Diastasis Recti Abdominis

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Description

Diastasis recti (also known as abdominal separation) is a disorder defined as a separation of the rectus abdominis muscle into right and left halves.

Clinically Relevant Anatomy

Normally, the two sides of the Rectus Abdominis are joined at the linea alba at the body midline.

Mechanism of Injury / Pathological Process

Diastasis of this muscle occurs principally in two populations: newborns and pregnant women.

• In the newborn, the rectus abdominis is not fully developed and may not be sealed together at midline. Diastasis recti is more common in premature and black newborns.
• In pregnant or postpartum women, the defect is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in multiparous women due to repeated episodes of stretching. When the defect occurs during pregnancy, the uterus can sometimes be seen bulging through the abdominal wall beneath the skin.

Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

Abdominal Binders:
Binders do have a place in the treatment of the condition, but the wrong or overuse of them can cause more problems. It is best not to use an abdominal binder unless absolutely necessary, for example during pregnancy in the third trimester and 6 weeks after delivery if there is a separation of 2 fingers or more.

Belly Band:
Wearing a belly band during pregnancy (one made specifically for pregnant women) will help increase proprioception and muscle awareness. A belly band or tight tube top can be used after childbirth for the same reasons.

Kegel Exercises:
Pelvic floor exercises will help strengthen deep abdominal muscles
because all the core muscles contract automatically as a cohesive group. These exercises can be performed through out pregnancy and may be started in the early postpartum period.

Breathing Exercises:
Breathing exercises help to retrain the diaphragm to relearn how to descend after childbirth. During pregnancy the diaphragm is pushed upwards by the growing uterus and loses its ability to descend during exhalation. Since the diaphragm forms the top of the core muscles, it is important to retrain it to function with a full excursion again. Here are 2 good exercises:
Inverted Breathing:
Lie supine with the buttock on a pillow wedge, raised above chest level. Teach patient to take short shallow breaths “through the pelvic diaphragm”. Have patient place one hand just above the pubic symphysis and teach them to feel for a slight up and down motion while they breathe in and out. Place the patients other hand on top of their chest and tell them to try not to have their chest rise when breathing.

Lateral Costal Breathing:
In the seated position have patient place their hands on the lateral sides of the rib cage. Teach them to “breathe into their hands” and to feel for the lateral expansion of the rib cage as they inhale and the movement of the ribcage toward the midline during exhalation.

Progressive Core Exercises:
There are several exercise that can be used to help restore core strength which will help close the gap in a diastasis. For more detail refer to Diane Lee’s well-published work on the Diastasis Recti. (http://dianelee.ca/education/article_diastasis.php)

Sit-Ups and Crunches:
Teach patient not to do sit-ups or other crunches to strengthen the abdominal muscles. Sit-ups and similar exercises put a great deal of strain on the pelvic floor and can cause further separation of the abdominal muscles and should be avoided in the prenatal and post-partum phases.

Body Mechanics:
It is important to teach patient how to perform ADL’s without increasing abdominal pressure, such as rolling out of bed, instead of doing a “sit-up” to get up. Avoid “jack-knifing” behavior that increases intra-abdominal pressure. Other activities to watch out for is getting out of a bath, lifting and carrying older children and heavy objects during pregnancy and the early postpartum period. Teach them to “exhale as you lift.”

Postural Awareness;
After pregnancy women tend to stand with and an exaggerated anterior pelvic tilt and with their pelvis pushed forward. In order to stand up against gravity their bodies typically develop areas of rigidity in upper lumbar and lower thoracic area along with the buttock muscles. Diane Lee refers to this as “back clenching and buttock griping behavior.” Manual therapy and relaxation exercises must be used prior to strengthening exercises. (http://dianelee.ca/articles/UnderstandYourBack&PGPopt.pdf)

Differential Diagnosis

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Key Evidence

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Resources

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Case Studies

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