Diastasis recti is a poorly defined condition most common in post-partum women. It can also affect men and women who have carried a lot of weight around their middle. The condition is characterised by separation of the abdominal muscles along a central tendon (the linea alba). This tendon is meant to stretch and give space to the growing bump, but it may not fully return to its pre-pregnancy state.

Diagnosing Diastasis Recti

The guidelines around diagnosis are murky, but it makes sense to avoid diagnosing the conditions in the first few weeks after birth. It takes time for the body to heal, and a diastasis is no different. Most pregnancies will cause a separation of muscles by the start of the third trimester, so there is little to gain by labelling this at an early stage. The separation can develop anywhere between the bottom of the sternum and the top of the pubis (front of the pelvis).

When the appropriate time comes to assess and diagnose, the process is simple. Your osteopath will ask you to lay on your back with your tummy exposed. They'll want you to bend your knees and rest your feet on the plinth. Then while observing or feeling the muscles of the abdominal wall, they will ask you to raise your head off the pillow. This puts enough stress on the abdomen to engage the muscles and increase pressure to test the linea alba. If the muscles engage with a gap more than 2 fingertip-widths, a diagnosis of diastasis recti can be considered. There may also be visible doming, where the abdomen bulges at the gap.

Width and doming are not the only important points to assess. Depth is relevant too. This is easily tested in the same position without too much discomfort.

Potential Effects of Diastasis Recti

Although it's true that the abdominal wall contributes to the function of the back and pelvic floor, research is undecided about the negative effects of diastasis. Some studies show a correlation between diastasis and back pain or pelvic floor issues, such as prolapses. Others show no link at all.

A diastasis may however make you more susceptible to developing a hernia, so be aware of the symptoms and know when to seek help.

Management Strategies

Most first line management comes down to exercises to rehabilitate the muscles. Avoid exercises that involve a lot of intra-abdominal pressure in the early phase. That means no sit ups, crunches, or planks. The earliest stages will involve breathing and diaphragm control, and more focus on engagement than power. Your osteopath can help to support you through the stages.

However, this is not just an issue of muscles, which are able to contract. The linea alba itself cannot contract, so progress is reliant on the surrounding tissues doing their part. If you're planning to have more children, aim to improve your separation as much as you can between pregnancies, but don't worry too much if some remains.

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