Months after I gave birth to my twins, a mom from a local multiples group introduced me to the words "diastasis recti" in casual conversation. As she explained the postpartum abdominal condition she suffered, I recognized it right away as the explanation for why my tummy still looked pregnant even months after delivery -- something that was proving to be a painful emotional blow.
The problem, I now know, is pretty common -- about two thirds of pregnant women have it. So why had I never even heard of it? In the months since, I've found it hard to uncover straight talk about the issue. It doesn't come up often in everyday conversation with other new moms, and most online chatter about it is relegated to message boards. But no more! Here's a primer on everything you need to know about diastasis recti.
In short, it's a gap in between your right and left abdominal wall muscles that can result in a rounded, protruding belly "pooch."
Chalk it up to hormones and your ever-expanding uterus, says Kevin Brenner, M.D., F.A.C.S., a board certified plastic and reconstructive surgeon based in Beverly Hills. "During the gestational period of pregnancy, connective tissue called the linea alba thins out in response to a mother's change in hormone levels in order to accommodate the enlarging uterus. This is one important way that a mother's body changes to allow a baby to grow in utero," he says.
Once you've delivered your baby, and your hormone levels return to their pre-pregnancy levels, that thinning generally improves. But in many cases, Dr. Brenner says, the tissues get so stretched out during pregnancy that they lose their elasticity and, therefore, the ability to retract back into position -- kind of like an overstretched rubber band.
Women may be more likely to develop diastasis recti if they are petite, carry multiple babies at a time, have had more than one pregnancy, carry their babies later in life, have poor muscle tone, or have a sway back posture. Your medical history could play a factor as well. "Women who had diastasis recti from a previous pregnancy will most likely develop the condition again," says Helene Byrne, a prenatal and postpartum health and fitness expert and founder of BeFit-Mom [befitmom.com]. "Women with a history of umbilical or ventral hernia, and pelvic instability, are at greater risk for developing it."
Protecting your vulnerable abdomen can help keep the muscles from separating. During pregnancy, always use the log roll maneuver when getting out of bed or up from the couch or floor, says Ben Butts, P.T., director of rehabilitation services and Performance Therapy at Providence Saint John's Health Center in Santa Monica, California. That means rolling onto one side with your torso and head aligned, then using your arms to help push yourself up to a sitting position.
There are also helpful exercises you can do while you're pregnant, according to Leah Keller, who developed the Dia Method meant to strengthen the pregnant abdominals and overall body for labor and postpartum recovery.
It's easy to perform a self-test for diastasis recti. Just lie on your back with your knees bent and feet on the floor. Put one hand on your belly, with your fingers on your midline at your navel. Press your fingertips down gently, and bring your head (shoulders stay on the ground) up into a mini crunch-like position. Feel for the sides of your rectus abdominis muscles, and see if and how far they are separated. Separation is commonly discussed in terms of finger widths -- for instance, two or three (or more) fingers' separation.
Exercise can be used to repair diastasis recti and should be undertaken as the first approach to healing -- just be sure to get the okay from your doctor postpartum. At-home workout programs, such as the MuTu System [mutusystem.com] developed by U.K.-based mom and trainer Wendy Powell, are meant to help specifically strengthen the core while avoiding exercises that can exacerbate the problem, such as crunches -- a major diastasis recti no-no. Physical therapy may also be recommended to work on diastasis recti.
If severe, diastasis may be corrected through surgery, generally done as a tummy tuck with excess skin removal. But think of that as a last resort. "Surgical repair of diastasis recti should only be done after a woman is sure that she is finished with family building," says Byrne.
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