Ladies, I’ve been quiet over here because I’ve been doing some serious homework!
I love the work that women like Wendy Powell and Katy Bowman are doing to bring information to the masses. I read and study and practice it every day. Sometimes, though, I have questions that I need to find the answers to myself. That’s what this post is: information from primary research I found pertaining to my burning questions about diastasis recti and postpartum health.
I am very much not a doctor and this is not medical advice. I am just another mom in the middle of this mess trying to figure things out. I’ve included links to the studies so you can make your own decisions and hopefully find encouragement like I did!
Is my body ever going to go back to the way it was before baby?
In a word: no. In three words and a contraction: no but there’s hope!
Women who’d had babies were compared to women who’d never had babies in a study in 2008. Their abs were measured for stiffness, thickness, and for diastasis recti at 0, 1, 2 and 12 months postpartum. The women who’d grown humans inside their bodies showed improvement over the 12 month period (and markedly by the two month mark) but they never regained the characteristics of the non-baby-having control group.
Baby mamas had thinner muscles, more distance between the halves, and more lax abdominal walls. My abs are more or less flapping in the wind so this does not necessarily come as a surprise. I hold out some hope that they study stopped measuring at 12 months and maybe further improvement happens over more time.
In similar studies with stretched/thinned out muscles, the muscles’ power was significantly decreased permanently. So, it’s definitely possible that we’ll never get back the full strength of the rectus abdominis (which does NOT mean we won’t ever have a strong core). I mean, look at all these other muscles working to keep things in place:
The authors of the study said that “exercises that target the return of a normal IRD (inter-recti distance), rectus abdominis width, thickness and length without loading and compressing the lumbar spine are required.” I’m pretty sure that sums up Mutu System and Restorative Exercise!
* I should note I’m not affiliated in any way with either of those companies, but I love what they do and I haven’t found anything more trustworthy and research based.
Is exercise really effective in reversing a diastasis recti or should I just do my best with it now but eventually get surgery?
If you’re up for more good news, women who did begin training (“training” in this study meant isometrically engaging the transverse abdominis, strength training, and cardio with a personal trainer) to correct a diastasis recti postpartum achieved the same reduction in diastasis as those who trained to prevent diastasis recti during pregnancy.
So, if the damage is already done – it’s not too late! And if the diastasis recti I have is present during pregnancy, I can still start doing work to prevent it worsening and then continue the regimen after birth.
Surgery to correct diastasis recti, on the other hand, had many associated complications according to a comprehensive literature review (hematomas, wound infection, dying skin, scarring) and about a 40% recurrence of the diastasis. Laparoscopic surgery had less complications than open abdominoplasty, though (aka little holes vs. the big cut).
I found out that different surgeons have different techniques (really tight folding of the connective tissue, looser folding, venetian blind folding, origami crane folding…just kidding, I made that last one up). Some techniques, like the really tight folding, are suspected to be more vulnerable to recurrence.
This same article also said that surgery to repair a diastasis recti should be considered cosmetic only, not functional like a hernia surgery. Surgery won’t restore muscle tone – that’s up to you and me to do.
Oookay, but this is more than “unsightly.” I have a bulging, lumpy, temperamental abdomen and it is a big deal, dangit!
Try this on for size: the severity of the diastasis recti is not the problem!
Laxity in the abdominal wall is the problem, and that laxity is indicated by the extent that innards poke through the abdomen. The force with which innards are pressing themselves into that lax abdominal wall has everything to do with alignment.
The biggest separation was usually around the belly button but that was not necessarily where the abdominal wall was most lax. Meaning, those pesky protrusions of innards did not necessarily happen where the biggest split was. I know this is true in my own body.
Straight from the horses’ mouths, “significant abdominal wall protrusions may occur without diastasis and flat abdomens may exhibit a diastasis. …the decision to perform diastasis repair should be influenced primarily by the evaluation of the protrusion rather than the diastasis.”
- Significant abdominal wall protrusions may occur without a diastasis recti
- Patients with a diastasis recti can have a flat tummy (Wendy told us this a long time ago!)
- The linea alba has a maximum stretch of 1-2 inches, regardless of how big the abdomen has swollen to (I’m looking at you, fetus!)
- Abdominal wall protrusions are caused by the stretching of the entire abdominal wall.
There are still more questions I have left unanswered. I would love to know about the nature of connective tissue and whether there is truth to the rumor that it’s more “shrinkable” in the first six months post partum. Does any one have information about this?
We’ll save the 18 pages I read about abdominal bloating for next time, so get your party hats on!