, relax and place a hand above your belly button, fingers straight pointing towards your stomach. Slow curl your head and shoulders up. See how many tips you can fit between your rectus abdominal muscle; you should be able to feel the borders. If you are having difficulty, then draw in the lower tummy muscles first on lying before you curl up. If you are still having trouble, then you can contact a women’s health physiotherapist to help you.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments for associated complications to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment.

If conservative management of diastasis recti is not beneficial and there is a hernia present, surgery can be considered ⁽⁹⁾. There are two types of hernia surgery:

• Open hernia repair surgery – the hernia is repaired through a cut (incision) in the belly. Open surgery is safe and effective and has been done for many years.
• Laparoscopic hernia repair – a surgeon inserts a thin, lighted scope through a small incision in the belly.

Your post-pregnancy body – NHS (www.nhs.uk)

https://thepogp.co.uk/Resources/119/fit_for_the_future