Yoga and Diastasis Recti
When it comes to postpartum health, anecdotal evidence abounds online. One particular issue that new mamas often ask about is diastasis recti (DR or DRA). If you're postnatal, and you're concerned about a gap in your belly, what should you do? If you're pregnant and hoping to avoid DR, what are the best practices? And how can yoga help?
Wait, what is DR?
Diastasis recti is abdominal separation between the two sides of the rectus abdominis muscle—that's the "6 pack" muscle the runs along the front of your body. Between the rectus abdominis muscle is the linea alba, which is connective tissue that stretches to create the DR gap. The width and depth of the gap varies, and so does the location: postnatal women might get this gap at the belly button, below it, or above it.
While you're carrying baby, your core muscles and this connective tissue stretch—as they should—to accommodate your expanding uterus. During pregnancy, most women have a gap, but by 6-8 weeks postpartum, the gap is gone. For some women, though, this separation between the two sides of the muscle persists.
What causes DR?
There are plenty of anecdotes and suggestions about why women might have DR postnatally, but very little comprehensive research to point to an exact answer. As one 2015 study put it: "It is a problem that no standard values of diastasis recti are given, no evidence-based therapy schemes are implemented and only rare and insufficient studies exist." Essentially, we don't have a lot of good information about DR.
Here's what we do know: mother's age does not matter, body weight and baby weight does not seem to matter, duration of labor does not matter. You might get DR whether you deliver vaginally or have a C-section.
Some research suggests, though, that if you're on baby number two (or three or four) you have a higher chance of ending up with diastasis. Additionally, some studies show that pregnant women who exercise are less likely to experience DR.
The good news about DR
DR is often only a cosmetic issue. Unless the diastasis is severe, it does not effect strength and stability. DR does not correlate with back pain, for instance. And while previous research suggested that DR might be connected to pelvic floor dysfunction, a newer study saw no connection between DR and pelvic floor strength or incontinence problems in first-time mothers.
What movements and poses are safe?
When it comes to safe movement and core exercises, the advice is much the same for prenatal women hoping to avoid DR and postnatal women try to heal it: get in touch with the deeper layer of your core—the transverse abdominis (TA) muscle—and utilize that for stability during core-engaging movements.
Avoid sit-ups, crunches or crunch-like exercises, and don't do anything that puts pressure on your belly and makes it bulge outward. (While you're pregnant, make sure you get up from lying down by rolling to one side and using your hands to push up to seated. Don't do a sit up.)
Pregnant or postnatal, anytime you're doing any movement that effects your core (uh, everything), try to activate your TA by engaging your belly toward your spine. (You can see a good overview of poses that help to strengthen the TA here.)
If you have DR, you'll want to avoid anything crunch-like until you've recovered as fully as you can. Even then, crunches aren't the most effective core exercise anyway; you're better off doing plank.
Binding for DR support
Some experts recommend binding or cinching during pregnancy and in the 6-8 weeks after to help offer a corset of support for the core. There's not much research on this, but some physical therapists suggest it. What is clear is that binding alone won't heal DR or prevent it. It might help, though!
How can yoga help?
Since we're not exactly sure why some women get DR, we don't have all the answers when it comes to prevention. But practicing yoga can give you some helpful tools: yoga helps you become more body aware and gives you greater physical strength, which are necessary for prevention and healing. Plus, plank is a common yoga pose that helps build strength and awareness in the deepest layer of the core, and most prenatal yoga classes will offer safe and effective ways to strengthen your core.
If you have DR, get help
If you're postpartum, talk to your midwife or OBGYN about DR, and ask them to test you for it. If you think you have DR (or pelvic floor pain, incontinence, low-back pain, or hip pain), see a physical therapist who specializes in women's health or a pelvic physical therapist.