Diastasis Fact Sheet

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Diastasis of the rectus abdominis muscle (DRAM) is a separation between the linea alba and the muscles that people commonly refer to as a ‘six-pack.’

Stretching of the abdominal muscles during pregnancy and development of DRAM is a normal occurrence. Up to 97% of women will have a degree of DRAM by the end of their third trimester.  The force placed on the abdominal wall by the growing baby and uterus, and hormonal changes of pregnancy which affect the soft tissues,  make pregnant and post-partum women prone to a DRAM.  In general, the linea alba thins and stretches and in some cases is torn.   

The DRAM should have a natural resolution with greatest recovery occurring between 1 day and 8 weeks after delivery, after which time recovery plateaus. Whilst DRAM is a normal occurrence, depending on the degree of separation, it can influence your posture and core function and may contribute to back pain, pelvic instability and pelvic floor dysfunction.

Risk factors may include:

·     Multiparity (multiple births)

·     Advanced maternal age (35+)

·     Returning to strenuous exercise or heavy lifting too early

·     Excessive weight gain

·     Bad posture

 

There is limited research into this area of women’s health (??put in a separate ‘box’)

 

Things to avoid during pregnancy and up to 6 months after:

·     Sit ups

·     Bending backwards

·     Deep belly breathing

·     Sitting straight up from lying (roll to your side first)

·     Heavy lifting

·     Frequently checking your DRAM as it actively pulls apart the abdominal muscles
(please do not check your DRAM during pregnancy)

 

Thing to do:

·     Roll on to your side before getting up from a lying position 

·     Regular pelvic floor exercises

·     When lifting activate your pelvic floor and stomach muscles first

·     Focus on ribs returning to prenatal position while breathing.

·     If needed use a support belt

·     Focus on maintaining a good posture

 

In the post natal period many women alter their posture due to fatigue, breast or bottle feeding and lack of core strength. The pelvis shifts forward, ribs flare and the shoulders roll forward. This means that there is constant pressure on the DRAM. Correcting a poor posture can be the key to correcting DRAM.

When pregnant the ribcage can increase in diameter by up to 7 cm, this does not always return to prenatal state.

There are many definitions of what constitutes a DRAM. Some people believe that any separation is  as a DRAM, whilst others define it as separation greater than 2 cm at the belly button.

References

1. Barbosa, S, Sá, R & Coca Velarde, L 2013, 'Diastasis of rectus abdominis in the immediate puerperium: correlation between imaging diagnosis and clinical examination', Archives of Gynecology & Obstetrics, vol. 288, no. 2, p. 299.

2. Benjamin, DR, van de Water, ATM & Peiris, CL 2014, 'Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review', Physiotherapy, vol. 100, no. 1, pp. 1-8.

3. LoMauro, A. and Aliverti, A. Breathe (Sheff). Respiratory physiology of pregnancy. Breathe. 2015 Dec; 11(4): 297–301.



Maria Ugrinovski