What is Postpartum Rectus Abdominis Diastasis?

What is Postpartum Rectus Abdominis Diastasis?

Diastasis recti abdominis (DRA) refers to the separation of the rectus abdominis muscles on both sides to the left and right sides at the linea alba. Generally, the separation distance is greater than 2cm, which will affect the appearance of the body and the quality of life.

Almost all women will experience different degrees of rectus abdominis separation in the late pregnancy. Most women will gradually recover after delivery, but 30% of women's rectus abdominis cannot recover 6 to 8 weeks after delivery. According to statistics, the incidence of postpartum DRA is as high as 30% to 70%, of which the incidence of DRA after vaginal delivery is 60.3% and the incidence of DRA after cesarean section is 70.8%. If timely intervention is not taken, 39% to 70% of women's rectus abdominis cannot be repaired 6 to 8 weeks after delivery.

Why does the rectus abdominis separate after childbirth?

The specific mechanism of DRA is still unclear, but it may be related to changes in hormone levels in late pregnancy and uterine enlargement. During pregnancy, especially in late pregnancy, changes in hormone levels during pregnancy and the gradual enlargement of the uterus due to fetal development change the elasticity of the abdominal connective tissue and increase the mechanical pressure, causing the abdominal wall to expand and extend, and the rectus abdominis on both sides will separate from the midline of the abdomen (also known as the linea alba. It is located on the anterior midline and is a white line formed by the intersecting aponeurosis of the two broad muscles on both sides.)

Under normal circumstances, after the pregnancy ends, hormone levels return to normal, the uterus no longer grows, the abdominal wall gradually recovers, and the rectus abdominis muscle moves back to the midline, usually returning to its original position in six months to a year. However, if the abdominal wall is weak, there are multiple births, or the fetus is too large, the rectus abdominis muscle may not be able to return to its original position.

How to measure the rectus abdominis separation?

Measuring the distance of rectus abdominis separation: The examiner stands on the right side of the patient, and the patient lies on his back with his knees bent and his hands crossed over his shoulders. The examiner places his fingers on the patient's navel and asks the patient to inhale, then exhale while gently lifting his head and shoulders off the bed, like doing sit-ups, and use a ruler to measure the abdominal muscle gap. When the rectus abdominis separation is greater than 2cm, the rectus abdominis loses its maximum contraction force and the abdominal muscles are stretched, resulting in a significant weakening of the flexor contraction of the trunk. The ratio of flexors to extensors is 0.5, and this ratio is usually 0.7 in the normal population.

Self-measurement: Lie on your back with your legs bent. Expose your abdomen, support your head with your left hand, and insert your right index and middle fingers vertically into your abdomen. Relax your body. Then lift your upper body and feel the abdominal muscles on both sides squeezing your fingers toward the middle. If you can't feel the squeezing, move your fingers to both sides until you find the tense muscles. Measure the distance between the muscles on both sides.

Normal: within 2 fingers (including 2 fingers)

Needs improvement: 2 to 3 fingers (do not perform exercises that involve bending and twisting the trunk, such as sit-ups, as this will aggravate the separation)

Need medical attention: 3 or more fingers

What are the dangers of DRA?

Affects appearance, causes low back pain, abdominal wall hernia

After the rectus abdominis is separated, the patient's abdomen becomes loose and bulging, which not only affects the appearance of the body, but also directly affects the normal physiological function of the abdominal wall and the rotation and stability of the trunk if it is not treated. First, it will lead to decreased spinal stability, which will lead to waist and back pain. Second, it will cause the intra-abdominal pressure to be unable to maintain normal, which may cause hernia (the small intestine protrudes from the abdominal wall to the outside of the body)3

Why does DRA cause low back pain and abdominal wall hernia?

As the degree of rectus abdominis separation continues to deepen, the strength of the abdominal muscles is greatly weakened, and the support for the waist and back is also significantly reduced. The anterolateral abdominal muscles have the function of protecting the abdominal organs and maintaining normal intra-abdominal pressure. They are also involved in completing physiological functions such as defecation, childbirth, vomiting and coughing. They have the functions of lowering the ribs to assist exhalation, and helping the spine to flex forward, lateral flexion and rotation. Therefore, the relaxation of the rectus abdominis and the mechanical balance of the waist and abdominal muscles can lead to the pelvis tilting forward, increasing the physiological curvature of the lumbar spine, aggravating the incidence of waist and back pain and the accumulation of abdominal fat, and causing long-term low back pain or abdominal wall hernia after childbirth.

What are the common risk factors for DRA?

History of abdominal surgery, high birth weight

It is generally believed that direct injury caused by tearing of the rectus abdominis muscle during abdominal surgery, including cesarean section, is an important cause of DRA.

The heavier the newborn is, the larger the pregnant woman's abdominal circumference is, and the greater the direct mechanical force is, which causes the abdominal muscles to be overstretched. In addition, the weight of the fetus directly compresses the abdominal muscles, making DRA more likely to occur.

How is DRA treated?

Abdominal breathing, self-training, electrical stimulation

If the rectus abdominis separation does not exceed 3 fingers, you can promote the recovery of rectus abdominis separation through the following postpartum exercises:

1. Abdominal breathing mainly exercises the transverse abdominal muscles and promotes the tightening of the internal abdominal muscles. The steps are as follows: lie flat or sit upright, relax your whole body, inhale slowly through your nose until you can't breathe anymore, hold for 5-10 seconds and then exhale slowly, and do this exercise for about 10 minutes every day.

2. Lie on your back and bend your knees. You can lie on your back on a yoga mat and bend your knees. Relax your whole body and try to breathe in and out deeply with your abdomen. Feel the expansion and contraction of your abdomen. Use your hands to push the fat from both sides of your abdomen toward the middle of your belly button. Exercise for 10 minutes each time and do 3 sets of exercise a day.

If the rectus abdominis is separated by more than 3 fingers, manual therapy or electrical stimulation therapy is required. Severe cases require surgical treatment.

Electrical stimulation combined with abdominal breathing can effectively relieve the physiological condition of the patient's spine and improve the inclination of the patient's pelvis, and plays an important role in the patient's blood circulation. The principle is to stimulate the patient's abdominal muscles, gradually awaken the damaged parts of the muscles, promote the patient's muscle contraction, and thus continuously improve the patient's abdominal muscle function. In addition, it can effectively promote the patient's muscles to gradually generate new collagen. Li Huan5's research shows that the total effective rate of electrical stimulation combined with abdominal breathing treatment is 95.00%, which is significantly higher than the total effective rate of abdominal breathing treatment alone, which is 60.00%.

1. Wang Qing, Yu Xiaojie, Yang Xin, Sun Xiuli & Wang Jianliu. Study on the influencing factors of postpartum rectus abdominis separation. Progress in Modern Obstetrics and Gynecology 28, 913–916 (2019).

2. Wei Ruimin, Xiao Xia, Lv Liqing, Luo Yudi & Deng Xianxin. Study on the efficacy of pelvic floor neuromuscular electrical stimulation combined with rehabilitation massage in promoting postpartum rectus abdominis separation. Chinese Journal of Maternal and Child Health 31, 4361–4364 (2016).

3. Wang Ying, Zhang Jie, Feng Yanxia & Ma Le. Observation on the effect of electrical stimulation in the treatment of postpartum rectus abdominis separation. Chinese Journal of Obstetrics and Gynecology (Electronic Edition) 13, 218–221 (2017).

4. Liao Bodan et al. Observation on the efficacy of electroacupuncture combined with massage in the treatment of postpartum rectus abdominis separation. Practical Clinical Integration of Traditional Chinese and Western Medicine 18, 85–86 (2018).

5. Li Huan. Exploring the clinical efficacy of electrical stimulation combined with abdominal breathing in the treatment of postpartum rectus abdominis separation. Electronic Journal of Modern Medicine and Health Research 2, 51 (2018).