Rectus diastasis after childbirth: recognize, prevent and treat

What is rectus diastasis?

Pregnancy demands maximum performance from the body. As the baby grows, the straight abdominal muscles move apart from the lower edge of the ribs to the pubic bone. The resulting gap can become relatively wide. Between the muscles is the so-called linea alba, an inelastic strip of tendon made of collagen. This can prevent the muscles from contracting again after birth. The resulting gap remains and is referred to as a rectus diastasis. This is illustrated under point 7 in the following diagram.

1. saw muscle 2. external oblique abdominal muscle (Musqulus obliquus externus abdominis) 3. navel 4. spinal cord nerves also called spinal nerves (Nervi spinalis) 5. internal oblique abdominal muscle (Musculus obliquus internus abdominis) 6. Straight abdominal muscle (rectus abdominis muscle) 7. separation of the straight abdominal muscles (rectus diastasis) 8. transverse abdominal muscle (transversus abdominis muscle) 9. V-shaped groin 10. pubic mound

What are the causes and risks of rectus diastasis?

It is not possible to predict whether a rectus diastasis will develop before pregnancy. However, there are several causes and factors that increase the risk of the gap between the abdominal muscles.

• Multiple pregnancies
  More babies require more space in the mother’s abdomen. The tissue is stretched more and the abdominal muscles move further apart. This makes involution more difficult and increases the risk of rectus diastasis.
  
  
• Slim women with a large child
  If the mother is particularly slim and the baby in the abdomen is larger than average at the same time, there is also a strong stretching of the tissue, which favors rectus diastasis.
  
  
• Caesarean section
  During a caesarean section, the abdominal wall is cut, the tissue is injured and thus weakened. This can also affect the stability of the straight abdominal muscles.
  
  
• Multiple births
  Each pregnancy is accompanied by a new strain on the tissue, which makes recovery after each birth more protracted and difficult.
  
  
• Very severely overweight (obesity)
  If there is additional fatty tissue in the abdomen, the pressure in the abdominal cavity increases, which promotes the separation of the straight abdominal muscles. Other risk factors are weaker muscles and changes in the connective tissue due to obesity.
  
  
• Abdominal surgery
  Similar to a caesarean section , other abdominal surgery also weakens the entire abdominal cavity, which makes rectus diastasis more likely.
  
  
• GeneticsInrare cases, weak connective tissue is already congenital, which increases the risk of rectus diastasis. It is also normal for the straight abdominal muscles of newborns to protrude further apart. The gap usually closes by itself over time. But sometimes it remains.

What are the symptoms of rectus diastasis after childbirth?

A rectus diastasis can be recognized by a noticeable gap in the front of the abdomen . This is often also visible, although it can usually be seen above the navel. In more severe cases, the abdomen may bulge forward between the straight abdominal muscles. These are the internal organs that protrude between the muscles. For example, the pointed part of the uterus may be visible under the skin.

Sometimes a rectus diastasis is already clearly recognizable during pregnancy. In these cases, individual parts of the baby’s body can be seen. However, this should not be confused with the typical, visible movements of the baby in the womb. These are completely normal and harmless.

How can you recognize a rectus diastasis?

After pregnancy, many women have a completely new body sensation. They have to recover from the strain and possible injuries of childbirth, deal with major hormonal changes and get to know their new everyday life with a baby.

It is not always easy to assess whether rectus diastasis is present. However, there are several methods to find out.

Follow-up care by the attending midwife

If you have a midwife for your and your baby’s postnatal care, a physical examination is part of the regular routine. This can determine whether you have a rectus diastasis.

Medical diagnosis of rectus diastasis

To be absolutely sure whether you have rectus diastasis, you should have a medical diagnosis carried out. In addition to a physical examination, the doctor can also use imaging techniques.

What consequences can an untreated rectus diastasis have?

The first sign of rectus diastasis is always the noticeable and visible gap between the straight abdominal muscles. It is usually a purely cosmetic problem to begin with. Once it has been recognized and diagnosed, you can also counteract it with certain exercises and support the regression. However, if rectus diastasis remains untreated, it can lead to various physical complaints later on.

The symptoms include

• Back pain,
• Pain in the hips and buttocks and
• a possible change in body statics.

Intestinal problems can also develop. An abdominal wall hernia, a so-called umbilical hernia, can also be the result of rectus diastasis.

Can rectus diastasis after childbirth be prevented?

There are a number of things you can do to prevent rectus diastasis from developing in the first place.

• Exercises
  Ideally, you will have already incorporated exercises for a strong core into your daily routine before pregnancy. But even after the birth, the right combination of rest and light exercises can support your body’s recovery.
  
  
• Avoid overloading
  Take care not to overload your body, especially your core. You should urgently avoid heavy pulling, pushing, lifting and carrying. This also includes intensive strength training. Instead, strengthen and stabilize your muscles with gentle abdominal and pelvic floor exercises. Also remember to lie down and stand up on your side. In this way, you protect the straight abdominal muscles that are under strain. Adapt your entire posture to your pregnancy at the beginning.

Give your body enough time to regain its strength. It has done a lot during pregnancy. This is the best way to prevent rectus diastasis.

What measures are available to reduce rectus diastasis after childbirth?

Even ideal prevention is not always a guarantee that rectus diastasis will not occur. However, if you have developed a gap between your straight abdominal muscles, you can usually counteract this well.

Exercises in your own home

You can start with light exercises to activate the lower abdomen and stabilize the abdominal and back muscles as early as the postpartum period. Light exercises for the lateral abdominal muscles, such as lateral raises, are well suited.

Postnatal course

Most midwives nowadays offer postnatal courses in groups. Alternatively, there are midwifery practices where several midwives join together and organize postnatal courses. In these classes, you perform the appropriate exercises for postnatal recovery and learn how to do them at home. At the same time, the midwife can check whether you have developed rectus diastasis and how your postnatal recovery is progressing.

Physiotherapy

In physiotherapy, you will receive treatment that is tailored precisely to your needs. This may involve strengthening your linea alba so that you can live well with rectus diastasis, or closing the gap over time. You will be shown exercises, strengthen your body awareness and learn the correct posture for everyday life.

What other treatment options are there for rectus diastasis?

In severe cases, even intensive and long-term exercises are not always successful. In these few exceptional cases, surgery to reduce rectus diastasis may be advisable. Only consider this if your family planning is complete. Otherwise, another pregnancy can ruin the results of the operation.

If you opt for surgery, the rectus diastasis is treated with a tummy tuck. This allows the straight abdominal muscles to be returned to their original position. At the same time, the muscles are strengthened and possible back pain is alleviated.

Treatment of various changes in the abdomen

Apart from the diagnosis of rectus diastasis, an unfavorable change in the shape of the abdomen can be caused by other different factors. Each of these changes can be corrected with a special treatment. This increasingly improves the appearance.

• Increased fatty tissue below the skin and above the abdominal muscles:
  Fat deposits can be corrected by liposuction.
  
• Excess sagging abdominal skin:
  Sagging skin can only be effectively corrected by skin tightening.
  
• Increased visceral fat (visceral fat):
  An accumulation of fat below the abdominal muscles in the abdominal area is not accessible via surgery. This fat can be reduced in the long term with exercise and diet.

Do you suffer from rectus diastasis? Our doctors in Saarbrücken will be happy to advise you on the right treatment. Make an appointment today for an individual consultation.