What Diastasis Recti Is and How to Know If You Have It
A common concern many women I have worked with postpartum is low-to-mid back pain, pelvic pain, and a feeling that they have no stability in their abdomen. This could be a condition not uncommon to women (and it happens to men, too!) called “diastasis recti.” Let’s look at what creates it and how you can determine if you have it.
The most exterior layer of abdominal muscles is called “rectus abdominus,” aka the “six-pack abs” popularly built up from abdominal crunches. Over pregnancy the abdominal muscles stretch to accommodate the expansion of the uterus and growth of the baby. For some women, the two vertical sheaths of the rectus abdominus muscle separate from the “linea alba,” the band of connective tissue at the midline of the abdomen. This is “diastasis recti” and it is treatable!
This separation of these muscles can worsen if the postpartum mother does not sit or move with appropriate posture and if she breathes insufficiently. To illustrate how this condition happens in daily life, think of the plastic coin purses popular in the 1980s that were oval in shape. They were opened by squeezing the two tall points of the oval toward each other, making the midline separate and allowing coins to go in or out of the purse.
For the rectus abdominus muscles, the midline is the linea alba and the purse is the abdominal sheath. Slouching or spinal flexion in which there is pressure on the abdomen (sit-ups and curl-ups!) puts pressure on both ends of the abdominal sheath and the two halves separate. If left untreated, this separation could leave you unstable while moving your torso and possibly cause back pain and/or pelvic pain. In extreme cases, over time you can herniate through the separation from excessive intra-abdominal pressure brought on by misalignments from forceful movements (for example, sit-ups or lifting heavy objects), especially if you are not breathing well. Before exploring practices for daily life to help heal diastasis recti, let’s look into how to discover it.
Start by lying on your back with your knees bent and feet on the floor. Relax and breathe naturally. Align your index and middle fingers and then place them just beneath the tip of the breastbone, pointing them downward toward the pelvis. Slightly curl the torso off the floor and feel if the two fingers descend into a gap. If they easily do, lie back down and place three fingers in the same place and repeat the curl up. Repeat this using four fingers. This helps you determine the approximate distance of the separation. Depending on the number of fingers that descend, gently press them down the length of the abdomen while noticing the width of the gap. The gap will naturally be larger around the naval in this postpartum period, but ideally it knits back together similarly to the linea alba of the upper and lower abdominal muscles as you heal. There will always be a small space between the two rectus abdominus muscles for the linea alba, so you can have functional expansion and compression of your abdomen.
Press your fingers down your abdomen from the tip of the breastbone to the pubic bone. Notice if the gap is wider at the upper abdomen or lower abdomen, or if it’s the same throughout. Relax the torso down, roll onto one side, and use your hands to help you sit up. You can follow this video to go through this assessment with me.
In the next blog and video, you can explore posture and breathing practices to work towards healing this condition. You can repeat this assessment every eight weeks to determine how your rectus abdominus is healing. Ideally, there will not be a separation more than one finger’s width between the two abdominal sheaths. I recommend asking your doctor, midwife, or physical therapist who assesses your pelvic floor to also determine diastasis recti and offer recommendations for repairing it.