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Rectus diastasis, commonly known as abdominal separation, refers to the separation of the rectus abdominis muscles along the midline of the abdomen. This condition typically occurs during pregnancy, as the growing foetus requires additional space, and the abdominal wall stretches to accommodate this. For many women, the separation reduces naturally within 6-8 weeks post-delivery, but in some cases, intervention may be required to optimise healing.

Signs & Symptoms

The primary sign of rectus diastasis is a noticeable gap or bulge along the midline of the abdomen. This separation is often more prominent when the abdominal muscles are engaged, such as when sitting up from a lying position. Other symptoms may include:

  • Visible bulging along the abdomen, particularly when lifting or straining.
  • Weakness in the abdominal muscles, leading to difficulty in performing normal activities such as sitting up or lifting objects.
  • Lower back pain, which is often due to the reduced support from the abdominal muscles.
  • Poor posture, caused by a weakened core.

Causes and Contributing Factors

Rectus diastasis is a natural and common occurrence during pregnancy. However, there are several factors that can influence the severity of the condition:

  • Pregnancy: The most significant cause of rectus diastasis is pregnancy itself. As the uterus expands, the growing baby requires space, which causes the abdominal muscles to stretch and separate.
  • Multiple pregnancies: Women who have had more than one pregnancy, particularly if pregnancies are closely spaced, are more likely to experience a more pronounced separation.
  • Excessive weight gain during pregnancy can increase the pressure on the abdominal wall.
  • Carrying a large baby or multiple babies can exacerbate the degree of separation.
  • Genetics: Your genetic predisposition plays a significant role in how well your muscles stretch, scar, and recover after birth.
  • Age: Older mothers may experience more significant separation due to reduced skin and muscle elasticity.
  • Improper exercise: Engaging in exercises that put excessive strain on the abdominal muscles during pregnancy or shortly after delivery can contribute to worsening the condition.

Grading

Rectus diastasis can be measured and graded based on the width of the separation between the rectus abdominis muscles. The measurement is typically taken above, at, and below the belly button.

  • Mild (0.5 to 2 cm gap): This is generally considered a minor separation that may not require specific treatment beyond self-care.
  • Moderate (2 to 4 cm gap): A moderate diastasis requires targeted rehabilitation exercises to improve muscle function and reduce the separation.
  • Severe (4 cm or more gap): This level of separation is significant and may cause symptoms such as back pain, poor posture, and a persistent abdominal bulge. More intensive physiotherapy and, in rare cases, surgical intervention may be needed.

Prognosis

For most women, rectus diastasis will naturally reduce in the weeks following delivery, typically within 6-8 weeks. However, the recovery process can vary greatly depending on individual factors such as the degree of separation, genetic predisposition, and postnatal management.

In cases where the separation does not reduce naturally, physiotherapy can play a crucial role in promoting healing. It is important to note that severe or untreated cases of rectus diastasis can lead to complications such as chronic back pain, pelvic floor dysfunction, and in extreme cases, abdominal hernias.

Treatment

Physiotherapy and Rehabilitation

Physiotherapy is one of the most effective ways to manage rectus diastasis post-pregnancy. Although physiotherapy cannot prevent or reduce the separation during pregnancy, it can significantly aid in the healing process after delivery. The first 4-6 weeks postpartum is a critical window for optimising recovery.

  • Abdominal binders/ compression garments: A physiotherapist can prescribe and measure a proper abdominal binder, which provides external support to the abdominal muscles. It helps to stabilise the core, encourage healing, and reduce the separation. It is crucial to have the binder fitted by a professional, as incorrect use can exacerbate the problem.
  • Posture and movement education: Advice on proper posture, lifting techniques, and safe movement strategies can prevent further strain on the abdominal muscles. This is particularly important when lifting the baby, nursing, or performing everyday tasks.
  • Targeted exercises: Physiotherapists will prescribe specific exercises that are tailored to your individual condition. These exercises are designed to re-engage the deep abdominal muscles and promote the knitting of the separated muscle fibres.
  • Pelvic floor exercises: Strengthening the pelvic floor muscles is crucial, as they work together with the core muscles to provide stability. Physiotherapists will guide you through pelvic floor exercises, also known as Kegels, to improve muscle tone and function.

Other Treatment Options

  • Surgical intervention: In severe cases of rectus diastasis that do not respond to physiotherapy or where complications arise (e.g., hernias), surgical intervention may be required.
  • General exercise: As part of the postnatal recovery process, regular low-impact exercise such as walking or swimming can help improve overall fitness and encourage gentle healing. However, high-impact exercises or those that put excessive pressure on the abdomen should be avoided until cleared by a health professional.
  • Continued physiotherapy support: For those experiencing related issues such as pelvic floor dysfunction, incontinence, or prolapse, further physiotherapy can be helpful in addressing these concerns alongside diastasis recti management.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.