I am SO EXCITED for today’s post! Dr. Krystyna Holland has been my husband’s friend since they were kids, and it has been really fun following along on her journey to becoming a physical therapist. I asked if she would be willing to answer some questions about Diastasis Recti, since it’s something that a lot of postpartum women have but either don’t realize, or don’t know how to manage.
She wrote this amazing blog post with reliable information to share with all of you! It covers what diastasis recti is, how you know if you have it, and how to manage it! With all that being said, here it is!
Dr. Holland is a Doctor of physical therapy specializing in orthopedics and pelvic health. She has a Pre- & Postnatal Coaching Certification through The Coaching & Training Women Academy, and is the founder of PotentiallyFaultyPelvicFloor.Com where she talks about navigating healthcare from both the patient and provider sides. She can be found at the blog site, on Instagram, or on Facebook, and is based out of Denver, CO
I feel like everywhere I look on the internet right now there programs being sold to women to “lose the pooch” and “get rid of mummy tummy” – touted as solutions to a common byproduct of pregnancy that many friends and patients of mine wish they could do without. “Mummy tummy” (as it’s known in pop culture) is a separation of the top layer of abdominal muscles during pregnancy that may or may not resolve on its own after delivery. Clinically it’s known as diastasis recti, DR, or DRA.
What is Diastasis Recti?
Imagine a set of six pack abs (think Jason Momoa in Aquaman). The line running down the center of the torso (from sternum to happy trail) is made of connective tissue, and called the linea alba. On either side of the linea alba are the top layer of abdominal muscles called the rectus abdominus. During pregnancy, connective tissue gets more stretchy, in order to make room for baby to grow, as well as for the body to be able to deliver. At some point, most women have some separation of the linea alba because the baby needs room to grow. While it is not preventable, it is manageable and treatable after delivery, often (but not always) without surgery.
How do I know if I have DR?
Common things I hear from people who have DR is that they “feel unstable” in their core/abdomen, that they “have a pooch” and that their “stomach bulges out” when they do things like sit up in bed or work out in the gym. You can also get checked for diastasis or check yourself. If you lay on the floor and take two fingers and try to push them below the sternum, at the top of your linea alba, like you’re trying to touch the floor through your stomach, then raise your head and shoulders off the ground. Can you feel a bulge on either side of your fingers? How many fingers can you fit into that space? Can you feel something that feels taut, like a rubberband under your fingers or is it squishy? If you repeat that all the way down the length of your abdomen, and can get more than 2 fingers in the space between the two sides of your abs or can push far down at any one spot, you may have a diastasis.
If you think you may have DR, I recommend going to a pelvic floor physical therapist for a second opinion. When I have something that I’m not sure is normal, it always makes me feel better to get someone else’s opinion, and DR isn’t any different. Many of my patients tell me that they had no idea that their bodies would change this much, not only during pregnancy, but after delivery, and that it’s really helpful to have someone that can talk to them about it and tell them what to expect and whether or not what is happening is normal.
What do I do if I have DR?
Ten years ago no one had even heard of the phrase “diastasis recti”. Now it’s everywhere, often times being used to sell products and services to moms who want to maximize their health or get back to their pre-baby body. DR is widely feared, and widely misunderstood.
When I, as a pelvic floor physical therapist, look at DR, I consider three big things. 1. How wide the split is, and 2. How responsive the linea alba is (more on that in a sec) and 3. How the core system is working together as a whole to meet the client’s goals. 1. The width of the split matters because there are times that the two sides of the rectus are too far apart to work well together for the job they were meant to do, and the client would ultimately benefit from surgery to improve. 2. Having a responsive linea alba refers to the ability to generate tension in the connective tissue, regardless of the length of the split. There are people who can have a “big” diastasis, but are able to manage it well because of their ability to generate tension in the linea alba. On the other hand, there are people who may have a small distance between the two sides of their rectus, but don’t have enough control to create that same tension. 3. To me, the implications of DR I am most interested in are those that relate to function. At the end of the day, the jobs of the core are to create stability and to regulate intraabdominal pressure that changes with things like breathing and exercise. So if mom can do that, doesn’t cone with increased load (whether that’s barbell or a baby), doesn’t have any other pelvic floor symptoms such as pelvic pain, urine leakage with laughing, jumping, coughing, or sneezing, pain with intercourse, or urinary frequency, and is able to meet her goals, as a PT, I’m not worried about the presence of a split.
Exercising with DR
Exercising postpartum is another internet landmine of misinformation. If you go looking, you will find plenty of “experts” who will tell people with DR never to do _______ exercises, which is really disheartening if _________ exercise is what you love to do. The truth is less depressing, but more nuanced: every person’s body is going to respond to exercise in a different way postpartum. There are going to be people with DR who can’t sit up from bed without getting coning, and people who only experience coning with really heavy loaded back squats. The list of exercises that each of those people should or should not do are different – right now. The key is finding the balance of exercises that allow you to handle intraabdominal pressure increases without doming, increasing urine leakage, or causing a heavy feeling in your pelvis – any of which would indicate that you aren’t managing the pressure of whatever activity you are doing. A pelvic floor physical therapist or a postpartum coach are going to be people who can help you find a strategy that will help you meet your goals safely. While there aren’t “bad” exercises for people with DR, there are certainly exercises that are bad right now, and regularly pushing past the limits of what your body can handle postpartum isn’t likely to set you up for success in the long term, and can do more harm than good in terms of athletic performance, incontinence, and pain.
How long postpartum is too long to work on my DR?
Postpartum is forever, and it is never too late to help you reach your goals. It doesn’t matter if your baby is two years or two decades old.
I know finding good information online is hard, and that being a mom is harder. When it comes to diastasis recti, know that there are a lot of options for managing the symptoms and improving your function, and that you can’t tell exactly how much the split will close until at least three months after you stop breastfeeding due to hormone fluctuations. With that said, I encourage anyone considering surgical options to wait until after that time to make that decision. I like to remind my patients (and myself!) that our bodies are incredibly resilient and can change a lot with the right training.
Providing good quality medical advice moms is really important to me, so please reach out at Krystyna.Holland@gmail.com or @Krystyna.Holland on Instagram or on my website with any questions or if you need help finding a pelvic floor physical therapist in your area. I’m happy to do free consult phone appointments and I have phone appointment options as well!