Diastasis Recti: Defining a “Normal” Gap

Diastasis Recti: Defining a “Normal” Gap Blog


Pregnancy and childbirth bring about multiple physical changes, including a widening gap between the right and left halves of your rectus abdominis muscle, to make room for your growing baby. This gap, called diastasis rectus abdominis (DRA), is normal and necessary for healthy fetal growth and development, and it usually closes up within several weeks after childbirth.

After childbirth, many new mothers are not prepared for the bodily changes that remain during the postpartum recovery phase. While a few lucky moms are able to slide into their skinny jeans within days after giving birth, most of us have soft fluffy bellies and a few extra lumps that were not there before we got pregnant.

In most cases, your abdomen will shrink back to its “normal” pre-pregnancy state within three to six months after birth. But in some cases, the linea alba, the connective tissue that stretches to create the diastasis gap, does not resume its former integrity, and it may even split apart, creating an undesirable bulge in the abdomen.

When extra belly bulge remains for weeks or months postpartum, you may become concerned that your diastasis recti will never go away, and that your body will never return to normal.

Defining Normal

To help women recover from DRA, and to arrive at a consensus about how much of a gap warrants surgery, practitioners have attempted to define “normal” diastasis in terms of gap width. However, what is normal for one woman is abnormal for another; measurements of the gap only have value when compared to each woman’s pre-pregnancy gap width, which is rarely measured.

In an effort to shed some light on the subject, a team of researchers (Beer et al., 2009) measured the linea alba widths of 150 women, aged 20-45, who had never given birth. Measurements were taken at three reference points: 3 cm above the umbilicus, 2 cm below the umbilicus and at the origin of the rectus abdominis at the xiphoid process.

Not only were the measurements different at all three reference points, but they varied greatly among the study participants. The research team concluded that the normal width of the linea alba in normal weight women before pregnancy is up to 15 mm at the xiphoid, up to 22 mm above the umbilicus, and up to16 mm below the umbilicus.

Narrowing the Gap

While there are cases where surgery is a viable solution for resolving a postpartum disastasis, conservative physical therapy treatment is often enough to tighten up your tummy. Moreover, surgery as a cosmetic solution does not address the more important issues of core instability and pelvic floor dysfunction associated with diastasis recti.

The women’s health specialists at NYC  NYDNR are ready to help you achieve and maintain your very best physical condition, before, during and after pregnancy. Being proactive before you become pregnant can help you have an easier pregnancy, with fewer complications during childbirth. It can also reduce your risk of unresolved diastasis recti and other health issues after your baby is born.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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