Have you ever heard of DRA? If you have been pregnant, it is likely a topic that you’ve heard of or learned about, or may have experienced during and after your pregnancy. Diastasis Rectus Abdominus is the stretching of the linea alba, which is the connective tissue that runs down the front of your abdomen and connects the left and right core muscles called your rectus abdominus, or “the 6 pack abs”. In pregnancy, the linea alba is stretched as the abdomen grows with growing baby. This can cause a doming or bulge to appear along the centre of the abdomen, and can remain present after delivery.
There are many misconceptions about this condition that can cause confusion and fear, both things expectant mothers do not need to experience. In the study by Mota et al, DRA was defined as a separation of the abdominal muscles more than 16mm at 2cm below the belly button.1 This study examined how common DRA was during and after pregnancy. They found that at 35 weeks pregnant, 100% of the participants tested positive for DRA, with a range of separation between 22 and 126mm. As well, they found that at 6 months postpartum, the prevalence in this same group was 35-39%. All women had some degree of separation of their core muscles in pregnancy, while only 35-39% remained at 6 months postpartum. During pregnancy this tissue has to undergo a level of stretching to accommodate the growing uterus and baby.
Furthermore, Mota et al. found that of those women who still had DRA 6 months post-partum, there were no statistical differences between them and those who did not have it, regarding their: pre-pregnancy body mass index (BMI), BMI at 6 months post-partum, weight gain, baby’s birth weight, woman’s abdominal circumference, hypermobility, and women with DRA at 6 months were NOT more likely to report low back pain.1 All this to say, we do not know what causes some women to continue to experience it while others do not. Many women believe it to be the result of their size before or during pregnancy, which is not supported by evidence. Although the evidence isn’t clear, decreasing the amount of load on the linea alba through proper posture, movement and lifting techniques could help to limit the amount of separation or frequency of separation, and therefore allow the linea alba to return to its pre-pregnancy position postpartum.
One thing we do know about DRA is that it is often linked to increased rate of pelvic organ prolapse (POP), pelvic girdle pain, and urinary incontinence. All of these conditions increase in the pregnant and postpartum population, and have all been found to be the result of: compromised activity of the deep muscles of the abdominal wall, overactivity of the superficial muscles, and improper recruitment strategies of these muscles. A proper assessment of DRA will include your trained healthcare professional, such as a physiotherapist with education in DRA, evaluating the abdominal wall and how it functions with the diaphragm and the pelvic floor. From this assessment, the therapist can provide an individual and specific treatment plan and exercise program to help address the issues that result in the DRA, pelvic pain or prolapse. As a pelvic floor physiotherapist, I have numerous certifications to assess and treat DRA, pelvic pain, prolapse, and many other conditions in pregnancy and postpartum. If you have any questions or would like to be assessed, contact the clinic at 613-362-1180, or book online. I’d be happy to meet you and help develop a plan that works for you.
-Sarah Despatie, PT