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Diastasis of Rectus Abdominis Muscle (DRAM)/ Abdominal Separation

  • Physiotherapy
diastasis-recti
4 yellow circles , from left to right, smallest to biggest

What is Diastasis Recti?

Diastasis Recti is the separation of the abdominal muscles (rectus abdominis), resulting in a gap of more than 2.8cm in the middle of the tummy. Although this impairment can happen in both men and women, it occurs more commonly in women due to the physical changes during pregnancy. The rates of incidence range from 67% to 100% in post-partum women.

Why does it matter?

Diastasis Recti can lead to:

  • Post-delivery
    lower back and pelvic pains
  • Faulty
    and poor postures due to poor core muscular stabilization of the spine and
    pelvis
  • Urinary
    incontinence, or uncontrolled leakage of urine
  • Gastrointestinal
    problems such as constipation and bloating
  • Abdominal
    hernias, the abnormal protrusion of tissue or an organ, such
    as the bowel, through the wall of the cavity in which it normally resides.

Who does it affect?

  • As
    mentioned, a diastasis can occur in both men & women. 
  • For
    men, DRAM can be caused by improper exercise technique such as weightlifting
    without proper form, thus placing too much pressure on the abdominal wall.
  • Newborns
    can also be born with abdominal diastasis. Such diastasis usually resolves as
    the baby grows.
  • For
    pregnant women, diastasis in the third trimester is inevitable as the uterus
    naturally stretches to allow for the rapid growth of the baby. This in
    turn initiates a separation of the rectus abdominis and linea alba (connective
    tissue between 6 packs) to accommodate the growing baby. This separation
    usually heals by itself in 8-12 weeks. For many new mums, however, the gap can
    persist. This is because the connective tissues are no longer providing tension
    and stability, resulting in compromised abdominal/tummy muscles. This lack of protection
    and stability affects the whole body both aesthetically and functionally. Most
    mummies complain of frustrating post-baby tummy protrusions that would not
    reduce even when their baby weight is long gone.

What to look out for?

Most often, diastasis recti (DRAM) or abdominal separation can be seen with a protruding dome down the length of the tummy, particularly around the belly button. You may notice this in every day movement, such as when getting up or lying down in bed.

You can assess your tummy if you are at least 8 weeks post-delivery. A diastasis occurs when there is a gap of more than 2.8cm (around 3 fingers spacing) between the abdominal muscles.

Here are some simple steps to help you identify DRAM:

  1. Lie
    on your back, with your knees bent and feet flat on the floor.
  2. Place
    your fingers on your belly button.
  3. Lift
    your head and neck slightly off the floor as if to do a sit-up or crunch, while
    tightening your abdominal muscles. Press your hand down gently between your
    abdominals, horizontal to your spine. If there is a gap larger than 2 to 3
    finger spaces, you could have DRAM
  4. Perform
    these tests above and below your belly button, and measure for gaps in these
    areas

How can a Physiotherapist help?

A proper assessment is required to determine the management plan. The aim of treatment will be to restore the function of the rectus abdominis and the surrounding core muscles, in order to stabilize the pelvis during activity and under load. As your body recovers and with better core muscles activation, symptoms such as lower back strains or pelvic pains will reduce. Musculoskeletal physiotherapists trained in the treatment of DRAM or physiotherapists specialized in pelvic floor dysfunctions can help assess and tailor a programme suited for your condition.

Feel free to send in any queries to our “Ask a Physiotherapist” Whatsapp Service at 98997967. Our physiotherapists will be ready to assist you.

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