Rectus Diastasis Abdominis - Part 1

The What, The Why and The How

I receive many queries and concerns from postnatal women regarding their “Mum-Tums”. There is so much pressure on women to snap back into shape after having children, and the images in the media don’t help this. Of course some women are blessed with an ability to shed their baby weight and tone up quickly, but for others [most] this is not quite so easy. The reality is that it takes time, sometimes several years, for a woman’s body to heal and restore itself after pregnancy and birth. And sometimes, it needs an extra helping hand to make this happen.

“Why do I still look pregnant 6 months on?”

“Why do I have a bulge in the middle of my tummy?”

“Why can I see my tummy moving after meals?”

“Why won’t my tummy go down – I’m doing regular sit ups and leg raises but they don’t seem to work?”

These are common questions I am asked, and they all lead to a potential diagnosis of Rectus Diastasis Abdominis [RDA], also known as tummy separation. Unfortunately, this seems to be a diagnosis for which women do not always receive sound, up to date, comprehensive advice, and they are frequently unsure of how to manage and restore their tummies safely and effectively in the months following childbirth. This problem may be compounded by expensive online packages which are frequently advertised on social media and the internet, which promise to 'fix' and resolve RDA, however one size does not always fit all and what may work for one woman may not work for another.

The aim of this first of a 3-part blog, is to provide some FREE information about what exactly RDA is, why and how it occurs and what you can do about it. Information is power, and if women don’t know about the What, the Why and the How, how will they be able to achieve optimal recovery in the most effective way?

So, what is Rectus Diastasis Abdominis and How does it happen?

The abdomen consists of several large muscles whose fibres criss-cross and interconnect at the midline. These muscles insert at the centre of the abdomen, into a band of tissue called the Linea Alba. This structure acts as a support and central tendon for the tummy muscles to attach. It is not a muscle itself, more of a strong, stretchy band of connective tissue. There is often much emphasis placed on the Rectus Abdominis [also known as the six-pack muscles] in RDA, however it is important to know that other abdominal muscles [Obliques and the Transversus Abdominis] also insert into the central Linea Alba and so play a role in it’s structure and function.

The role of the Linea Alba is to provide support and stability to the abdominal wall, to maintain appropriate pressure from within the abdomen and to transfer load across the abdomen, from one side to the other, during movement and function.

During pregnancy, the abdominal muscles must lengthen and stretch to accommodate the growing baby. This means that the Linea Alba must stretch too, and circulating hormones in the blood assist in this process.

Sometimes though, the connective tissue can stretch so much that it loses its elasticity and tensile strength and it weakens. The abdominal muscles continue to exert a pull onto the Linea Alba, and they separate at the midline. It is this separation which is referred to as RDA [See the below image by Burrell Education, used with Permission].

Why does it occur? 

Most women will have a degree of RDA by the end of their pregnancy. In most of these women, this will resolve with the first 8 weeks postpartum. However, in approximately 40% of women, RDA persists and further specialist rehabilitation will be required to enable recovery.

There are not clear reasons as to why RDA persists in some women and not others, however some theories have suggested that excessive weight gain during pregnancy, delivery by Caesarean section, genetic factors, and exercise and lifestyle patterns may be influential.

RDA can vary in severity. In practice, a RDA of more than 2.5cm [approximately 2 fingers width] is considered significant, however some RDA widths can reach up to 23cm. Small tears can also occur within the Linea Alba, resulting in hernias, commonly at the level of the tummy button or above. It is not always the degree of separation that takes place, but how the abdominal responds to it that is important.

What does it mean if I have a RDA?

As the Linea Alba plays such an important role in the function of the abdomen as a whole, if it becomes weakened and dysfunctional, this may lead to a number of other problems developing.  If weakened and overstretched, it will now struggle to maintain the pressure from within the abdomen and the tummy can protrude outward as a result. Movement of the bowel may sometimes be seen through the thinned tissue and you may experience a central or midline ‘bulge’ which is particularly obvious during instances of increased pressure inside the abdomen, such as coughing, when getting up from lying down, or during sit ups. If these activities are performed regularly or incorrectly, this places repeated strain and pressure upon the Linea Alba which may deform it further and may ultimately make your RDA worse. The Linea Alba can  lose its functional ability to effectively transmit forces across the abdomen and muscle imbalances may occur as the body responds to regain stability. Spinal, ribcage and pelvic issues may develop, resulting in pain, stiffness and postural problems.

RDA can also lead to pelvic floor problems. The change of pressure management within the abdomen can result in a downward direction of pressure into the pelvic floor during activities such as coughing and sneezing or sitting to standing. This can eventually lead to the development of pelvic floor dysfunctions, including urinary or faecal incontinence, or pelvic organ prolapse.

 So to summarise, if you suspect that you may have a RDA, it is essential that you seek help and have a thorough examination by a therapist experienced in this field, to check for the issues highlighted and to determine how your abdominal wall is functioning. It may seem tempting to opt for a 'quick online fix',  but without a proper physical assessment of all the potential factors at play, you may not be managing your RDA appropriately. Each woman must be treated as an individual and there are no prescriptive recipes for the treatment of this condition. 

At Enliven Health we offer complete Women’s Health assessments for the postpartum woman, including the Mummy MOT, during which we will be able to comprehensively assess if you have RDA, which can lead on to effective treatment and recovery. If in doubt get in touch now – The new year is the perfect time to take control of your postnatal health!

In Part Two……

The assessment of RDA – What is involved and is it just about ‘The gap’?

Rectus Diastasis Abdominis - Part 1