Diastasis Recti Abdominus

Diastasis Recti Abdominus Muscle), or DRA(M), is the name given to the widening of the linea alba, the connective tissue which joins the 2 sides of the abdominal wall together, through the middle of the abdomen.

DRA is often described as the abdominal wall ‘splitting’ or ‘separating’, giving the impression that it should be avoided or that something has gone wrong with the body: this is not true. The widening and thinning of the linea alba – along with the whole abdominal wall – is the body’s normal adaption to pregnancy as the bump grows. This widening and thinning happens in all pregnant women by the 3rd trimester

However, as the abdominal wall becomes thinner and more stretched it is more vulnerable to excessive pressure and strain. DRA only becomes a problem when the abdominal muscles are not able to cope with the pressures and strains the body goes through during day-to-day activity.

Signs that the abdominal muscles may not be working properly include:

  • A bulging or doming in the centre of your tummy when sitting up
  • Discomfort along the centre of your tummy, especially when you have been more active.
  • A feeling of a gap when you feel along the middle of your tummy, or your fingers excessively sinking into the gap.
  • Lower back pain.
  • Symptoms of incontinence or heaviness or dragging in the pelvic floor

Activities that put particular strain on the abdominal muscles are:

  • Heavy lifting or straining which causes you to hold your breath or ‘valsalva’
  • Sit ups (these should be avoided after 16 weeks)
  • Excessive coughing, sneezing or vomiting
  • Any activity that causes a feeling of pressure through the pelvic floor or causes visible doming of the abdomen

To help support the abdominal wall through pregnancy you can:

  • Continue to exercise through pregnancy but modify your programme; seek professional advice if you are unsure.
  • Wear an abdominal support if your bump feels particularly big and uncomfortable or if you spend a lot of time on your feet.
  • Listen to your body and rest when you need to.
  • ‘Switch on’, or engage, your abdominal muscles before doing a strenuous activity such as lifting. To engage your muscles: stand tall and lengthen your spine; place your hand under your bump; switch on your pelvic floor and gently lift your bump off your hand.
Lifting the bump to engage the abdominal muscles

The first 6-8 weeks after having your baby are when your abdominal wall is at its weakest and most vulnerable as it recovers post-pregnancy. Most of the narrowing of the linea alba occurs during this time and supporting your body’s healing should be prioritised. To support recovery it is important that you:

Take in good nutrition, especially protein-rich foods. Protein is essential for good healing so if you are vegetarian or vegan make sure you are getting enough. Plan ahead during pregnancy to stock your freezer or get meals delivered.

A soft, elasticated abdominal support can help to alleviate discomfort and to take the strain off your abdomen while it is healing. You do not want to wear anything corseted, that is so tight that you feel pressure on your pelvic floor, or that restricts your breathing.

Allow your body to heal with adequate rest. Sometimes the temptation is to get back to normal as quickly as possible. Take this time to heal and to avoid any activity that causes your linea alba or abdomen to bulge.

Do not strain on the toilet; keep hydrated and eat plenty of veg to help prevent constipation.

After 2 months or so most women will recover their abdominal wall integrity and be able to start to increase their exercise and activity with no problem. Some women may find they still have a tummy that looks pregnant, or notice the symptoms listed earlier, especially when trying to increase activity. In this case, it is advised to seek the advice of women’s health physio. They will be able to help you regain your abdominal strength and function.
Which exercises are suitable after pregnancy is dependent on each individual woman and her circumstances.

The table below is a guide. If you are unsure whether an exercise is right for you then seek professional help. Harder exercises won’t remain out of reach forever but need building up to. When you are thinking about postpartum recovery you need to plan for the ‘long game’. Muscle strength can take 6-8 weeks to improve; however, connective tissue takes longer, up to 2 years to strengthen and remodel.

Time after birthAim of exerciseTypes of exercise
0-8 weeksRecovery and core connectionPelvic-floor exercises, optimise breathing pattern and posture, gentle stretches
8-14 weeksProgress core exercises, begin cardiovascular work and introduce strengthYoga, Pilates, walking, light weights, modified circuits
14-48 weeksIncrease intensity, build strength, return to activity  Walk/ run programme, increase weights

When exercising ask yourself the following questions:

  • Can you do the exercise without pain?
  • Can you do the exercise without leaking or feeling extra pressure in the vagina/ pelvis?
  • Do you feel you have control over your body and can maintain your form?
  • Can you maintain tension in your linea alba without excessive doming or bulging?

If the answer to these questions is no, or it doesn’t feel right, then stop and seek advice from a women’s health professional.

If you have an abdominal wall that is not working properly the worst things you can do are either to do nothing and try to put up with it, or to blitz it with a high-intensity abdominal work out! Seeing a professional will help you to find a middle way back to fitness.