Abdominal diastasis, diastasis rectus abdominis, diastasis recti, abdominal separation, ab gap, “mummy tummy” ….. it has a lot of names. But whatever you call it, I want you to know a little bit more about it so you can be better equipped to manage it.

What is it an abdominal diastasis?

Diastasis Rectus Abdominis (also known as DRA) is a common occurrence where the linea alba (the line of connective tissue between your six-pack muscles) gets stretched. Note that I said stretched, not torn. Think of pizza dough - stretching the pizza dough is a diastasis, but there are no holes or tears in the pizza dough (which would be a hernia).

DRA most commonly occurs during pregnancy but can also occur in people who have never been pregnant, such as people who lift really heavy weights with poor abdominal engagement and technique.

DRA is considered a normal change in pregnancy!

Your body stretches to accommodate the growing baby and honestly, stretching is kind of the name of the game when it comes to pregnancy. Did you know that uterine capacity increases from 4ml to 4000ml at term and abdominal length increases by an average of 115% at 38 weeks gestation? Can you imagine how uncomfortable pregnancy would be if your stomach didn’t stretch? I can only imagine the heartburn.

So I hope we can all agree that the stretch is a good thing and we are on team stretch - yay for stretch! But unfortunately, as with other body parts faced with a sudden increase and then decrease in size (RIP pre-baby boobs), it is also quite common for that stretch to remain after pregnancy.

How common is DRA?

Way more common than you think! Here’s the research from Mota et al and Sperstad et al showing how common DRA is in pregnancy:

33.1% of women at 21 weeks pregnant
100% of women at 35 weeks pregnant
60% of women at 6 weeks post-partum
32% of women at 12 months post-partum

How do I know if I have a diastasis?

There are a few ways to tell! The most obvious sign that people notice is the presence of an abdominal “dome”, “cone” or “triangling” of their stomach when they exercise or during daily activities (like getting up from the couch or straining on the toilet). This is a protrusion or bulge down the center line of your stomach when you attempt to use your muscles without correctly preparing or stabilizing first.

Some common movements which can cause doming are crunches, “V” sits, Russian twists, pull ups and getting up from bed or a reclined position. This picture is someone with a diastasis doing a double leg lift without any preparation for the movement. Can you see the peak down the middle of her tummy? This is what we are talking about when we say “the dome.”

Avoiding the dome is one of the biggest considerations for proper DRA management.

If you haven’t noticed a dome you may also be able to feel the increased space between your abdominals.

To test yourself for DRA:

Lie flat on your back and press your fingers into your midline right underneath your sternum.
Press again a few inches down and keep going all the way down to your pubic bone.
When you press you might feel that some places feel firm and springy while in other places your fingers might sink in deeper. This could indicate an area that has stretched.
You can confirm this with a head lift test: with your fingers in the soft spot do a mini crunch and lift your head and shoulders off the ground, does the soft spot narrow? If it does that is another indication that you likely have a diastasis (the narrowing is a good thing, don’t let it freak you out!).

Need a visual? Check out this youtube video for a guide to assessing your own DRA.

Still not sure if you have a DRA? A pelvic floor physio, midwife or OB could also tell you right away if you have a diastasis and give you further direction.

Is it my fault?

This is a question I hear a lot and the answer is usually a resounding NO. Women often say to me “maybe if I didn’t gain so much weight” or “maybe if I was younger then my gap wouldn’t be so big” but according to the research this simply isn’t true.

According to a wide body of research, here is a list of things that are NOT risk factors for DRA:

Age
Ethnicity
Height
Pre-pregnancy weight
Duration of labour
Method of delivery
Weight gain during pregnancy
Baby weight at birth
Gestational age
Exercise training before, during and after pregnancy
BMI before pregnancy or at 6 months postpartum

Some things that we think might contribute to a diastasis are:

Having multiple pregnancies close together
Being pregnant with multiples
Heavy lifting using a Valsalva technique
Genetics

Will it go away?

While some natural recovery can occur in the first 8 weeks postpartum a large number of women will still have a DRA and need to learn how to properly manage it going forwards.

How do I manage my DRA?

Management will include learning proper movement and abdominal techniques so you can exercise without worsening your diastasis. You will need to avoid the dome. I know I mentioned that earlier but it needs to be repeated.

Exercises and movements which cause a dome will need to be modified until you are strong enough to maintain control throughout the entire movement.

Take a look at the pictures on the right hand side. You can see the doming in the DRA in the top picture. Through proper technique, this doming can be controlled - this is demonstrated in the bottom picture. This person has properly activated the rest of her abdomen and is in control of the movement. Can you see how her stomach remains flat even when she lifts her legs?

(For what its worth, this lady deserves a lot of credit because that move is really hard to do properly and I’m sure it took some time and practice to get to this level!)

The most important thing to remember:

AVOID THE DOME. Say no to the dome. You are now a dome-free zone.

A pelvic floor physiotherapist will be able to assess your abdominal diastasis, teach you correct abdominal control techniques, give you exercises to increase your abdominal strength and endurance, and help you transition back to your preferred type of exercise.

If you suspect you have an abdominal diastasis and want to investigate further, please feel free to book with Nicole at Ladner Village Physiotherapy by booking online or calling us at (778) 630-8800. She will be happy to help!