Due to hormonal changes and a growing uterus, the abdominal muscles become over-stretched and weak, compromising posture, trunk stability, respiration, trunk motion, and vaginal delivery. Pre-pregnancy fitness levels can decrease risk and severity of RD. It is safe to exercise during pregnancy to strengthen the abdominals and optimize the recruitment and function of the core (diaphragm, abdominals, and pelvic floor musculature). Different strategies are often required to recruit and strengthen properly. This is best done with the help of a physiotherapist trained in this area.
While there is a high incidence of RD in pregnant and post partum women, this phenomenon varies in severity. We clinically quantify this with finger width. We will have the patient lying on their back while palpating the centre line of the abdomen, observing and feeling for any existing gap between the right and left abdominals. The right and left abdominals are join together at the linea alba. Any gap greater than 2 cm is considered to be RD. It is most often widest at the umbilicus and narrower at the top where the linea alba meets the sternum and the bottom where it meets the pelvis. Surgical correction is rarely indicated except for cosmetic reasons or in severe widening. It is important to note that this is different than a hernia where one is at risk for strangulation of the intestines; there is no such risk of this with RD.
Due to the importance of our abdominals for trunk movement and control, breathing, support of the abdominal organs, posture, and bowel and bladder function, weakness in this area is often accompanied by low back pain, and impaired function of our ability to void and evacuate the bowels. The remedy is exercise!
In most women, RD will naturally resolve over time. Women who participate in regular exercise prior to pregnancy are more likely to have smaller RD than women who do not exercise and therefore will require little to no intervention. Resolution of RD can be anywhere take up to one year post delivery or longer. RD can still be detected in women many years after their last delivery.
While this condition requires more research, exercise has been shown to help resolve the condition. Certain abdominal exercises coupled with diaphragmatic breathing (belly breathing) have been shown to be effective. I cannot emphasize enough the importance of proper breathing. Diaphragmatic breathing often needs to be retrained in pregnant and post-partum women due to postural changes and adaptations that occur to accommodate the growing uterus. We are often unaware our breathing mechanics have changed at all after pregnancy. Therefore, breathing in addition to assessing the abdominals and pelvic floor is required to provide the best set of exercises for this condition.
Ideally, all of us moms should seek the care of a post-partum/pelvic floor trained physiotherapist to help regain their fitness and optimize the function of their core during and after pregnancy. They can develop an exercise program tailored to your individual needs and help you not only tolerate the physical demands of being a mom, but also help you get back to doing the activities you love, improving your quality of life and sense of well being.
~ Lisa, Physiotherapist
Chiarello et al, The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women,
Journal of Women's Health Physical Therapy: April 2005 - Volume 29 - Issue 1 - p 11-16
Giridharan, G.Vaishnavi. (2019). Effectiveness of Exercise in Treating Rectus Abdominis Diastasis. Biomedicine. 38(4).