For many women they may never hear the words Diastasis or Prolapse. However, if you plan on having a baby, or are postpartum, chances are you’ll be hearing mention of these two conditions at some point. Diastasis and Prolapse are sadly often associated with fear of movement as women worry that it isn’t safe to exercise with these conditions, but we know that this is not the case at all! So, let’s understand them both further with the help of Hollie Grant, Pre and Postnatal Fitness Expert & Founder of The Bump Plan.
What is Diastasis?
Our abdominal wall can be defined as the muscular space between the front of the pelvis, and the front of the ribcage. Within the abdominal wall we have our Transverse Abdominis which runs around our trunk like a corset, our Obliques which run in a diagonal fashion across the abdominal wall, and then the Rectus Abdominis. The Rectus Abdominis are the “famous” muscles as they are the “6-pack muscles”.
Now the Rectus Abdominis is made up of two muscles bellies, that run vertically down the centre of our abdominal wall like two strips of bacon. They do not connect directly to each other, but in fact connect to a connective piece of tissue called the Linea Alba. During pregnancy, as our bumps grow, the Rectus Abdominis muscles move further away from each other, which causes a thinning and widening of the Linea Alba. This is what we define as Diastasis Rectus Abdominis, or DRA – a thinning and widening of the Linea Alba and associated increased laxity of the anterior abdominal wall (1).
DRA is a completely normal, functional part of pregnancy. 100% of women and birthing parents will have DRA at 35 weeks’ gestation and 39% still at 6 months (2). It’s therefore not something we are aiming to avoid, or be fearful of, but it is something that we will need to consider when exercising postnatally.
Top tips for being physically active with Diastasis:
It is usually safe, and often recommended, to exercise with this condition. Staying physically active is vital for our physical and mental health, so here are some tips on how to move safely with these conditions.
- Get an understanding of “Managing Core Pressure” – When we move, we create a certain amount of pressure in the core, and how we manage that pressure can help us manage our symptoms. For example, if we are doing an exercise that causes lots of pressure to our Linea Alba called Doming (this may look like your tummy going pointy) we may want to regress the exercise a little until we can better manage that pressure.
- Listen to your body – How does it feel after exercise? Do your symptoms feel worse post exercise? If so, you may be overdoing it or need to work at a lower intensity or shorter duration initially before gradually building your way up.
- Work closely with your GP. It’s important you request support from your healthcare provider – staying active is so beneficial and they should be able to help support you in doing so.
- Do your pelvic floor exercises – with the exception of those who have a tight (hypertonic) pelvic floor, most women will benefit from some pelvic floor exercises (also referred to as Kegels). These will help build strength in the pelvic floor, which can help with both DRA and Prolapse symptoms.
- Learn to move well – I would say technique is really important for all activities, but particularly when working with a diastasis. Really think about how your body moves, when you feel pressure on your pelvic floor or Linea Alba, whether you are leaking during certain moves, how you feel afterwards, and how to maintain good form when exercising. It can really help to ensure we are managing load well and creating some good habits that are transferable to everyday life.
- Mommers, Elwin H H et al. “The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options.” Surgical endoscopy vol. 31,12 (2017): 4934-4949. doi:10.1007/s00464-017-5607-9
- P.G. Fernandes da Mota, A.G. Pascoal, A.I. Carita, K. Bo. “Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain.” Man Ther, 20 (2015), pp. 200-205, 10.1016/j.math.2014.09.002
- Jelovsek, John Eric, Christopher Maher, and Matthew D. Barber. “Pelvic Organ Prolapse.” The Lancet 369 (2007): 1027–38.