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Diastasis Rectus Abdominis (DRA)
(Tummy separation)
Diastasis Rectus Abdominis (DRA) is a
common condition that can occur during
pregnancy, involving separation of the
abdominal muscles from the midline.
DRA may cause you to feel unsupported
in your trunk area and disrupt the optimal
functioning of your core. If you are
concerned that you may have DRA, speak
to one of our physiotherapists who can
assess, treat and provide solutions for
minimizing the effects of DRA on your
quality of life.
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What can be done for DRA during pregnancy?
Unfortunately there has not been any research published show how DRA can be minimized during pregnancy. However, clinical reasoning indicates women with higher abdominal tone pre-pregnancy are at more risk of developing DRA. Keep in mind the following tips:
 
•Avoid exercises involving sit-ups during pregnancy
 
•Avoid any actions that would involve a sit-up motion, for example, sitting up from lying on your back to get out of bed
 
•In cases where you feel much unsupported in your
abdominal region, a tubigrip or pelvic girdle belt may help.
What is DRA and what causes it?
Your abdominal muscles run several layers deep,
attaching to your ribs and running down to your pelvis
and are joined together at the midline, known as the
linea alba. Imagine a corset – the laces are the linea
alba holding the corset (your abdominal muscles) in
together. If you tighten the laces, the corset bodice
becomes tighter and more supportive. Conversely,
loosening the laces results in the corset not offering
much support at all. During pregnancy, your body
produces hormones that cause the linea alba to
loosen. This stretching of the
linea alba allows more room in
your abdominal area for your
growing baby. However, your
abdominal muscles start to
separate apart and end up in a
position where they are not able
to function optimally, often
leading to pain in the pelvis and back.
 
After you give birth, it may take some time
for the muscle separation to be reversed.
Appropriate exercises can help the muscles return
together, which could take several weeks or
months.
Assessment of DRA
 
Our trained physiotherapists can assess you for DRA during and after your pregnancy. Muscle separation is
generally measured in terms of finger widths. We may also use Real Time Ultrasound to assess core muscle function in conjunction with lumbo-pelvic stability
assessment and treatment.
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Management of DRA
 
During pregnancy:
 
• Education on the importance of bracing the deep core muscles (Transversus Abdominis and pelvic floor muscles) with normal breathing patterns
 
• Postural review and correction
 
• Advice on activities of normal life e.g. getting out of bed, rolling in bed, lifting etc.
 
• Tubigrip (a “boob tube” like compressive garment) to support the trunk and pelvic region
 
• Pelvic girdle belt to aid in holding the uterus inwards towards the spine rather than pulling forward
 
After you give birth:

• Continued use of the tubigrip garment will provide support to your abdominal and pelvic region in the recovery phase

 • SRC Recovery Shorts are designed specifically for abdominal support in the postpartum period

• Our physiotherapists can show you safe abdominal bracing techniques and exercises to aid the reduction of DRA

• Other core stabilizing exercises can assist in return to daily life
Returning to exercise after pregnancy
It is recommended that all women be assessed for
suitability to return to exercise after giving birth.
Returning to exercise without appropriate
guidance may result in worsening the condition or
causing a herniation. It is important to strengthen
your core muscles after giving birth, but if your
muscles are not working in an optimal position
then it can lead to other health problems such as
back and pelvic pain.
 
In a study done by Spitznagle et al (2007), it was
found that 66% of women who had DRA also had at
least one support related pelvic floor dysfunction
(stress urinary incontinence, faecal incontinence
and/or pelvic organ prolapse). High intensity
exercise, such as running, with any of these
conditions can make them worse due to the
increased intra-abdominal pressure on your pelvic
organs. Speak to one of our physiotherapists if you
are experiencing any issues with your bowel and
bladder motions prior to returning to exercise.
Surgery for DRA.
 
In cases where there has been extensive damage
to the linea alba and the woman no longer has
functional core stability, surgical repair of the linea
alba may be explored. However, surgery is not for
everyone and consideration needs to be given to
various factors
Tel:  0412 382 834
Email:  info@sydneywomensphysiotherapy.com.au