Diastasis recti: Separation of the abdominal muscles
DIASTASIS recti is an abnormal separation of the rectus abdominis muscles (the muscles responsible for a ‘six-pack’) and is a common complaint of women after pregnancy.
Normally a thick sheath connects the two muscle sets, but it can become stretched by a growing abdomen, when women have larger babies, multiple pregnancy (twins, triplets), more than one pregnancies, or in women who are obese.
According to obstetrician-gynaecologist (ObGyn)Dr Anna-Kay Taylor Christmas, it is diagnosed on exam by palpation of the abnormally large space between the muscles on the abdominal wall.
“It may look like a ridge running down the middle of the abdomen, and usually becomes more pronounced with coughing or straining, and disappearing when relaxed. The patient may be able to insert her finger or fingers into the space. If it is present during pregnancy, it may be possible to feel the uterus through the skin of the abdomen. In more severe cases, further imaging such as an ultrasound or CT scan may be required to differentiate it from a hernia, which is a different type of weakness in the abdominal wall,” the ObGyn explained.
She said the symptoms tend to be mainly cosmetic, as diastasis recti may result in ‘mummy tummy’, a slightly lower abdominal bulge that is difficult to remove even when normal weight is returned. With more severe separation, symptoms may become more pronounced and include pain or discomfort, core weakness and difficulty lifting objects, lower back pain and altered posture.
However, Dr Taylor Christmas said many cases resolve spontaneously within eight weeks of delivery after pregnancy. But for those that do not, treatment is largely conservative, consisting mainly of core-strengthening exercises.
“It is important to do the correct exercise techniques which involve pulling the abdominal muscles towards the back, such as what is done with planks, for example. Incorrect manoeuvres such as crunches, although commonly used to improve abdominal muscle tone, may actually worsen the diastasis, as they involve pushing the abdominal muscles outwards. If unsure, a physiotherapist is a good person to assist with proper exercise routines,” she said.
In addition, for some severe cases, Dr Taylor Christmas said exercise alone may not be enough and surgery may actually be required to correct the defect.
“This is usually reserved for patients who do not improve with time and exercise and in whom the symptoms are problematic to the point of interfering with normal functioning. The surgery can be done open or laparoscopically through tiny keyhole incisions,” she said.
Dr Taylor Christmas maintained that the condition cannot always be prevented, but it can be limited by avoiding excess weight gain before and after pregnancy.
