What is Diastasis Recti - Abdominal Separation?

One of my biggest fears for the postnatal life was to get abdominal separation (or with a more technical term, diastasis recti). This seemed to be a high risk for me as my mum had an ever growing abdominal hernia and I felt like I might be genetically prone to it. Even though knowing that for her it wasn't necessarily the pregnancies bringing it on (as she did have hernia in her childhood too), it is quite clear to me now, that the 3 pregnancies and childbirth did contribute to her adult situation too.

I was very much switched on when I first learned about it in dept while I was pregnant with my first child, and I was relieved to learn how to take care of it.

Primarily I want to write in simple words about what it really is. First of all, the word "separation" makes it sound worst than what it actually is. Your abdominals are not physically separated when you have this condition. I'm going to explain it more detailed right now.

Did you know we have 4 abdominal muscles?

The outer layer is called the rectus abdominis, this is the most superficial one, and this is the one which can easily be seen when somebody has the 6 packs. This one goes from the bottom of your sternum and chest down to the front of your pubic bone. And this is the one which has the linea alba on it's midline, a long fibrous tissue. This muscle's primary role is to bend your body forward.

Then we have 2 layers on the sides, the external and the internal obliques, which are covering your sides on the front, starting from your lower ribs, your hip bone and pubic bone, going towards the linea alba and onto the abdominal aponeurosis, a sheet of connective tissue at the front of your abdomen. Both of these abdominal muscles pay a great role in bending your torso sideways and stabilising your core.

The inner layer is called the transversus abdominis, which is hugging your core like a belt. In more details this one is coming from the lower ribs, the thoracolumbar fascia (a sheet of connective tissue on the lower back), from the pubic bones and the inguinal ligament at the front of the pubic bones. This one attaches onto the linea alba, the joint at the front of the pubic bones, and the bottom of the sternum. This muscle is mostly working for stabilising the core and to manage intra abdominal pressure along with the other abdominal muscles, diaphragm and pelvic floor muscles.

So what happens, when somebody has an abdominal separation? Are the tissues in the midline opening up? No. If there is an opening in the tissue than we are talking about a much more serious condition, called hernia which definitely requires medical attention. The abdominal separation means that the connective tissue in the midline is stretched out and in consequence the two sides of the abdominal muscles are positioned further away from each other than at a healthy state. This is very common to happen during (but not exclusively in) pregnancy. Due to the hormonal changes in pregnancy our abdominals and connective tissues of the area need to stretch out more and more to allow space for the growing baby, uterus and placenta. While our body is recovering to a certain level by itself after childbirth, the tissues doesn't get back to their pre-pregnancy length and firmness for most of us. I would wait the initial 6 weeks of natural recovery to pass before checking for abdominal separation. A smaller distance is considered to be normal/healthy and quite common, especially shortly after giving birth. It is considered to be an abdominal separation if the gap between the muscles is wider than 2-3 finger width (2 cm). This separation can be present anywhere in the midline. The gap between your muscles can show on the upper part between your sternum and bellybutton, around your bellybutton, on the lower part between your bellybutton and pubic bone, or in combination of 2 of these locations, or all the way through. This condition is not final, the gap doesn't necessarily stay with you forever. However, it is very important to take good care of it, you can do specific workouts to reduce, or in some occasions to actually close the gap. (Please keep in mind that "closing the gap" in this sense means to decrease it under 3cm.)

Why is it concerning to have abdominal separation?

Having a gap between the two sides of your abs might not seem to be a big thing other than aesthetics. It might drag your self esteem if you want to meet today's society's expectations of having a perfect belly, which I personally find quite unfortunate, we shouldn't have that kind of a pressure over our head at all. But there is more than the looks. And this is where it becomes more complex. The abdominal muscles pay a big role in keeping the abdominal pressure in a healthy level and to keep a stable core. Having the tissues stretched out contributes to lower muscle strength, and in consequence less resistance against the intraabdominal pressure or instability. This can lead to lower back aches and more pressure going to the (likewise stretched out) pelvic floor muscles, causing leaks. Now if we add the everyday chores of caring for a baby, only thinking about all the times we need to pick them up, change their nappies, feed them, it is getting pretty obvious that a lot of extra work is required from our core to support our body. This can all be improved by adequate exercises and it is crucial to do them regularly even after the expected changes have occurred to maintain good levels of core strength and to keep the gap on the minimal level. Not to mention, it does help in decreasing the waist width too.

I think this explains why do I put so much emphasis on abdominal separation at my sessions. I check every client at their first session and depending on the findings I do offer follow ups too.

Please make sure to check yourself/get yourself checked for abdominal separation and make sure to get educated on how to improve and prevent the gap from growing and eventually become an abdominal hernia.

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