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How to identify and treat Diastasis recti

To correct abdominal diastasis the treatment can be done with exercise, physical therapy or, ultimately, surgery, when the separation is greater than 5 cm and the exercises were not effective in correcting the situation.

These treatment options can begin after normal birth, or shortly after the cesarean section is healed, but if surgery is indicated, it can only be performed when the doctor recommends it. In some cases, women choose to have the corrective surgery after the baby stops breastfeeding so that it is more comfortable for the two.

How to identify and treat Diastasis recti

What is a diastasis:

Abdominal diastasis consists in the separation of the abdominal muscles and connective tissue that usually occurs during pregnancy, being the main cause of abdominal flaccidity and postpartum low back pain.

This distance can reach up to 10 cm and is due to the weakening of the rectus abdominis, also called the six-pack that is very stretched due to the growth of the uterus during pregnancy, rapid weight loss, but also can happen outside of pregnancy, when a person lifts very heavy objects in a wrong posture.

Some women have such a large gap that they can press 3 or 4 fingers in their abdomen and these 'sink' as if there was a hole in the belly, because there is no muscular wall to prevent the entrance of the fingers.

How to know if you have diastasis recti

You may begin to suspect you have a diastasis after childbirth when you feel the area below your belly is too soft and flabby or you notice a lump in your abdomen when you lift some weight, crouch or cough, for example.

To make sure it is an abdominal diastasis you should:

  • Lie with your belly up and press your index and middle fingers about 2 cm above and below the navel and then
  • Contract the abdomen as if performing an abdominal exercise.

Normally the the abdomen contracts, and your fingers jump a bit upwards, but in cases of diastasis the fingers do not move, it is possible to even put 3 or 4 fingers side by side without them moving even with an abdominal contraction.

Some situations that favor the development of abdominal diastasis are having more than one pregnancy, pregnancy of twins, having baby's with more than 4 kg at birth and having more than 35 years of age. When it is unrelated to pregnancy it occurs due to the weakening of your abs.

How to end a postpartum diastasis

The treatment options for curing abdominal diastasis and getting your belly hard again are:

1. Clinical Pilates Exercises

The exercises are a great help in the treatment but must be performed with supervision of a physiotherapist or personal trainer because poorly executed can cause an increase in intra-abdominal pressure, and increase the separation of the rectus abdominis, worsening the diastasis or leading to a hernia.

These exercises are best indicated because they contract the abdominal transverse and the inferior fibers of the rectus abdominis, strengthening them, without there being excessive pressure in the rectus abdominis.

2. Physiotherapy

In physical therapy equipment such as FES can be used because it promotes the contraction of the muscles. This appliance can be done for 15 to 20 minutes and is very effective in strengthening the rectus abdominis.

3. Surgery

Surgery is the last resort for diastasis correction, but it is very simple and consists of sewing the muscles. Although the surgery can be performed only for this purpose, the doctor may also suggest liposuction or abdominoplasty to remove excess fat, sewing the muscle to finish.

What to do to leave your belly hard

During treatment to correct abdominal diastasis it is also recommended you:

  • Maintain a good posture while standing and sitting;
  • Maintain contraction of the transverse abdominal muscle throughout the day. All you have to do is try to bring your belly button closer to your back, shrinking your belly especially when you're sitting, but you should keep that contraction all day long;
  • Avoid as much as possible to bend your body forward, because doing traditional abdominal exercises may worsen the diastasis;
  • Whenever you need to get something off the floor, bend your legs, squatting your body, instead of leaning forward;
  • Change the baby's diaper on a high surface like a diaper changer, or if you need to change the diaper on the bed, you should get down on your knees and not lean forward;
  • Use a postpartum brace for most of the day and even to sleep, but do not forget to keep your belly curled inward to strengthen the transverse abdomen during the day.

In addition, it is important not to perform traditional abdominal exercises, nor oblique abdominal exercise so as not to worsen the diastasis.

How long does treatment last

The treatment time may vary depending on the size of the diastasis, the greater the separation, the more difficult it is to promote the union of the fibers only with exercises or physiotherapy. However in a diastase less than 5 cm, if the treatment is performed daily, in about 2 to 3 months it will be possible to observe the reduction of the diastasis.

Diastasis complications

The main complication of abdominal diastasis is the onset of back pain in the lower back. This pain occurs because the abdominal muscles act as a natural band that protects the spine while walking, sitting and exercising. When this muscle is very weak, the spine becomes overloaded and there is a greater risk of developing a herniated disc, for example. Therefore, it is important to perform the treatment, promoting the union and strengthening of the abdominal fibers.


Bibliografia

  • REV. SABERES, ROLIM DE MOURA. A intervenção fisioterapêutica na diástase do músculo reto abdominal (DMRA). 2017. Link: <facsaopaulo.edu.br>. Access in 30 May 2019
  • GLUPPE, Sandra L; et al. Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Phys Ther. Vol.98. n.4; 260–268, 2018
  • FEITOSA, Gleiciane Zeferino; SOUZA, Vitória Regina Lima de; LOURENZI, Vaneska da Graça Cruz Martinelli. Intervenção fisioterapêutica no tratamento da diástase abdominal pós-parto: uma revisão de literatura. Ciências Biológicas e de Saúde Unit. Vol.4. n.2; 239-250, 2017
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