Diastasis Recti 101: Understanding & Correcting A Common Pregnancy Issue
By Meagan - May 27, 2014
Guest Post by Kelly of The Tummy Team Diastasis Recti is an extremely common and nearly completely undiagnosed medical condition affecting over 80% of women who have given birth as well as millions of men, children and women who have never had a baby. Diastasis Recti is simply the separation (overstretching) of the connective tissue that holds the abdominal wall together in the center of your stomach. If it is assessed at all, it is commonly misdiagnosed as an umbilical or ventral hernia. The main difference is a hernia is an actual tear in the tissue and the diastasis is a mild to severe overstretching of this tissue. Understanding the anatomy of the abdominal wall helps better visualize this condition and comprehend why it must no longer be ignored. Our abdominal wall consists of 3 layers of muscle all attached in the center of the tummy to preferably a thick strip of connective tissue called the Linea Albea. The outermost layer is the Rectus Abdominis (the crunch muscle, six pack, etc.) and is the most superficial, running essentially from the sternum to the pubic bone and connecting to the Linea Albea. The middle layer is formed by the Obliques (the twisting muscles) which connect diagonally from the ribs to the Linea Albea in the center of the tummy and from the Linea Albea to the pelvis. Then there is the highly ignored and essential innermost layer, your Transverse Abdominis. This corset like muscle (or “God given girdle”) wraps around the entire torso beginning along the sides of your spine, running around the love handle area and attaching to the lower 6 ribs all the way down to the pelvis and pubic bone. This muscle also attaches at the center to the Linea Albea. All three layers of the abdominals connect in the middle of your belly to a line of fascia/connective tissue called the Linea Albea. The abdominals are the only muscles in the body that have connective tissue right in the middle of the muscle. This connective tissue is part of a perfect design; it is not there by accident. However, the connective tissue responds differently than muscle and it can stretch some to allow room for a growing uterus. With a diasatasis the connective tissue has stretched excessively. The excessive stretching seen in diastasis recti dramatically affects the integrity of the tissue. Since this tissue holds all 3 layers of the abdominal wall together, damage to this connective tissue decreases the effectiveness of the abdominal wall the hold the body together. Diastasis Recti is not only a medical diagnosis in itself, it also represents a much more significant issue. Diastasis Recti is most often a result of a very inactive and therefore weak internal (transverse) core. Due to the position and mass of the Transverse Abdominis, strength of this muscle can help protect the connective tissue by keeping the core pulled together. When this muscle is strong and active it acts to connect the pelvis to the rib cage, stabilize the entire body, support the spine and elongate the core. The daily functional use of this corset minimizes and can eliminate the excessive pressure that often is placed on the Linea Albea.
What is the cause Diastasis Recti?It is essentially a combination of an inactive internal core and chronic movement patterns that collapse, brace, bear down, bulge or flare the abdominal wall placing excessive, repetitive, forward, forceful pressure on the Linea Albea. The action of the internal corset muscle, the transverse, is to pull together, stabilize and elongate the torso. In the absence of that muscle, the body is force to stabilize with air pressure and postures that push out and pull apart the abdominal wall. Hormones during pregnancy increase laxity in the connective tissue and the growing uterus adds constant pressure out on that tissue adding another set of factors that can contribute to the connective tissue being vulnerable. Chronic bearing down due to constipation or when giving birth are additional contributing factors that push out on and cause damage to this connective tissue. Chronic, collapsed and rounded mothering postures (nursing, holding babies, changing diapers, reaching over cribs, tending to toddlers, etc) also contribute to a diastasis risk. Thus, we can clearly understand why we see some level of diastasis in >80% of moms. However, crunches, bracing, bearing down, disuse of the core muscles, collapsed sitting and standing postures can put anyone at risk of developing a diastasis.
So if it is so common, isn’t it normal?Well, if you have not heard common and normal are not the same things. Just because it is common for Americans to be about 30lbs overweight does not mean it is normal, healthy or without medical or physical consequence. Yes, the body was designed to allow for a small amount of stretching in the connective tissue and ligaments of the abdominal wall and pelvis to accommodate a baby and birth through the birth canal. But excessive stretching changes the integrity of the support system and causes numerous physical side effects. If the abdominal wall is separated and the core muscles are inactive or ineffective, the body essentially collapses into itself. Excessive pressure is put on the spine, the pelvis, the hips (the knees and feet for that matter), the intestinal tract and the muscles of the pelvic floor. The body cannot maintain an elongated, balanced, upright posture so the pelvis tilts, the gluts and hamstrings and hip flexors over fire, the upper back rounds and the shoulders, neck and mid back overcompensate- all in an attempt to stabilize, support and balance out the body. Diastasis Recti during pregnancy will additionally decrease the support of the uterus and affect the baby’s alignment which will directly affect birth and therefore birth recovery as well. The “core” is essential to hold your entire body together. Damage to the core is not a cosmetic issue, it is a structural issue. Loss of the integrity of this structure contributes to low back pain, upper back pain, constipation, pelvic floor issues (including leakage- stress and urgency incontinence, prolapse, prostate issues in men and pain with intimacy), pelvic instability, hip pain, abdominal pain, hernias (if the tissue becomes so thin it tears), protruding tummy and so much more.
Under The RadarSo why is this undiagnosed, misdiagnosed and ignored by the medical community? Great question! We have several theories. First of all, traditionally there has been very little effective treatment of this condition. As a physical therapist, I was taught next to nothing about diastasis and the abdominal wall in school and what we were taught is completely contradictory to how the body heals. So there is little information on it in school. Second, the condition has become more prevalent in the past 20 years as we sit more (with inactive cores), do more “crunch” fitness instead of functional activation of the core and have babies later in life when we are entering pregnancy with a weaker core. Third, in general the medical profession does not like to check for things that they have no great solution for. It is sad to say, but true. There has been no great solution in the past for diastasis recti but they do have a “treatment” for hernias. Technically, hernias can be repaired with surgery. (I say technically because abdominal hernia surgeries have a 50% failure rate.) Due to this lack of information and absence of confidence on this condition, one of three things typically happen when you are seen by your doctor or midwife…
- The doctor or midwife does not even check for a diastasis recti.
- The doctor or midwife check (often because you say “what the heck is wrong with my stomach” or something to that affect) and they check incorrectly and/or say there is nothing you can do- “it might get better on its own”, but likely “it is your badge of honor for being a mom” or something else ridiculous that is unhelpful.
- The doctor or midwife check and tell you that you have a hernia and you can only correct it with surgery.