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What is Diastasis Recti Abdominis (DRA)?

Diastasis Recti Abdominis (DRA) is weakening or laxity of the linea alba, which is the vertical line of connective tissue between your rectus abdominis muscles (AKA the six pack abs!). The term “diastasis” refers to “separation”, so you may often hear people describe DRA as a separation of the abdominal muscles. I know that can sound scary, but take a deep breath! DRA can be functional as long as there is a strong underlying base (AKA your transversus abdominis or TA) and a general understanding of how to optimize pressure management (AKA coordination of breathing).

DRA commonly occurs as a result of pregnancy due to the increased stretch on the abdomen as the baby grows, but can also result from heavy or repetitive lifting for work, sport or exercise.

DRA may be diagnosed by an ultrasound or simply by finger width. DRA is defined by a distance greater than or equal to 3 finger widths across when placed horizontally on the linea alba during a mini-crunch. This test additionally incorporates the depth to which the fingers sink down into the abdomen and the assessment of the tensile strength of this tissue.

Those at a higher risk of developing DRA include women who are pregnant, have multiple pregnancies and/or births, have a large baby, have a cesarean birth, have other abdominal surgeries, are older than 33 years of age, experience excessive weight gain as a result of or outside of pregnancy, and lift heavy weights or materials repetitively.

Signs and symptoms of DRA may include lumbopelvic pain, pelvic floor dysfunction (i.e. leakage, urgency, frequency, pain), core weakness, and doming or bulging of the abdomen with core exercises, transitions or heavy lifting.

In a study by Sperstad et al (2016) surveying 300 women during pregnancy and 12 months after childbirth, DRA was prevalent in 33.1% at 21 weeks gestation, 60% at 6 weeks postpartum, 45.4% at 6 months postpartum and 32.6% at 12 months postpartum. As you can see, the prevalence of DRA tends to improve with time and natural healing, however DRA will still affect roughly one in three women even one year after the birth of their baby.

Luckily, there are ways you can safely and effectively strengthen your core and prevent symptoms from worsening. A physical therapist can help guide and educate you through this process to help you reach your goals!

PT for DRA will often focus on strengthening the hips and abdominals with a primary focus on the deepest layer of the core, the transversus abdominis (TA). Another major focus is learning how to optimize intra-abdominal pressure control with breathing as well as enhancing lumbopelvic stability. A pelvic floor specialist will additionally integrate manual skills and techniques to target abdominal scarring, myofascial mobility restrictions and pain as well as identify potential pelvic floor issues and tailor an exercise program specifically to your needs.

“Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain” (Sperstad et al., 2016)