What is Diastasis Rectus Abdominis (DRA)?
Diastasis Rectus Abdominis (DRA), also known as abdominal separation, is separation of muscle bellies midline in the muscle, rectus abdominus along the fascial connection of the line alba. A study looking at DRA in pregnant and postpartum women showed at third trimester 66% and postpartum 53% of women had a DRA present.
Women with Diastasis Rectus Abdominis will often have a core that is potentially poorly functioning. All abdominal muscle (transversus abdominus, internal and external obliques and rectus abdominus) meet at the facial connection. They are all compromised resulting in a lack of protection and stability affecting the whole body functionally and aesthetically. When the core system does not support the body as it should, the body may compensate leading to other musculoskeletal injuries such as back pain, incontinence and organ prolapse.
What are signs and symptoms of DRA
The sign and symptoms can vary. They can occur as a result of our muscular support system (core) for the back, pelvis and organs to weaken, therefore the connective tissue take the load instead of the muscles. Some of the most common signs and symptoms are:
- Bulging, doming and sagging through the abdomen
- Pain in the back, pelvic floor, pelvis and abdomen
- Pelvic floor problems such as urinary and fecal incontinence and organ prolapse
- Gastro-intestinal disturbances such as bloating and constipation
What is the cause of DRA?
The cause of DRA is a result of increased intra-abdominal pressures in the abdomen and pelvic floor that occurs during pregnancy as the belly expands. This occurs in all pregnant women to allow for the growth of the baby. Most likely all women have some level of diastasis in the third trimeter as a result of this. However, it becomes a problem if the gap remains widened at 8 weeks postpartum.
How to test for DRA?
Lie on your back with your knees bent and feet flat on the floor. Your head and neck should be relaxed then place you hand facing you and 2 fingers just above your belly button. Lift your head and neck just off the floor and press down into your belly with the 2 fingers. You are feeling for the presence of gapping which is measured in finger widths.
What should you avoid?
Certain activities can put the DRA at greater risk such as:
- crunches and sit ups
- straight leg raises
- functional activities like rolling and sitting up
How can physiotherapy help?
Physiotherapy can help to restore the form and function of your core system. Treatment would include:
- Manual Therapy to address any muscular and alignment imbalances
- Progressive exercise program which addresses your breathing pattern, abdominal and pelvic floor muscles
- Body mechanics in functional activities of daily living
- Postural awareness
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About the Author
Lee DG, Lee LJ, & McLaughlin L 2007. The role of fascia in both function and dysfunction and the potential consequences following pregnancy and delivery. Journal of Bodywork and Movement Therapies 12, 333-348
Boissonnault J S. Blaschak M J 1988. Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy (68):7