Postpartum physical health is an area that is often under-addressed in women’s health. The female body goes through many changes during pregnancy and not all of these changes immediately reverse, or reverse at all, after birth. A significant portion of mothers experience pain months after birth, which may linger without proper muscle rehabilitation and treatment.

Muscle areas causing postpartum pain often include the large muscle groups of the abdomen and/or back.

Diastasis recti (DR) is a condition describing a separation between the left and right side of the muscles that cover the abdomen called the rectus abdominis muscles, which are often referred to as the “six-pack” muscles. DR is a common result of a dysfunctional adaptation of the abdominal muscles to an increase in intra-abdominal pressure, such as in pregnancy.

Understanding diastasis recti

A 2016 study found that from a study group of 300 women between 19 and 40 years old, 33 percent experienced DR by 21 weeks of pregnancy, 60 percent by 6 weeks after giving birth, 45 percent at 6 months after birth, and 33 percent at one year after birth. Potential risk factors for DR include:

  • Older age
  • Giving birth more than once
  • Giving birth via cesarean section
  • Gaining more than the expected amount of weight during pregnancy
  • High birth weight

DR is a sign of body misalignment, a weakened core, and misdirected pressure into the abdomen. Women with DR often experience symptoms as a result of weakened abdominal muscles after pregnancy, such as:

  • Continuing to look pregnant after giving birth; looking constantly bloated
  • Cone-shaped belly when laying on back
  • Painful sex
  • Pelvic pain
  • Incontinence
  • Back and knee pain
  • Higher risk of injury in back, pelvis, and knees
  • Pelvic muscle and tissue weakening

How is diastasis recti diagnosed?

Many women do not realize that the changes they notice in their body are because of DR, as opposed to common pregnancy weight gain. The American College of Obstetricians and Gynecologists notes that 6-week follow-up visits may be lacking in comprehensive postpartum care and that postpartum women may need more consistent and frequent follow-ups for several months.

DR is not commonly diagnosed or discussed, and often women do not notice the signs of DR until past the standard six-week checkup after giving birth.

A healthcare practitioner like a licensed naturopathic doctor (ND) can diagnose DR through a detailed interview including a physical exam that feels for the separation of rectus abdominis muscles.

Why choose naturopathic care?

NDs understand and respect the unique postpartum body changes of pregnancy which can include DR. By addressing the whole person and not just the immediate condition, NDs utilize skills in understanding body mechanics and alignment to diagnose where DR patterns have been established and offer solutions for improving functionality in the abdominal muscles.

DR is one of many physical complaints that may be experienced during postpartum recovery. Some NDs have additional training in pelvic floor rehabilitation that involves internal exams as well as reprogramming movement and breathing patterns. They can also offer exercises to provide support for physical complaints like backache and muscle and joint pain.

How is diastasis recti treated?

NDs focus on addressing dysfunctional movement and breathing patterns, use therapeutic nutrition, and may perform or recommend bodywork for patients with DR.

Movement

The first priority in addressing movement is to correct movement patterns like walking, sitting, standing, and sitting, and breathing patterns that may be leading to excessive intra-abdominal pressure. In treating DR, NDs will also assign appropriate core exercises to strengthen the connective tissue and abdominal muscles. Exercise during the antenatal period reduced the presence of diastasis of the rectus abdominis muscle by 35 percent. These exercises take the place of crunches, sit-ups, and planks, which can exacerbate DR.

NDs might also tell patients to:

  • Avoid wearing high-heeled shoes
  • Increase fiber and water intake to maintain regular bowel movements and to prevent the need for straining.

Some women may use compression wraps in an attempt to retrain core muscles and prevent DR, but NDs stress that “belly binding” after birth will only relieve symptoms – not the condition as a whole – and will only work temporarily. NDs instead focus on correcting the underlying problem to rebuild core strength and functional movement.

Nutrition

For patients with DR, NDs recommend supporting tissue repair and collagen production using a combination of diet and nutrient supplementation to maintain optimal levels of protein, essential fatty acids, zinc, iron, and vitamins C, A, and B. Bone broth and collagen powders may be suggested.

Bodywork

In addition to implementing changes in physical activity and nutrition practice, NDs might recommend bodywork therapist such as:

  • Craniosacral therapy: noninvasive manipulation of soft tissues and fascia, as well as relief of compression of bones in the head, lower back, and spinal column
  • Internal pelvic floor therapy: physical therapy that may help relieve DR symptoms like incontinence and painful sex; a trained physical therapist works externally and internally to relax pelvic muscles

Mental Health

While mental health may not be a direct contributor to DR itself, it’s important to always recognize the effect that physical changes can have on mental health after pregnancy. Naturopathic doctors understand the mind-body connection to help successfully treat postpartum patients.

Diastasis recti is a frequently experienced, but often under-addressed physical condition that is common after pregnancy. Treating this condition is an important part of addressing the whole patient and promoting maternal health. Your naturopathic doctor can support your postpartum journey with whole-body comprehensive care.

A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). The AANP and the INM would like to acknowledge Morgan MacDermott, ND, for her contributions to the content of this FAQ. Find more from Dr. MacDermott @MilkMedicine