Diastasis Recti Abdominis (“Mummy Tummy”)

What is Diastasis Recti Abdominis (DRA) and what causes it?

DRA is a separation of the rectus abdominus (RA) muscles (or “abs”) due to a stretching of the connective tissue (the “linea alba”) that joins them together. These muscles run vertically from your rib cage to your pelvis, and of course you have one set on each side of your midline. The contents of your abdomen are enclosed by these – and other – muscles at the front, and by your spine and back muscles behind. This contains everything neatly, but these muscles also provide support for your back in stabilising your upper body and keeping you upright!

DRA can occur in women and men if the abdomen becomes distended due to obesity, or weakens due to chronic straining, or many years of abdominal loading / lifting with a poor technique. However, one of the most common causes of DRA is pregnancy, or pregnancies, resulting from a stretching of the abdomen in the 3rd trimester, and the associated changes in hormones, which makes connective tissue and ligaments more stretchy – which, of course, is all a necessary process! Not all women will have a lasting DRA, and indeed in many cases it will resolve. Unfortunately, the risk factors for a DRA beyond 8 weeks postpartum are unclear and recent research (Mota et al, 2014), found factors such as pre-pregnancy BMI, weight gain during pregnancy, baby’s weight, or hypermobility, to be of little value in terms of predicting the condition. That said, DRA is common and the above study found that around 40% of women had a DRA at 6 months postpartum.

Does DRA matter?

Despite the high incidence of DRA, the answer is yes – DRA does matter! And for different reasons. For a lot of women, their initial concerns may be cosmetic. Their abdomen may look and feel quite different to how it used to and for some this is enough to seek advice. However, even if this is not of concern to you, it does not mean it isn’t important to get help from your physiotherapist. As alluded to above, DRA weakens the overall important role of the abdomen – particularly when it comes to support for your upper body. The los of tension across the abdomen reduces the ability of this large muscle group to support your posture, resulting in an increased reliance on the muscles in your back, and often, back pain. Couple this loss of support with a change in regular movements and activities (such as increased the lifting and bending over that comes with early motherhood), and you have a number of risk factors for chronic low back pain.

Although most commonly we think of our ‘six-pack’ muscles (RA) as our abs, our abdominals are actually formed by 3 layers of muscles and also closely related to our all-important pelvic floor muscles. So, not only do our back muscles have an increased demand, but also all of these muscle groups. Without the support of the RA, these muscles struggle to do their own tasks and we can experience associated difficulties such as a loss of pelvic stability, and reduced pelvic floor control. Of course, this can manifest in myriad ways, such as pelvic or hip pain, and a loss of bladder and bowel control, or painful sex. These are topics in themselves and I will save that for another day, but hopefully you can now see the importance of doing what you can to address a DRA and loss of abdominal support.

How can I tell if I have DRA?