April 21, 2020

By Carolyn Yates, PT, DPT

During the later part of pregnancy, your belly will expand to make room for the baby. During this time, your abdominal muscles may separate to allow your belly to expand fully. While it’s totally normal and very common, for some it doesn’t go away postpartum, which can cause back pain and instability. However, adjusting how you move can help limit the separation and set you up for a faster recovery.

What is diastasis recti?

Diastasis recti is the separation of the rectus abdominis muscles (aka the six-pack ab muscles). Diastasis during pregnancy is a totally normal occurrence and a 100% incidence rate of DR has been reported in some research studies. During pregnancy, increased levels of hormones (relaxin, progesterone, and estrogen) soften connective tissues and results in the weakening of the linea alba. The linea alba is the connective tissue that holds the medial edges of the neighboring rectus abdominis muscles together. As the baby grows, the linea alba continues to be stretched and the rectus abdominis muscles elongate around the baby. This is completely natural.

How do I know if I am developing diastasis recti during pregnancy?

Different research studies have reported different levels of occurrence of diastasis during pregnancy but know that it is a natural occurrence and happens to allow for space for your growing baby. You most likely have a separation. The main things to focus on are not doing excessive movements that will exacerbate it.

How to limit diastasis during pregnancy:

Although most women will have a diastasis during pregnancy (remember, it is a natural occurrence to make space for growing babe), there are things you can do and avoid doing to help prevent more-than-necessary separation.

Things to avoid:

• Sit-ups. This exercise places strain directly through the rectus abdominis muscles. When you are not pregnant, the linea alba is taut and strong and maintains the integrity of the rectus abdominis muscles as they contract and relax through this exercise. When you are pregnant, the linea alba is softened and therefore has a tougher time holding the rectus abdominis muscles together. Sit-ups will further strain the linea alba.
• Sitting straight up from a lying-down position. Similar to doing sit-ups, this maneuver will strain the already softened linea alba.

Things to do:

• Learn how to properly engage your transverse abdominis. The transverse abdominis is the “corset” muscle of the core. This muscle helps stabilize and support our bodies as we move through space. Research has shown that learning how to engage this muscle and then focusing on engaging it during exercise programs and daily life activities, such as getting in and out of bed, can help prevent diastasis from progressing more than necessary.
• Learn how to properly engage your pelvic floor muscles. The pelvic floor muscles are an integral part of the core complex and it will help your transverse abdominis activate and stay strong if you are able to properly engage your pelvic floor muscles. A good cue to try is to imagine you have a marble at the opening of your vagina. Try to “pick the marble up” and pull it up inside and then “put it back down”. You should not be engaging your butt or groin muscles when you do this.

Remember, it is natural to have separation during pregnancy, but you don’t want to exacerbate it. Taking simple steps to avoid exacerbation and focusing on strengthening your transverse abdominis and pelvic floor muscles are the best things you can do for your body as your belly grows.

Related: How to prepare your pelvic floor for labor and delivery

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.