How do naturopathic doctors diagnose and treat diastasis recti?

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

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

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.