What is pregnancy related Rectus Abdominis Diastasis or DRAM?

by Dr. Alison Gault

Rectus Abdominis Diastasis is otherwise know as diastasis recti or an abdominal muscle split. It is a condition of pregnancy in which the connective tissue that joins the two bands of 6 pack muscles or Rectus Abdominis separates more than 2.5 finger widths.  This is a condition that rarely causes any symptoms but can be distressing. Rectus abdominis diastasis usually rectifies itself post partum.

Symptoms of pregnancy related rectus abdominis diastasis

Primary Symptoms

A palpable or visible gap of more than 2.5 finger widths runs from under the sternum (breast bone) to above the belly button. The gap and any bulging is more obvious with muscle contraction and increased abdominal pressure such as getting up out of a chair or coughing. The gap and bulging may disappear when relaxed.  You can check for diastasis recti yourself by placing your hand above your belly button and doing a sit-up like motion that moves your ribs closer to your pelvis.

Secondary Symptoms

  • Abnormal functioning of the abdominal muscles occurs due to the altered muscle integrity and the strength.
  • An increase in likelihood of developing low back and pelvic pain pre and post partum.
  • May be a factor in persistent post partum low back and pelvic pain.
  • May effect functioning of the pelvic floor due to a decrease of stability in the pelvis. This may contribute to post partum incontinence.
  • The babies movement can be more easily felt in the gap between the muscles. The uterus may bulge out of the gap slightly.
  • An outline of parts of the baby may be seen in the gap in more severe cases.

IMPORTANT:  If you feel a hard, round or painful bulge in the belly button or along your midline, consult your GP, midwife or Obstetrician as your may have a hernia.

Testing for Rectus Abdominis Diastasis

  • Lie on the ground with your knees bent and your feet on the floor.
  • Place your hand in your midline and above the belly button.
  • Perform a contraction of your rectus abdominis by lifting your head off the ground and bringing your rib cage closer to your pelvis.

Test positive if:

  • There is a gap between the muscles over 2.5 finger widths.
  • The abdominal muscles don’t come closer together as you contract the muscles.
  • There is a palpable and visible bulging in the midline under your hand.

What’s happening and why?

The anterior abdominal wall consists of 5 muscles which join in the midline at the linea alba. The Linea alba is a connective tissue band that travels from the bottom of the sternum (breast bone) to the pubic region. The rectus abdominis muscle or 6 pack muscle passes on either side of this band. These muscle contracts to flex the trunk such as doing a sit up.

As the baby, placenta and uterus grows, the abdominal wall stretches to make room by the physical pressure and the action of the connective tissue softening hormone relaxin. A diastasis recti occurs when the linia alba cannot stretch anymore and splits. As all the muscles of the anterior abdominal wall attach into the linea alba, the split can affect the ability of these muscles to function properly to stabilise the low back and pelvis.

You may have increased risk of developing Rectus Abdominis Diastasis if:

  • You have been pregnant before as the abdominal wall has already been stretched.
  • You are pregnant with multiples.
  • If you have experienced Rectus Abdominis Diastasis in pervious pregnancies you are likely to have separation again and to a greater severity.
  • You have weak abdominals.
  • If you are petite as your bump has nowhere to go but out.
  • You may be more susceptible because of your genetic makeup.

Complications of rectus abdominis diastasis

A complication that can occur from Rectus Abdominis Diastasis is a hernia. A hernia occurs when part of the contents of the abdominal cavity such as the bowel bulge out through the gap in the abdominals. This can be very painful and may become life threatening if blood supply becomes blocked to that organ.

Postpartum resolution

Don’t panic if you feel a gap in your midline in the few weeks postpartum, it may just be a softness in the linea alba rather than a split.The split will generally rectify itself  postpartum as the physical pressure against the abdominal wall of the baby and the uterus is reduced as are the levels of relaxin. The effects of relaxin however still continue for approximately 6 months postpartum especially if you are breastfeeding.

Signs of recovery is a reduction in the gap to under 2.5 finger widths and a return to normal in the density of the tissue between the two abdominal muscles.  At this point, there is no longer a risk of herniation.

If you are not planning to have anymore children and still have a noticeable gap of over 2.5 finger widths apart between your rectus abdominis muscles after 6 months postpartum and the area has not returned to the firmness of before pregnancy, you may consider a “tummy tuck” surgery.

How can products help your Rectus Abdominis Diastasis?

A pregnancy lumbar or belly belt can assist supporting the weight of your bump and taking strain off the low back, abdominal muscles and pelvis.  A lumber belt is recommended if you are also experiencing low back pain as well as the diastasis.

body pillow can assist by improving alignment when sleeping by lifting your belly to reduce strain on your abdominal muscles and may decrease drag that can happen when lying on your side.

A leg spacer can help to improve pelvic and lumbar alignment when sleeping  which ultimately assists in reducing the strain on your abdominal muscles as well as muscles in your low back and pelvis.

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