Worried about Diastasis Recti during Pregnancy? Here is what a Durham Pelvic Floor PT wants you to know
Worried about Diastasis Recti during Pregnancy? Here is what a Durham Pelvic Floor PT wants you to know –
If you’re pregnant woman who wants to keep training, maintain her fitness, and continue feeling like herself while her body changes and you have noticed bulging in your midline or coning when you get out of bed, it’s understandable that you might wonder if you are doing something wrong.
If you are like any of the active moms I help as a pelvic floor PT during pregnancy who are worried about exercises to prevent diastasis recti during pregnancy and want to gain a deeper understanding of what exercises to focus on postpartum, this blog will guide you through the contemporary understanding of diastasis recti during pregnancy that challenges that idea that your abs are “ripped” or “separated”.
What is Diastasis Recti during pregnancy
During pregnancy, the abdominal's natural stretch and the connective tissue in between the 2 six pack muscles called the linea alba widens due to physiological, mechanical, and hormonal influences from your body growing a baby.
This means for active women concerned about preventing diastasis recti during pregnancy, the better question is how can you safely maintain your strength, fitness, and capacity as your body changes while pregnant.
How using this contemporary approach to care elevated my clients body confidence.
“Revolutionary”
Is what my postpartum client said after I explained the contemporary way we understand diastasis recti during pregnancy and postpartum
Like many moms after birth - she was researching online and asking friends what happened to them.
Naturally, this brought a lot more questions to the surface specifically about healing diastasis recti - the space between her 2 six pack muscles.
Working together with my client we made a fundamental shift so that her fear of diastasis recti was eliminated, We flipped the narrative about Diastasis Recti during pregnancy and postpartum-
➡️FROM something is separated as this leads many women to believe that it is something they need to fix
✅TO: it’s stretched out, it's thinned, it sounds like it's something the body was naturally designed to do to accommodate a baby, which means fear is not indicated.
Is Diastasis Recti Normal During Pregnancy?
It happens naturally to up to 100% of women during pregnancy as a result of the body creating space for a growing baby.
This means that because this is a natural process, diastasis recti during pregnancy is not preventable and the amazing news is that research also supports that doing abdominal exercises during pregnancy as exercise does not widen the space between the 2 six pack muscles, known as the intra- recti distance.
Can You Prevent Diastasis Recti During Pregnancy?
Because the occurrence of diastasis recti during pregnancy is normal in up to 100% of women, the goal during pregnancy shouldn't be to prevent your abdominal wall from adapting to pregnancy.
Instead, the goal is to maintain strength and physical capacity while adapting your exercise to your changing body and my role as a pelvic floor PT is to help guide to you continue exercising so that you get the benefits of your bone health, heart health, as well as reduce your risk of gestational diabetes and gestational hypertension or preeclampsia.
Does Coning or Bulging Mean You Have Diastasis Recti?
Coning or doming is another point of confusion for many moms and it's important to know that seeing doming or coning during pregnancy is not a sign that you are doing something wrong.
This is where the nuisances of each woman's individual capacity play a role and where personalized approach with a pelvic floor PT who has an advanced understanding of diastasis recti during pregnancy and postpartum can help you gain clarity on what your body is telling you.
Your unique capacity & progressive overload still matter for injury risk mitigation in pregnancy & postpartum.
This is exactly where I come in as a pelvic floor PT supporting active moms during pregnancy, if you are fearful of an exercise for any reason, it is important you know your options so that you are not scared to move.
Furthermore, coning or doming or the presence of diastasis recti during pregnancy or postpartum doesn't provide information about how strong your abdominal muscles are.
Can You Do Abdominal Exercises With Diastasis Recti During Pregnancy?
The challenge is that women are doing their research, but the outdated narrative exists.
They're hearing from well-meaning providers, personal trainers, friends, and the internet:
❌ Don't do crunches.
❌ Don't do planks.
❌ Don't do sit-ups.
❌ Don't do this or that.
While abdominal exercises are considered safe during pregnancy, the individualized support is key for each woman's unique current skills & physical needs.
Training your whole abdominal wall in pregnancy and postpartum is key for your health as a parent who has a vigorously demanding job of caring for a growing baby, however the appropriate exercise for you depends on your training history, current capacity, symptoms, goals, and the changes happening in your body.
Examples:
The CrossFit athlete who can do GHD sit-ups before she got pregnant will have different capacity that the women who has never done a sit up
Both will need to train their abs in a multidimensional way during pregnancy.
Both will benefit from continued abdominal training postpartum (and for the rest of their lives!)
During the Empowered Pregnant Athlete Program I have created for pelvic floor physical therapy support during pregnancy, pillar 1 Clarity is where I walk moms through what is happening in their core during every trimester and provide bespoke guidance on how to maintain fitness smartly as their baby grows.
Does Exercise Cause Diastasis Recti During Pregnancy?
If you are worried that exercise causes Diastasis Recti in pregnancy you are not alone, this study shows up to 70% of pregnant are worried about how their belly looks and how this influences their body image during pregnancy and postpartum.
Training your abdominal muscles during pregnancy does not mean you are causing damage to your abdominal wall.
Further more, training your abs in pregnancy and postpartum is important, safe, and does not cause diastasis.
Why the Language We Use About Diastasis Recti Matters
What most women don’t realize is that how you feel about your changed body matters more than you think as research has also shown that body image and how you function are influenced by beliefs about diastasis recti.
Using language such as ripped or separated often scares women and implies they have a problem that needs to be fixed whereas when we approach diastasis recti during pregnancy as a natural change, there is less fear about doing something wrong.
Here's an important consideration–
It takes on average more than 10 years for research to become routine clinical practice.
And sometimes the advice you’re receiving isn’t wrong because someone doesn’t care.
Unless your provider is actively investing in continuing education and staying current with the research, they may unintentionally repeat outdated messages.
(In other words— not everyone is a Diastasis nerd like yours truly and reads research articles for fun on a Friday night 😂🤓)
This also means if you are googling Diastasis recti during pregnancy…even well respected health information can provide old and outdated information about Diastasis reci during pregnancy or postpartum as standards to clinical practice do not change as quickly as the research does.
Why Personalized Pelvic Floor Physical Therapy Can Help During Pregnancy
As a pelvic floor PT specializing in helping active women navigate pelvic floor issues like leakage, prolapse, constipation, while also in the midst of pregnancy and postpartum, I often see a big gap in several areas about women's bodies.
Working with a pelvic floor physical therapist during pregnancy help provide guidance on diastasis recti pregnancy, how to stay active during each trimester, and receiving a personalized assessment of your pelvic floor can support you with understanding how to relax and lengthen your pelvic floor during birth so support pelvic floor injury risk mitigation.
Pregnancy changes your whole body and not just your abs or your breast. While hormones do contribute to changes in the ligaments to prepare the body for growing a baby and birth, the pelvic floor often get strained by the additional weight of the baby.
This is important to know because while the uterus does all the work in labor— the pelvic floor needs to get out of the way and this is where pelvic floor physical therapy can be a game changer during pregnancy.
Every week I help active women with pelvic floor problems like leakage or prolapse that interrupt their fitness goals as a result of major pelvic floor injury from a birth they had years ago and it’s important to know, it’s not your fault if you feel clueless about pelvic floor physical therapy or Diastasis Recti during pregnancy, the truth is that women are not taught about this part of their bodies.
Within my Empowered Pregnant Athlete program, I have dedicated sessions for moms gain clarity in their bodies signals as well as to practice effective pushing techniques so that they approach labor with calm and trust in their bodies ability to handle labor challenges.
What Does Diastasis Recti Mean for Postpartum Recovery?
Most women will have a diastasis that will resolve on its on postpartum
This is important because avoiding movements because of fear of doing something wrong leads to weak muscles over time and for some women even years after your baby is born.
I see this all the time in my clinic- moms who were told not to do abdominal exercises because of diastasis throughout multiple pregnancies and postpartum, this leads to chronic deconditioning in the abs as well as low body confidence.
Far too many times I am the 3rd or 4th pelvic PT that they have gone to because they never got clarity on how to build strength or reassurance that they aren’t doing anything wrong.
There is not 1 size fits for how your body “should look” after a baby and how it looks after birth is multifactorial.
Quite often the postpartum moms I help as a pelvic floor PT noticed-
Stretched out connective tissue
Loose skin
Belly fat
and worry that this is diastasis— But it’s not.
My goal isn't simply to tell you which exercises are “safe.” It's to help you understand your body well enough to make confident decisions about your training as your pregnancy progresses.
This is why I believe it is important for moms to work with a provider who can give them personalized information and guidance in the direction of supporting their goals of feeling like their unique self again.
For moms worried about persistent diastasis recti postpartum, is also important to know this- you don’t have to change a diastasis in order to feel strong and working with a qualified pelvic floor PT after birth can support you to have peace of mind in your change body as well as provide guidance for your return to fitness postpartum
I believe moms deserve to understand what is happening in your body so that you can continue to tap into the strength that it is capable of.
If you are a pregnant woman who wants to keep training, maintain her fitness, and continue feeling like herself while her body changes confidently throughout each trimester, I’d love to support you.
Next on your reading list
References:
Theordossen et al. “Diastasis Rectus Abdominis: Time to Reconsider Our Approach. A Scoping Review”. DOI: 10.1097/JWH.0000000000000383
Gluppe S, Ellström Engh M, Bø K. Primiparous women's knowledge of diastasis recti abdominis, concerns about abdominal appearance, treatments, and perceived abdominal muscle strength 6-8 months postpartum. A cross sectional comparison study. BMC Womens Health. 2022 Nov 2;22(1):428. doi: 10.1186/s12905-022-02009-0.
Eriksson Crommert M, Petrov Fieril K, Gustavsson C. Women's experiences of living with increased inter-recti distance after childbirth: an interview study. BMC Womens Health. 2020 Nov 23;20(1):260. doi: 10.1186/s12905-020-01123-1.
Gluppe SB, Ellström Engh M, Bø K. Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial. J Physiother. 2023 Jul;69(3):160-167. doi: 10.1016/j.jphys.2023.05.017.
Theodorsen NM, Bø K, Fersum KV, Haukenes I, Moe-Nilssen R. Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. J Physiother. 2024 Apr;70(2):142-148. doi: 10.1016/j.jphys.2024.02.002. Epub 2024 Mar 11. PMID: 38472049.
Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, Ross D, Montgomery A. European Hernia Society guidelines on management of rectus diastasis. Br J Surg. 2021 Oct 23;108(10):1189-1191. doi: 10.1093/bjs/znab128. PMID: 34595502; PMCID: PMC10364860.
Deering, et al. Exercise Program Reduces Inter-Recti Distance in Female Runners Up to 2 Years Postpartum, Journal of Women's Health Physical Therapy 44(1):p 9-18, January/March 2020. | DOI: 10.1097/JWH.0000000000000157
Fuentes Aparicio L, Rejano-Campo M, Donnelly GM, Vicente-Campos V. Self-reported symptoms in women with diastasis rectus abdominis: A systematic review. J Gynecol Obstet Hum Reprod. 2021 Sep;50(7):101995. doi: 10.1016/j.jogoh.2020.101995.