Diastasis Rectus Abdominis (DRA)

January 16, 2024

What is Diastasis Rectus Abdominis, or DRA?

Diastasis Recti is a common impairment of the abdominal wall where the abdominal muscles separate along the midline of the abdomen at the linea alba. The rectus abdominis muscle runs vertically along the front of your stomach. It is divided into left and right sides by a band of connective tissue called the linea alba that runs down the middle. Often during pregnancy, especially during the third trimester, the muscles expand and stretch with the quickly growing uterus and baby. Once you deliver your baby, the linea alba can heal and come back together because it is highly elastic. But if that tissue is overstretched and loses the elasticity, the gap might not fully close, resulting in a DRA.

How Might I Know If I Have a DRA?

Here are some symptoms that could be an indication.

Visible bulge or “pooching” that protrudes above and/or below the belly button.
A softness or jelly-like feeling around your belly button.
Coning/tenting/doming appearance along midline above or below belly button when you contract your abdominals.
The separation itself is not painful, but you might have other pain as a result, including low back pain, hip pain, pelvic pain, or pain with intercourse.
Urinary incontinence
Constipation
Weakness in core

While lying on your back with knees bent up, lift your head off the floor. Place your fingers in the gap or separation. A separation of 2 finger widths or less is considered normal, anything greater is considered having a DRA.

Are There Risk Factors for Developing DRA?

Risk factors for developing more significant DRAs could include multiple pregnancies and pregnancies close together where you might not have fully recovered, being over 35 years of age when pregnant, have multiples (twins, triplets, etc.), having a big baby, being petite, and having a vaginal delivery with pushing which increases abdominal pressure.

What Should I Do If I Have a DRA?

If you suspect you have a DRA, do not worry. Almost 60% of women experience this after pregnancy. You will want to have it assessed at your next doctors visit or come see a pelvic health physical therapist who can assess and get you started on the best movements and core

strengthening exercises based on the level of your separation and your overall condition. The focus is strengthening your inner core muscles without increasing intra-abdominal pressure. You want to avoid movements and exercises that cause that “pooching” to occur. Starting with the basics of diaphragmatic breathing, transverse abdominus setting, pelvic floor muscle activation, and postural awareness is key. Initially, traditional core exercises might be too advanced, but as you get stronger in your inner core, then you can progress with more arm/leg movements and multi directional work.

Things To Be Mindful of With Having a DRA:

Limit heavy lifting. Initially we encourage nothing heavier than your baby, but as you get stronger that will increase. Be mindful to breathe and avoid that Valsalva. Exhale as you do the lift/work.
When getting in and out of bed, remember to log roll and use your arms to help lift/lower your body, vs “jack knife” where you sit straight up using your abs but also increasing that intra-abdominal pressure.
Avoid movements and activities that “pooch” the DRA out, such as sit ups and crunches and double leg raises.
Avoid over extension of lumbar spine, bending backwards, or overstretching abdominals.

Initially, if DRA is significant, binders can be helpful for postural support and approximating the rectus borders, however, avoid dependency on these. Transitioning to active core strengthening early on is the ideal.

Is There Anything I Can Do During Pregnancy to Prevent DRA From Occurring?

Due to hormonal changes in our body and the rapidly growing baby during pregnancy, some separation is normal and expected. Things to work on to minimize that overstretching during pregnancy are as follows…

Maintain a healthy weight gain during pregnancy with healthy eating and exercise.
Use proper lifting techniques and have awareness of posture.
Perform consistent and safe core exercises.
Minimize straining during lifting and during bowel movements.
Log roll to get in/out of bed.

If your DRA is severe and you continue to have symptoms despite building your core strength, or you have concerns about your appearance, surgery called abdominoplasty may be an option. This is only recommended when you decide you are done having children. It is often encouraged to work on your core strength for at least a year before you decide to have this done. Talk to your doctor about the pros and cons and what kind of recovery is involved.

Our pelvic health and core experts at New Life PT can guide you if you aren’t sure where to start. Give us a call 608.742.9356 or send us an email scheduling@newlifept.com to be scheduled for an initial evaluation and determine what options are available to you.

Our My Core Floor program has great workouts to improve core strength and DRA and also some good talks/guest speaker series to reference for DRA as well, so just another great resource to utilize.