Debunking Myths about Diastasis Recti and When Pelvic Floor Physical Therapy Can Help

What is diastasis recti? Do I have it? We hear these questions day in and day out in our practice. Diastasis recti is the stretching of abdominal muscles and the connective tissue along your belly, due to an increase in intra-abdominal pressure. Diastasis recti is measured by the width of space between your abdominals, at the level of your navel, and above and below it. It can occur during pregnancy, labor or delivery. The increase of hormones during pregnancy can make you more susceptible to diastasis recti.

What defines our core? The main muscles in the core are the rectus abdominis, obliques, transverse abdominis, and some back musculature.  This area supports your trunk, your posture and allows us to stand erect. There are “guidelines” out there that state that a separation of two fingers or less in your abdomen is optimal to effectively exercise. This is a myth. The gap between your abdominal muscles is not related to proper exercising, core strength or control. For example, some people demonstrate excellent core control with a three-finger separation of abdominals while some people have a bulging abdominal wall with a two-finger separation. Whether you have a two- or three- finger separation between abdominal muscles, you can still have strong core function. However, a doming or bulging abdominal wall, during core exercise, determines how much your core can handle. When there is doming, the abdominal wall is not strong enough to work against the intra-abdominal pressure inside your trunk. The muscle is not able to support the organs internally and a bulge may appear along the abdominal wall. 

Often after delivery, a woman may feel mushiness and deflation in her core. When she starts to rebuild core strength, she should focus on the specific muscles that need to be strengthened. If you have a good sense of where your rectus abdominis, obliques, and transverse abdominis are located, then you can safely and effectively strengthen the proper muscles, eventually adding more challenging movements.  

Physical therapists educate patients on what exercises are safe and what exercises are unsafe for treating diastasis recti. Each person is unique depending on:

1. Their baseline muscle tone

2. Their muscle weakness 

3. How well they manage abdominal pressure and if they have doming during certain movement

Core exercises are good for diastasis, but you want to know which exercises are the most appropriate for you. These are questions to ask yourself and a pelvic floor physical therapist:

1. Do I know where my pelvic floor is and can I contract it?  

2. Do I know where my transverse abdominals are and can I contract them? 

3. Can I contract my pelvic floor simultaneously with my transverse abdominals? 

If the answer to any one of these three questions is NO, then speak with a pelvic floor physical therapist.

1. When I do core exercises do I lose engage my transverse abdominals and pelvic floor? You should be able to engage these for a certain amount of time.  

2. Does my abdominal wall bulge during exercises, especially during core exercise?

If the answer to either of these two questions is YES, then speak with a pelvic floor physical therapist.

Thinking through these questions and answers, and speaking with a pelvic floor physical therapist will provide a more effective treatment plan, as compared to following a list of internet-found exercises that are not specific to your needs. Your physical therapist can tailor a specific program for you. The result will be an effective and enjoyable exercise program.