Everyting you want (need) to know about the diastasis

During pregnancy, your abdominal muscles give way to make space for your growing baby. The separation of the rectus abdominal muscles on the midline of the connective tissue connecting these (the linea alba) is called a diastasis. The linea alba runs from the bottom of the sternum to the top of the pubic bone and is usually about one cm in width. A diastasis can occur anywhere from the top to the bottom of the midline. 

The rectus abdominal muscles, together with the other abdominal muscles, make up a part of the core. The core is the centre of your body from which all movement is made possible. The core consists of:

• The diaphragm, important in breathing

• The abdominal muscles

• The back muscles

• The pelvic floor
  
  

These muscles make your body into a corset, as it were protecting the internal organs and the spine. Besides this, they stabilise the body. Because of this, you have more control over your body’s movements. A strong core allows you to be flexible and stable, reducing the chance of injuries. Your core muscles are active during most physical activities, both during daily activities and during a workout. These muscles are active as stabilisers during a lot of exercises, for instance when performing a plank. But you also use the core muscles when lifting your child or the shopping bag.

When you have just given birth, you will often still have a diastasis. There won't only be a separation between the rectus abdominal muscles, but you will also notice that the core muscles don't work together properly because of this separation. As a result, you could experience an overload of certain muscle groups, which could lead to e.g. lower back complaints, pelvic complaints or obstipation. It could take up to six months for your core to function optimally again. If the core doesn't heal by itself and the core muscles don't start to cooperate naturally, it would be wise to consult a specialised pelvic physiotherapist.

Having a diastasis is completely normal during the third trimester. There are however a number of factors that could increase the chance of a wide diastasis, which could decrease the speed of recovery after delivery:

• Falling pregnant if you are over 34

• Having been pregnant before

• Caesarean section

• Prolonged increased abdominal pressure, for example, because of a superficial breathing pattern or because of pushing hard

• Being pregnant with twins or triplets

• A large baby or a lot of amniotic fluid

• Wrong kind of load on the linea alba during pregnancy, which increases the amount of strain

• Constipation

• Wrong kind of strength training during or after pregnancy, increasing strain on the linea alba

It can be very troublesome to have a diastasis; you could have complaints like:

• Posture and stability problems, increasing the chance of back and pelvic complaints

• Having trouble being able to take abdominal pressure (when coughing, sneezing or pushing), which could lead to problems with breathing and difficulty with pushing during delivery

• Less internal support of the intestines, possibly leading to problems when having a stool

• Constipation

• In the case of a large diastasis during pregnancy, there is a higher probability of having to have a caesarean section
  
  

Things can also change cosmetically if there still is a diastasis after delivery. The stomach could not flatten, resembling a pregnant belly of a few months. We call this mommy-tummy. If this is the case for you, we advise going to a specialist to get personalised exercises to help with recovery.

Usually, a diastasis recovers naturally within the first six months after delivery. After pregnancy, you could do a monthly check of your diastasis to monitor the progress of recovery. If you are experiencing complaints or if progress stagnates, get in touch with a registered pelvic floor therapist.

Checking your diastasis yourself:

• Lie on your back with your knees bent and at hip width and your head on the ground.

• Place your fingers just above your navel on your bare skin.

• Lift your head, making a double chin, and lift your shoulder blades just off the floor so that your abdominal muscles contract. 

• Use your fingers to feel the linea alba along the entire length, from the navel to the sternum and from the navel to the pubic bone. 

• Feel the distance between the left and right abdominal muscles and the depth/tension of the linea alba.

The distance between the two rectus abdominal muscles is not the most important aspect. It is much more important that all abdominal muscles and the entire core can work together again for a good posture and movements. This test is just an indication. It could very well happen that the full function and collaboration of the core has returned, even though there is still a separation between the rectus abdominal muscles. As long as there are no complaints, this isn't a problem. 

It is important to regain proper function of the core muscles after delivery. For this reason, it is helpful to be able to contract the deep transverse abdominal muscle, or the transversus abdominis, and to be able to integrate this into daily activities. Because the deep transverse abdominal muscle and the pelvic floor are part of the core and work together, contracting one of these will stimulate the contraction of the other. By training the deep transverse abdominal muscle, your entire core will become stronger. 

The exercise below can be started right after delivery. You can start exercising the muscle straight away:

• Lie on your back with your back and pelvis in a neutral position and a slight curve in the back.

• Breath out, contract the pelvic floor to create tension in the deep transverse abdominal muscle. This is a slight tension which you can feel deep in your lower abdomen. 

• Hold this tension for one to two seconds and then relax for five seconds. 

• Repeat ten times.

• Build up? Do a set of ten repetitions three times.

If the diastasis doesn't recover enough after delivery, complaints start to occur and the exercise above doesn't help enough, we advise getting in touch with a registered pelvic floor therapist. He/she can take measurements and give you personalised exercises which are aimed at proper cooperation of all the core muscles..