Diastasis rectus abdominis

Diastasis recti, or diastasis rectus abdominis (DRA), is a condition where the right and left halves of the rectus abdominis muscle, which meet at the midline of the abdomen, separate. This separation occurs when the connective tissue between the abdominal muscles (linea alba) stretches and weakens, allowing the abdominal muscles to separate.

Diastasis recti is most commonly seen in pregnant women, particularly during and after pregnancy. However, it can also occur in men, women who have never been pregnant, and in infants.

1. DIASTASIS RECTUS ABDOMINIS Dr. Saima Mustafa (pt)

2. Definition Diastasis recti is commonly defined as gap of roughly 2.7 cm or greater between the two sides of rectus abdominis muscle palpated above below or at the level of umbilicus.

3. In pregnant or postpartum  women, the defect is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in multiparous  women due to repeated episodes of stretching. The etiology of this separation is unknown; however, the continuity and integrity of the abdominal musculature are disrupted. Any separation larger than 2 cm or two finger widths is considered significant.

4.  symptoms of diastasis recti Most people don't notice signs of diastasis recti until they are postpartum. You can have diastasis recti during pregnancy, but it's hard to distinguish because your abdomen is stretched. Common signs of diastasis recti during the postpartum period are: A visible bulge or "pooch" that protrudes just above or below the belly button. Softness or jelly-like feeling around your belly button. Coning or doming when you contract your ab muscles. Difficulty lifting objects, walking or performing everyday tasks.. Pelvic or hip pain Low back pain Poor posture. Urine leaking  when you sneeze or cough. Constipation. Feeling weak in your abdominals.

5.   Risk factors for developing diastasis recti Several factors can increase your risk for developing diastasis recti: Having multiple pregnancies (especially back-to-back). Being over 35 years old. Having multiples  (such as twins or triplets). Having a heavy or big baby. Being extremely petite. Vaginal delivery. Pushing can increase abdominal pressure.

6. How do I prevent diastasis recti? Some abdominal separation is normal and expected with pregnancy. There are some things you can do to lower your risk for developing diastasis recti: Healthy weight gain during pregnancy : Exercising and eating healthy foods to keep weight gain within a healthy range. Proper posture and deep breathing : Stand up straight with your shoulders back. Take deep breaths that allow your ribs to expand and not just your belly. Safe core exercises : Avoid exercises like sit-ups and crunches that put pressure on your abdominals after 12 weeks of pregnancy and postpartum. Don't strain while lifting : Certain day-to-day activities like lifting grocery bags or your children can put undue strain on your abdominals. Log roll when getting out of bed : If you're pregnant or postpartum, roll to one side and use your arms to push up out of bed.

7. Variations

8. Diastasis Symptoms and Complications  It causes the stomach to protrude because of the extra space between the left and right abdominal muscles. Some people call this a “pooch” or a “mummy tummy”. Diastasis can cause organs, such as the bladder, to descend because the core is unable to provide the necessary support. This lack of support can lead to serious medical conditions such as: prolapse, and incontinence (urine leaking) when accompanied by inter-abdominal pressure (sneezing, jumping, etc). It can make it hard to move normally. In rare cases, if the connective tissue tears, it can cause a hernia. Some symptoms of diastasis recti include: lower back pain, pelvic pain, hip pain, constipation

9. Diagnosis Your healthcare provider will evaluate if diastasis is present, where it's located and how severe it is. Diastasis recti can occur above the belly button, below the belly button and at the belly button. Your provider will use their hands and fingers to feel the abdominal area for gaps and muscle tone. Some providers may use  ultrasound , measuring tape or a tool called a caliper for a more accurate measurement. This exam typically occurs at your postpartum appointment before being cleared for exercise. An abdominal gap wider than 2 centimeters is considered diastasis recti. Diastasis recti is also measured in finger widths, for example, two or three fingers' separation.

10. Abdominal ultrasonography  provides objective evidence for the diagnosis, and also confirms that the bulge is not a  hernia . An  abdominal CT scan  is an acceptable alternative to an ultrasound. People can perform a basic self-test for diastasis recti at home by following these steps: Lie on the back with the knees bent and the feet on the floor. Place one hand over the midline of the abdomen, keeping the fingers flat.

11. 3. Place the other hand under the head and neck. 4. Lift the head slowly and press down on the abdomen with the finger pads. 5. Feel for a gap between the muscles. If a person feels a space of more than two finger widths, they should contact a doctor.

12. Treatment Physiotherapy Management: Lie on your back, knees bent. Cross your hands at your waist and guide your recti muscles towards the midline to stabilize them. Take in a deep breath. As you slowly exhale, perform a pelvic muscle contraction and raise your hand off the bed. (keep your shoulders on bed)

13. While you lift, gently pull your underlying muscles together with your hands. If your tummy is too large, wrap a sheet or large towel around the body , and grasp the ends with opposite hands. Apply same pull Slowly return to the starting position as you breathe in. Try to do 10 in a row, at least 3 times a day.

14. Do not perform a standard curl-up (raising your shoulders off the bed) until your center seam does not bulge or hollow and you feel only 2 fingers widths or less separation between recti muscles. If at any time (weeks, months, years later) you notice the gap returning, just repeat this exercise to decrease it. Poorly executed abdominal exercises can cause an increase in intra-abdominal pressure, this force may cause further recti separation and its accompanying bulge/ hernia to worsen.

15. Hence, it is important to monitor DRA (and the hernia if any) before prescribing any abdominal exercises. Unsuitable abdominal exercises include sit ups, straight leg raises, pilates movements, especially trunk rotation activities, such as criss-cross sit ups which target obliques, can strain the abdominals excessively. Weakness in the core muscles contributes to insufficient force closure of the sacroiliac joint leading to pelvic instability, which can eventually lead to lower-back and hip pain. In the worst case scenario, this recti separation can result in hernia.

16. At the initial visit, the patient is given instructions on 1) correct body mechanics, 2) proper posture, 3) appropriate exercises to activate the abdominal musculature, and 4) appropriate exercises to re-approximate the recti bellies without increasing insta-abdominal pressure.

17. Progression Head lift with pelvic tilt Pelvic tilt exercise Leg sliding Trunk curls Modified bicycle Core muscle strengthening

18. Special precautions Avoid all activities that places stress on the midline, that stretch or overly expand the abdominal wall Repetitive trunk movements or diagonal twist i.e. during a tennis serve Exercises that require lying backward over a large exercise ball Yoga postures that stretch the abs, such as “cow pose,” up-dog, all back-bends and belly breathing Exercise that cause the abdominal wall to bulge out Lifting and carrying heavy objects Intense coughing while abdominal muscles are unsupported.

19. EXERCISES TO AVOID IF YOU HAVE DIASTASIS RECTI: Standard crunches Crossover/bicycle crunches Standard sit ups Double leg raises Push-ups Press-ups Front planks Swimming Golf Tennis Softball

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