Diastasis recti abdominis (DRA) and exercise in women during and after pregnancy

Diastasis recti abdominis (DRA) is the widening of the midline that separates the two rectus abdominis muscles. Between the two muscles runs a thick white fascia, the linea alba, that holds them together and has a normal width of about 2.7 cm [1]. During pregnancy this line is susceptible to horizontal stretch mainly due to hormonoelastic changes of the connective tissues and the mechanical loads that stress this particular area as the fetus grows.

The DRA usually happens at the second semester of pregnancy. At the third semester 66% to 100% of pregnant women have DRA [2, 3, 4] and 53% have DRA immediately after childbirth [5].

There are three ways to measure DRA. A) Finger width, B) Imaging ultrasound and C) calipers. Studies have shown that all three methods are reliable. The most reliable method is ultrasound imaging but in clinical settings the finger width and calipers are more practical [6,7].

Risk factors for DRA are age (older than 34 years old), multiple pregnancy (e.g. twins), big fetuses and the C-section [8].

Clinical Course of DRA

Most of the reduction of DRA usually takes place in the 8 first weeks postpartum [9] and it’s prevalence more than 1 year postpartum has been shown to reach a 32,6% of the women that were diagnosed with DRA as they were pregnant [10].

DRA has been correlated with lumbar and pelvic pain [11], reduction of strength and stamina of the abdominal muscles even in women that followed aerobic exercise programs during pregnancy [12] and with urogynecological dysfunction [13]. The latter is very interesting because we see that women that had DRA due to pregnancy (-ies) where found to have pelvic floor issues and urinal incontinence when they reached menopause.

There seem to be two types of women that develop DRA due to pregnancy. The first type are these women that, through exercise, managed to develop ways to overcome the functional limitations that appear with DRA and are capable of transferring mechanical loads through their trunk successfully, with or without reducing their DRA. The second type are women that have DRA that perseveres and have not managed to develop coping strategies, leading to lumbar pain and movement dysfunction mainly regarding their trunk [14]. The women that fit to the second type have to do regular and specific exercise and if the dysfunction and pain do not get better then surgery is the next option [15, 16].

DRA and Therapeutic Exercise

Strengthening of the abdominal muscles can help women with DRA reduce the width of the linea alba and overcome their functional limitations and pain. Another benefit is the aesthetic result of exercise that will boost up the women’s confidence and moral by reducing the gap between their abdominals. The exercises have to target the rectus abdominus muscle and the other muscles of the trunk. The sessions are more effective if they are supervised by experts such as clinical Pilates instructors.

Exercise during pregnancy

Compared to women that do not perform any kind of exercise during pregnancy, those that exercise during their pregnancy have 33,3% chance of not developing DRA [17].

However most impressive are the results from exercise in the cases of women that have already developed DRA during pregnancy. There are statistics that show that women that followed systematically exercise regimes during pregnancy developed the smallest DRA and for these women DRA correction time was the least [18, 8]. Even regular walking during pregnancy has been shown to reduce chances of developing DRA [5].

Exercise after pregnancy

Supervised therapeutic exercise such as Pilates impressively can reduce the size of the DRA of women after childbirth. Clinical Pilates focuses a lot on the correct way of contracting the abdominal wall and the pelvic floor for women with DRA, leading to better functional and aesthetic results. In addition to exercise special taping tacniques can enhance the therapeutic results [19, 20, 21, 22].

Conclusions

In conclusion we see that DRA is a very common issue that has discomforting effects on women after pregnancy, such as limitations in the function of the musculoskeletal system that has to do with distribution of mechanical load when walking, running, bending etc, but also the pelvic floor muscles and of curse lumbar pain. We know that therapeutic exercise during pregnancy can reduce the chances of one acquiring DRA but also can reduce the DRA itself with remarkable results in function and appearance of the abdomen. It is therefore strongly advised that pregnant women after consulting their obstetrics specialist should follow a supervised exercise program that focuses on strength and control of the trunk and the pelvic floor. The most suitable type of exercise for targeting the aforementioned goals is Clinical Pilates.

References

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