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Diastasis–Do You Have One?

Before a diastasis.

After a diastasis.

For those of us who have been pregnant, we are all too familiar with the stretching of our tummies, and the “pooch” that seems to want to stick around for months after giving birth. Eager to lose the pregnancy pounds and get our flat belly back, most of us will jump right into doing sit-ups, without giving it a second thought. However, we do need to think about it as this is one of the worst things we could do to our stomach. Why? Chances are you have a diastasis–an uncommon word for a very common problem with women who have been pregnant. What exactly is a diastasis, and how can it be healed? The Colic Calm Journal turned to Lynn Leech, PT, from Intuitive Hands Physical Therapy and a Women’s Health specialist who teaches how women can restrengthen their abdominal muscles, get rid of their “Pooch” and help cure a Diastasis Recti.

Can you explain what exactly diastasis is? And what causes it?

The Rectus Abdominus muscle has two sets of muscle fibers that run up and down from the sternum, or chest plate, down to the pubic bone. They are separated by a connective tissue called the linea alba. During pregnancy as the uterus expands these muscle bellies can become separated and the connective tissue between them stretched thin to make room for the uterus.  This separation is called a diastasis.  A diastasis can also happen to anyone who engages in repetitive, forward, forceful movements like coughing, sneezing, laughing, or doing sit ups incorrectly.

Are there things that pregnant women should avoid doing in order to avoid a diastasis?

You want to avoid any forward forceful movement with your belly, such as laughing, coughing and sneezing.   One of the worst things we do on a daily basis is getting up and down from laying down the wrong way.  If you just sit straight up or “jack knife” up or down, you will most likely bulge your abdomen forward and put excess strain on this connective tissue, thus making it weaker and your split bigger.  A better way to lay down and get up is to roll over onto your side keeping your head down before your start your rolling.

How can a woman tell if she has it?

To determine whether you have a Diastasis Recti:

  • Find a comfortable position lying on your back
  • Place your fingers perpendicularly, pointing down toward your spine into your belly button
  • Lift your head just enough to engage your abdominal muscles- if you lift it too far the muscles come together and you don’t have a true sense of how separated the muscles are.

Any fingers that fill the space between the two muscle fibers of the rectus abdminus let’s you know you have a separation. You also want to look at how deep can you sink into the space between the muscle bellies. The deeper in you go means the linea alba, or connective tissue between the two muscle bellies is not healed.  Another key sign you have a separation is when you lift your head engaging your abdominal muscles and you see a bulge in the midline of your abdomen, that’s a diastasis.

What are things to avoid when you have a diastasis?

Any active, twisting motions will make a disastasis worse.  Anything that causes your abdomen to bulge forward you also need to avoid.   Also wearing a front loading baby carrier will cause increased force on the abdomen and can make a diastasis worse.

What’s the connection between a hernia and diastasis?

A hernia is when an organ pushes through an opening or weakness in the supportive wall of muscle, connective tissue or membranes.  A diastasis is not a hernia as the connective tissue is still intact although very thin and the intestines are not coming through the membrane.  Though when this connective tissue breaks away from the rectus muscle then an opening is created and a hernia can occur.

If a woman has the diastasis with a hernia, is surgery unavoidable?

Yes if the connective tissue is not intact then surgery is your best option for fixing the hernia with a diastasis.  However it is important to learn how to heal a diastasis so the surgery you do have is more successful and you don’t undo what they just fixed.

What kind of ab exercises can a woman do if crunches are a “no-no?”

The main focus needs to be on strengthening the transverse abdominus muscle  because when you contract this muscle it helps to bring the muscle bellies of the rectus closer together again.   After pregnancy the transverse abdominus muscle which attaches at your lower spine and runs completely around your waist and inserts in the front at the rectus abdominus sheath.  It’s the corset of our body.  Think about how stretched out this muscle got.  So the best way to strengthen this is to pull your belly button all the way back to your spine as tight as you can go then try and squeeze it even tighter.  Do this as often as you can.  You need to work this muscle at end range to help shorten this muscle back to it pre-pregnancy state.

In my class, I teach a couple of ways to work the transverse abdominus and the best part is you don’t have to lie down to do it.  You can do them anywhere and anytime.

Can a diastasis always be closed (for example, if a woman had a baby five years ago, is it too late)?

I had a 72 year old woman with an 8 inch separation between her muscle bellies from 7 pregnancies.  Within two weeks of doing the program she had brought it into 6 inches and lost an 1 ½ in her belly circumference.   So it does not matter how long it’s been separated, you can always heal it.  The longer you wait though the longer it takes to heal it.

My belly-button poked out during each of my two pregnancies, but went right back in after I gave birth. Does this mean that I had diastasis or a hernia?

You had a diastasis during the pregnancy but were one of the lucky ones that had it heal on it’s own.    I had a mom come to my class and within two to three weeks she was an “innie” again!

Even though you have a split while you are pregnant, it is possible to heal the split and not make it get worse as your belly gets bigger.  Also, if you have multiple pregnancies it is really important to heal your split as much as you can before getting pregnant again.  The more pregnancies you have without healing a diastasis the bigger the split will get with successive pregnancies.  Having a weak transverse abdominus muscle is the reason you start to show earlier in the second or third pregnancies than you did in the first pregnancy.

About Lynn Leech, PT: As a Women’s Health specialist, Lynn has experience working with Post Traumatic Stress Disorder, Women’s issues, physical pain and emotional trauma. With intimate knowledge of issues residing in the pelvis, sacroiliac joint and the pelvic floor muscles, Lynn has treated dis-ease in these areas that manifest as bladder problems, pelvic pain and/or pelvic floor dysfunction.

Lynn holds a Bachelor of Science in Physical Therapy from St. Louis University, St. Louis Missouri. A true teacher, Lynn continues to supplement her professional experience with training to complement and update her practice.

Lynn can be reached at  303-845-0604 or or by email at lleechpt@comcast.net. Her practice, Intuitive Hands Physical Therapy is located in SW Longmont, CO, but Lynn does offer Skype sessions for anyone out of state that would like to learn how to heal a diastasis or get rid of their “pooch” for good. Visit the Intuitive Hands Physical Therapy website for more information: www.IntuitiveHandsPT.com.

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