What is DRA?
Diastasis recti abdominals (DRA), or the separation of the abdominal muscles, is a condition that primarily affects women during and after pregnancy. However, this issue can also affect men and non-pregnant individuals, making it a broader concern than many might realize. The abdominal muscles play a key role in holding up our posture, all movement, and supporting internal organs. When these muscles become separated and unable to work efficiently, it can lead to a range of symptoms, from cosmetic concerns to functional impairments like back pain or even pelvic floor issues.
While diastasis recti abdominals (DRA) is a common condition, affecting up to 60% of pregnant women by the third trimester, not everyone is equally at risk. There are several factors that can increase the likelihood of developing DR, from anatomical predispositions to lifestyle habits. Understanding these risk factors is key to both preventing and managing this condition.
Risk Factors Associated with DRA
1. Pregnancy
Pregnancy is the most significant risk factor for developing diastasis recti. As the uterus with baby inside grow, it pushes against the abdominal muscles, causing them to lengthen & stretch. The linea alba, a connective tissue running down the center of the abdomen, becomes thinner and weaker as the pressure increases. This separation of the rectus abdominis muscles (the “six-pack” muscles) is a natural part of pregnancy, but the degree of separation varies from woman to woman.
Multiple Pregnancies: Women who have been pregnant more than once are at an increased risk of developing diastasis recti. With each subsequent pregnancy, the abdominal muscles are repeatedly stretched, making them weaker and more prone to separation. This is particularly true if pregnancies occur close together, as the muscles may not have fully recovered from the previous pregnancy.
Multiple Births (Twins, Triplets, etc.): Carrying more than one baby further increases the likelihood of developing DR. A larger uterus means greater pressure on the abdominal wall, leading to more significant muscle separation.
Large Babies: If a baby is larger than average, it can place additional strain on the abdominal muscles, increasing the risk of diastasis recti. **This risk factor is one I see often in the PT clinic.**
2. Improper Exercise and Straining
Physical activity is essential for overall health, but improper exercise techniques or excessive straining can increase the risk of developing diastasis recti, when pregnant or not pregnant. Certain exercises that place undue pressure on the abdominal wall, particularly in the later stages of pregnancy or postpartum, can cause or worsen the separation of the muscles.
Heavy Lifting: Lifting heavy objects or engaging in high-intensity exercises without proper core engagement can put undue stress and strain on the weakened abdominal muscles. This risk is especially pronounced for individuals who lift weights without first addressing deep core muscle activation or pre-existing muscle separation.
Abdominal Exercises: Surprisingly, traditional abdominal exercises like crunches, sit-ups, and leg lifts can exacerbate diastasis recti if done incorrectly, especially in the postpartum period. These exercises increase intra-abdominal pressure, which can strain the rectus abdominals muscles more, causing more gapping.
For both pregnant and non-pregnant individuals, it’s important to focus on exercises that strengthen the deep core muscles, like the transverse abdominis, rather than exercises that place excessive pressure on the outer abdominal muscles. A pelvic floor physical therapist can guide safe and effective exercise techniques to prevent or reduce DR.
3. Age
Age can play a significant role in the development of diastasis recti. Older mothers, particularly those over the age of 35, are at a higher risk of developing DRA. This is because as we age, our connective tissues naturally lose elasticity and strength. The linea alba, in particular, may become less resilient, increasing the risk of separation under the strain of pregnancy or other abdominal pressure.
Older individuals who are not pregnant may also be at risk for DRA due to age-related weakening of the abdominal muscles and connective tissue. As the body’s natural collagen production decreases with age, the connective tissues become less able to withstand pressure and tension, leading to the possibility of separation in both men and women.
4. Excessive Weight Gain or Obesity
Excess weight, particularly around the abdominal region, can put significant pressure on the abdominal muscles, leading to separation over time. Both men and women who are obese are at a higher risk of developing diastasis recti due to the constant strain placed on the abdominal wall.
In women, excessive weight gain during pregnancy is another risk factor. A higher-than-average weight gain stretches the abdominal muscles even more than usual, exacerbating the risk of separation. While some weight gain is a natural and healthy part of pregnancy, significant gains beyond recommended guidelines can increase the risk of complications, including diastasis recti.
5. Genetics and Connective Tissue Weakness
Genetics plays a role in the likelihood of developing diastasis recti. Some individuals are born with a predisposition to weaker connective tissue, including the linea alba, making them more susceptible to abdominal muscle separation. This genetic predisposition can affect both men and women and may contribute to diastasis recti outside of pregnancy.
For example, conditions like Ehlers-Danlos syndrome, which affects connective tissue, may increase the risk of DR. In individuals with weak or overly elastic connective tissues, the abdominal muscles are less capable of withstanding pressure, leading to a higher likelihood of separation.
6. Chronic Cough or Respiratory Issues
Chronic coughing, whether due to asthma, smoking, or other respiratory issues, can create repeated pressure on the abdominal muscles. Each time you cough, the abdominal muscles contract, and over time, this repetitive motion can contribute to diastasis recti, especially if there is already weakness in the abdominal wall.
Individuals with chronic respiratory conditions or persistent coughing should learn now to properly contract their abdominal muscles and engage in core strengthening exercises to mitigate the impact on their core muscles with coughing.
7. Pelvic Floor Dysfunction
There is a strong connection between diastasis recti and pelvic floor dysfunction. The core and pelvic floor muscles work together to support the spine, organs, and overall core movement. Weakness or dysfunction in one area can lead to problems in the other. Women with pelvic floor issues, such as urinary incontinence or pelvic organ prolapse, are more likely to develop or have persistent DR, and vice versa.
Summary
Some risk factors are uncontrollable - a large baby, genetic risk factors, and having a respiratory condition. Other risk factors are controllable. No matter if the risk factor is controllable or uncontrollable, a holistic approach to strengthening and coordinating the core and pelvic floor muscles can significantly reduce the risk of both conditions. A pelvic floor physical therapist evaluates the state of your core and pelvic floor and prescribes tailored exercises to promote healing and prevent worsening symptoms. Piston breathing is a is a focused and productive core exercise to connect to your core and pelvic floor - give piston breathing a try!
Managing & Preventing DRA
Diastasis recti abdominals (DRA) is a multifactorial condition influenced by pregnancy, age, genetics, weight, and exercise form. Understanding these risk factors allows individuals to take proactive steps toward prevention and healing of your diastasis recti abdominals. Rehabilitation has to do with managing your intra-abdominal pressure to decrease pressure on the gap (or diastasis). To understand the specific questions about your body and diastasis recti, see a pelvic floor physical therapist who will take the time to perform a whole body evaluation of your movement, strength, breathing and symptoms.