Do you have diastasis recti?

Becky Dickinson examines diastasis recti – a condition which affects countless numbers of new mothers, yet many have never even heard of it

For most women, pregnancy is not without a degree of collateral damage. Few of us are lucky enough to escape completely unscathed. I remember my midwife blithely remarking, a few days post-partum, that I may never return to my ‘former svelte self’. She was right, of course.

But while a few stretch marks are a small price to pay for a healthy baby, for many mums the physical legacy runs much more than skin deep. Around two thirds of women are left with a condition called diastasis recti, or DR. This is where the muscles of the abdominal wall, the rectus abdominis, or ‘six pack’ muscles, separate during pregnancy and fail to knit back together afterwards, leaving a gap down the centre of the abdomen. It can affect anyone, but is more common in women who have had previous pregnancies as the muscles have already been weakened. It’s also more likely to affect petite women, or those carrying multiples, as the bigger the bump, the greater the strain on the abdominal muscles.

As GP Dr Rupert Critchley explains, DR is often unavoidable: “As the body prepares for the expanding uterus, hormones thin the connecting tissue between the right and left abdominal wall muscles. This is part of the body’s preparations for giving birth.”

While it’s natural for most women to have some DR during pregnancy, problems can arise if the gap fails to resolve itself within a few months after giving birth. As well as leaving an unsightly bulge, the condition can also cause back pain, constipation, stress incontinence and in extreme cases, a hernia, where organs bulge through the torn abdominal wall.

Despite its prevalence, scores of women have never heard of DR. Even more worryingly, most women aren’t checked for the condition at their routine postnatal appointments.

However, it is possible to check for the condition yourself. Simply lie on your back with your legs bent and your feet flat on the floor. Place one hand behind your head, and the other hand on your abdomen, with your fingers (palm down) just above your belly button. Raise your head and neck off the floor very slightly, rolling your upper body into a ‘crunch’ and press down with your fingertips. If you can feel a gap that is wider than two finger widths you may have a muscle separation.Repeat the test a couple of inches above and below the belly button.

So what happens if you do have a gap? The first thing is not to panic. And the second is to resist heading straight back to the gym. In fact, Caroline Bragg, head PT with postnatal retreat group &Breathe, says jumping straight back into exercise is the worst thing you can do.

“If these muscles are worked before the gap has healed, this is when a permanent bulge might occur as your muscles can’t retake the shape they had pre-pregnancy,” she says.

Instead, you need to focus on rebuilding your core and pelvic floor: “With a deep or large gap, it’s unsafe to return to high-impact exercise such as running. Avoid anything in forward flexion – this means sit-ups and crunches, as well as things like sitting up in bed (roll to one side to get up instead) and bending to tie shoe laces (elevate your foot). Even if you had an emergency c-section, you probably did a lot of pushing before surgery, and with a planned c-section you still carried the weight of a baby for months,” she adds. “Taking the time to rehab your core means you will have a much better recovery and can get back to your exercise regime with full efficiency.”

Gentle pilates and targeted exercises can help, however, it’s vital to find an instructor who specialises in postnatal fitness. Personal trainer Claire Gregory developed DR herself following the birth of her second child four years ago, and was shocked at the number of mum-and-baby bootcamps on offer. She says: “New mums are a vulnerable group, and exercise can do a lot of damage if you’re not doing the right thing. I felt there was nowhere safe to go.”

Claire is now on the committee of The Guild of Pregnancy and Postnatal Exercise Instructors. Like Caroline, she’s passionate about raising awareness of DR. And while it is incredibly common, the good news is, for the vast majority of women, the condition can be improved with the correct exercises. Only in extreme cases will surgery be needed to reconnect the muscles.

Think you have DR?
If so, it’s best to consult a professional first. Once you’ve been given the go ahead, here are some basic exercises to try at home.

Diaphragmatic Breathing
“Diaphragmatic breathing is key as it works with your pelvic floor and core,” says Caroline. Lie on your back, with your hands on top of your lower ribcage and inhale. Feel the diaphragm make the lower ribs expand into your hands. As you exhale, focus on contracting your diaphragm.

Single Leg Heel Slides
Lie on your back, knees bent and feet flat on the floor. Keep your arms by your sides. Engage your pelvic floor muscles (as if stopping the flow of urine). Keeping your pelvis and spine neutral, exhale to slowly extend one leg out, keeping the heel on the ground. Inhale to slowly slide the leg back in. Repeat on the other side.

Tabletop Toe Taps
Lie flat on your back and lift both legs to a tabletop position, with your knees directly over hips. Without letting your lower back lift off the ground, slowly lower one leg to the floor keeping the same tabletop shape. Keep pulling your navel into your spine as you exhale. When your toes touch the ground, inhale and lift your leg back up to the original position. Repeat with other leg.

Want more? How to keep up your pelvic floor fitness