The Big Deal with DR (Diastasis Recti)
Last year, Diastasis Recti (DR) made a big splash in the news when NPR covered a story on an exercise to flatten the “mummy tummy”. While it is common for pregnant women to experience diastasis recti during pregnancy (some studies state as many as 100% of women will experience DR during their pregnancy), even those who have never been pregnant can be affected by this orthopedic condition.
What is DR anyway? DR is a separation of the rectus abdominis muscle (superficial abdominal muscle) from the central connective tissue called the linea alba. The degree of separation of the muscles, sometimes called the “inter-recti distance” is often measured to gauge the severity of the condition.
This separation occurs during pregnancy because the connective tissue is thinned and stretched as the fetus grows. Anything that affects the integrity of the abdominal wall can cause DR to occur, however. People who have had abdominal surgery, who have had large fluctuations in weight, with connective tissue disorders, and even those who simply place too much stress on their abdomen during heavy workouts are all at risk for developing DR.
Often patients become aware that they have this condition because of the cosmetic effects. Patients report they feel they still look pregnant over a year later due to a protruding abdomen or notice a large bulge in the middle of the abdomen with abdominal exercises. Others may not notice symptoms for years.
So, why does it matter? If DR goes untreated it has been associated with some problems down the road. One review published in 2014 put it this way:
“The abdominal wall has important functions in posture, trunk and pelvic stability, respiration, trunk movement and support of the abdominal [organs]. An increase in the inter-recti distance puts these functions in jeopardy, and can weaken abdominal muscles and influence their functions. This may result in altered trunk mechanics, impaired pelvic stability and changed posture, which leave the lumbar spine and pelvis more vulnerable to injury.”
DR has also been associated with an increased risk of urinary incontinence, fecal incontinence, and development of pelvic organ prolapse.
That’s the bad news. The good news is DR is easily treatable in most people! Often physical therapists will address this issue by instructing patients in specific exercises that target the transverse abdominis (the deepest layer of the abdominal muscles). Activating this muscle helps bring tension back into the linea alba and close the gap between the rectus abdominis muscles. Your therapist will likely also provide you with exercises specific to your particular needs to help strengthen the surrounding muscles and make sure that compensatory patterns of movement haven’t developed over time. Patients note that they often have improved physical appearance as well as decreased pain, urinary/fecal leakage and improved function after treatment.
If you think you may have DR or just simply want to rule it out, ask your physical therapist to screen you. Screening for DR is quick and easy, and catching it earlier can save you a major headache (or backache) down the road!
Thanks for reading!
Heather Draper, PT, DPT
Heather Draper was a interim physical therapist with Functionize Health & Physical Therapy. She specializes in treating patients with a variety of pelvic health conditions as well as low back, hip and SI pain. She earned her doctorate in physical therapy from the University of North Georgia where she participated in research related to diastasis recti causes, effects and treatment. Heather’s email is email@example.com. For more information visit www.functionizehealth.com.
Benjamin D, van de Water A, Peiris C. Systematic review: Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy [serial online]. March 1, 2014; 100:1-8. Available from: ScienceDirect, Ipswich, MA.