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Can You Prevent Diastasis Recti During Pregnancy?

The short answer to this question…

No.

You cannot completely prevent or avoid Diastasis Recti (DR) during pregnancy. That’s because some degree of DR is a normal and necessary pregnancy adaptation to allow space for your baby to grow. Therefore, virtually everyone experiences some degree of DR during pregnancy. In fact, some studies show that 100% of pregnant people experience Diastasis Recti during the 3rd trimester (Sptiznagle et. al., 2007).

That said, you certainly CAN reduce the severity of DR and set yourself up for a faster postpartum recovery. Much of what can exacerbate DR — and therefore lengthen the postpartum recovery process — are behaviors that are within your control. So, in this article, we’ll help you understand what DR is, what types of activities or behaviors can worsen it, and what you can do to mitigate the degree of DR you experience during pregnancy.

What Diastasis Recti Is

DR is a “wider than usual” separation between the left and right sides of the rectus abdominis (or “6 pack” muscle). One commonly used definition is a separation of 2.7 cm (about 2 finger-widths) or greater at the umbilicus (Rath et a., 1996). The word “diastasis” means separation, and “recti” refers to the rectus abdominis muscle. You can see a visual of how this might look below.

DR can often present as a “torpedo-like” protrusion in the belly. It is often easiest to see it during any movement that engages the abdominal muscles, such as in the images below. What you are seeing is the abdominal contents protruding through the separation.

What Causes Diastasis Recti During Pregnancy

DR is your body’s natural way of creating space for your growing baby. To illustrate how it occurs, look at the diagram below. The left side shows a non-pregnant individual. Here, you can see there is a tissue that runs down the midline of the body – from the sternum to the pubic bone – connecting the left and right sides of the rectus abdominis (“6-pack”) muscle. This tissue is called the linea alba.

As the belly grows during pregnancy, it increases the pressure within the core, otherwise known as intra-abdominal pressure (IAP). This increased pressure pushes outward onto the abdominal wall — stretching the linea alba (as you see in the image on the right) — which thins and weakens the linea alba. When this happens, the left and right sides of the rectus abdominis muscle begin to widen.

This shifting and stretching is not a “bad” thing by any means. It is a normal and natural part of pregnancy so that your little one (or ones!) will have space to grow and be able to head out when the time is right.

That said, there are certainly activities and behaviors that can increase the severity of DR during pregnancy (or any other time, for that matter). These are factors that are within your control, so let’s discuss them now.

Additional Factors that Exacerbate DR

While pregnancy is one (normal and natural) cause factor that can cause a thinning and stretching of the linea alba, the following activities or behaviors place even more pressure on that tissue, which can exacerbate DR.

  • Pregnancy Alignment Shifts: Neutral Alignment is key to reducing stress on your soft tissues (including the linea alba). Unfortunately, the physical changes of pregnancy tend to pull the body out of neutral alignment. You can see how the common anterior pelvic tilt (forward-tipped pelvis) creates an excessive arch in the low back, which places greater pressure on the linea alba (and the low back muscles).

  • Breath-holding upon exertion: This is also known as the Valsalva maneuver and is often used by weightlifters when lifting very heavy loads, as you see in the top image below. You may find yourself doing this when trying to lift a heavy object as well. Breath-holding upon exertion elevates IAP (intra-abdominal pressure), which does lead to greater force production. However, it has the side effect of placing excessive pressure on your abdominal wall. This is also why DR can be experienced by powerlifters and athletes. Another example of breath-holding is bearing down on the toilet during a difficult bowel movement. While this can be an effective strategy if constipated, if used consistently over time, it can lead to issues with DR.
  • Weak or “overwhelmed” deep core muscles: One of the many functions of the deep core muscles is to regulate the pressure within the core (IAP). If these muscles are weak – or overwhelmed from the stresses of pregnancy — they can’t regulate pressure as well. They are also less effective at resisting the alignment shifts discussed above.
  • Engaging in “traditional” core work with a larger belly: As the belly grows (and increases IAP), performing “traditional” core exercises – like the types of movements shown below — could exacerbate DR because they further elevate IAP beyond that caused by the growing belly.

Tips to Minimize the Severity of DR During Pregnancy

Now that you know what factors contribute to worsening DR, let’s focus on ways to minimize these behaviors and expedite your postpartum recovery.

  • Get in neutral alignment: Sitting, standing, and moving your body in neutral alignment helps to alleviate pressure on the linea alba.
  • Master the “#1 Most Effective Core Exercise”: As mentioned above, your deep core muscles are responsible for regulating IAP (and soooo many other things). The best way to activate and strengthen your deep core muscles is through optimal breathing mechanics. You can accomplish this by mastering 360° Breathing (a.k.a. the “#1 most effective core exercise”).
  • Exhale on the Effort: After mastering 360° Breathingincorporate it into your movements by “exhaling on the effort.” In other words, inhale on the easier portion of the movement (like lowering down into a squat or extending your arms for a bicep curl) and exhaling to perform the more challenging portion of the movement (like standing up from the squat or curling). Exhaling on the effort allows you to generate the necessary force for a movement in a much safer way than breath-holding upon exertion. If you are someone who traditionally uses the Valsalva maneuver to lift heavy loads, we advise not doing this during the perinatal period given the elevated IAP during pregnancy, and weaker core tissues in the early postpartum period.
  • Try to limit “bearing down” on the toilet. This is another example of breath-holding upon exertion, which elevates IAP. We appreciate that this can be easier said than done since constipation is a common side effect during pregnancy. For help with this, see these 10 Tips to Reduce Pregnancy Constipation. If possible, seeing a pelvic floor physical therapist is another great option to help with constipation, which can be a consequence of an overactive pelvic floor.
  • Regress traditional core work as pregnancy progresses: As the belly grows, and IAP increases, it is necessary to regress traditional core exercises to help manage this pressure. See below for some resources to help you understand when to start avoiding or regressing certain exercises, and why.
  • Watch for “coning” in the belly: This is an incredibly helpful tool. As we discussed above, coning in the belly is a telltale sign of Diastasis Recti. If you see this during a movement, it means that the current challenge is too great for you at this time. It does not mean you will never be able to do the movement again. Simply decrease the challenge until you no longer see the coning.

Additional Resources

Explore the following resources to help you prevent DR during pregnancy and heal it effectively afterward.

  • Your Guide to Diastasis Recti: This guide gives you more information about DR — including how to more accurately assess for it and how to effectively heal it through postural adjustments and specific core recovery exercises ($27).
  • Movements to Avoid by Trimester: This guide goes into detail on the types of movements to avoid or regress by trimester, and why. It also clarifies what types of movements (that you may think you need to avoid) are actually perfectly safe throughout pregnancy. Finally, since every body is different, it explains how to identify when a movement is not appropriate for you ($27).
  • Prenatal Self-Guided Training Programs: These programs take you through a complete training program (tailored to your stage) with safe & effective exercises that will help you mitigate DR (and other pregnancy pains & issues), move with energy and ease, experience a smoother delivery, and recover faster after birth. All programs are one-time purchases with lifetime access ($99 – $229).
  • Become a ProNatal Certified CoachIf you are a health and fitness professional interested in learning how to train pre & postnatal clients, explore our industry-leading Pre/Postnatal Fitness Specialist Certification. In this comprehensive course, you will get in-depth information about Diastasis Recti (and many other common pregnancy pains & issues) and learn a detailed protocol to take your postpartum clients through to heal DR and build a truly strong and functional core ($699 – $799).

Sources:

Rath, A.M., Attali, P., Dumas, J.L., Goldlust, D., Zhang, J., Chevrel, J.P. (1996). The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical and Radiology Anatomy. 18, 281-288.

Spitznagle, T. M., Leong, F. C., & Van Dillen, L. R. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International urogynecology journal, 18(3), 321-328.