Diastasis of Rectus Abdominis Muscle (DRAM)/ Abdominal Separation

Physio&SoleClinic Diastasis Recti, Physiotherapy, Pre & Postnatal September 30 2020

What is Diastasis Recti?

Diastasis Recti is the separation of the abdominal muscles (rectus abdominis), which  results in a gap of at least 2.8cm in the middle of the tummy. Although this can happen in both men and women, it occurs more commonly in women due to the physical changes during pregnancy. The rates of occurrences range from 67% to 100% in post-partum women.

Why does it matter?

Diastasis Recti can lead to:

• Pain the lower back and pelvic region post-delivery
• Poor core muscular stabilization of the pelvis and spine due to poor and faulty postures
• Urinary incontinence
• Gastrointestinal problems like bloating and constipation
• Abdominal hernias, abnormal organ or tissue protrusion, such as the bowel, through the cavity wall in which it usually resides.

Who does it affect?

• It affects both men and women. 
• In men, DRAM can be due to improper exercise technique when weightlifting without proper form, resulting in too much pressure on the abdominal wall.
• Newborns can also be born with abdominal diastasis, but usually resolves as the baby grows.
• In pregnant women, it is inevitable in the third trimester as the uterus rapidly stretches to allow growth of the baby. This will cause the separation of the rectus abdominis and linea alba (connective tissue between the six packs) to make room for the growing baby. This separation usually heals itself in about 8-12 weeks. However, the gap can persist for many new mums. This is due to the connective tissue no longer providing tension and stability, thus, resulting in compromised tummy/abdominal muscles. The lack of stability and protection affects the body both aesthetically and functionally. Many new mums complain of frustrating post-baby tummy protrusions which would not reduce even after they have lost the baby weight.

What to look out for?

Often, diastasis recti (DRAM) or abdominal separation can be seen with a protruding dome down the length of the tummy, particularly around the belly button. You may notice this in your daily movement like when lying down or getting up from the bed.

Assess your tummy if you are at least 8 weeks post-delivery. A diastasis occurs when there is a gap of more than 2.8cm (around 3 fingers spacing) between the abdominal muscles.

Here are some simple steps to help you identify DRAM:

1. Lie on your back, with your knees bent and feet flat on the floor.
2. Place your fingers on your belly button.
3. Lift your head and neck slightly off the floor as if you are doing a sit-up or crunch, while tightening your abdominal muscles. Press your hand down gently between your abdominals, horizontal to your spine. If there is a gap larger than 2 to 3 finger spaces, you could have DRAM
4. Do these tests above and below your belly button, and measure for gaps in these areas

How can a Women’s Health Physiotherapist help?

A thorough assessment is necessary in order to determine the management plan. The main aim of diastasis recti treatment will be to restore the function of the rectus abdominis and the surrounding core muscles, stabilize the pelvis during activity and under load. When your body recovers and with better core muscles activation, lower back strains or pelvic pains will reduce. Musculoskeletal physiotherapists who are trained in the treatment of DRAM or physiotherapists specialized in pelvic floor dysfunctions can help to assess and customise a programme suited to your condition.

Feel free to send in any queries to our “Ask a Physiotherapist” Whatsapp Service at 98997967. Our physiotherapists will be ready to assist you.

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