Updated: Jul 4
The "mommy pouch" or Diastasis Recti (DRA) is a medical condition that needs addressing, rather than a moral failing of a mom postpartum.
It occurs when the abdominal wall is over-distended and loses the ability to manage pressure in the system.
But this can occur even without a "gap" in the abdominal muscles, as faulty recruitment patterns in the core system can create a distended look in the abdominal wall postpartum. (This also happens in men).
But believe it or not, doing crunches, sit ups, v-ups and everything else you're doing in an Ab Lab class might actually be making it all worse!
Medical solutions for DRA include physical therapy and surgery. Physical therapy should be used before and after surgery if surgery is required, in order to improve healing times and decrease risk of reoccurrence post op.
Physical Therapy is the best intervention for Diastasis Recti and should always be implemented before considering an Abdominoplasty.
To understand why this is, let's first get into what Diastasis Recti actually is. The word Diastasis means separation. Recti refers to the Rectus Abdominis, which are the two superficial strap-like muscles that comprise our "six-pack" abs.
We define DRA as a separation of two fingers, or two centimeters, however emerging research suggests that the depth is actually more a concern than the width of the gap.
Who gets DRA
When DRA occurs, the two muscles are separated. This is a common occurrence during the later stages of pregnancy, but can also appear in infants, abdominal obesity, and IBS/constipation, abdominal surgeries, and heavy lifting with poor mechanics.
DRA in Pregnancy
DRA is very common during pregnancy, normal DRA will occur around the third trimester and often spontaneously heal by 6-8 weeks postpartum.
27% of women in the second trimester have DRA
66% of women in the third trimester have DRA
53% persist immediately postpartum
36% remain at 7 weeks postpartum
(Boissonault and Bleschak)
Spontaneous healing of DRA only occurs up to 8 weeks postpartum. No further improvements will be made without intervention (Coldron Y et al). This is one reason why early postpartum physical therapy is so critical for moms. Moms can and should begin healing their DRA immediately postpartum.
Also, as mentioned above you do not have to have an actual DRA separation to have misfiring in the abdominal muscles that physical therapy can help.
DRA is also associated with other issues including prolapse, pee leaks, pelvic and back pain, and increased risk of abdominal injury.
Can pelvic floor PT fix it?
Pelvic floor physical therapy will help retrain the core system to support the body and in doing so heal the DRA. Some clients find that their separation decreases, others regain strength and support but have no decrease in separation.
Pelvic floor physical therapy will always help restore the system to healthy function and strength, but only surgery is a guaranteed fix for the gap.
As abdominoplasty surgery is extremely invasive with a difficult recovery time and 40% failure rate, it is a great solution for moms that really need it but should be considered a last resort for extreme cases of DRA.
For those that find abdominoplasty to be a good option for them, doing prehab before surgery to learn how to correctly engage your core muscles and then following up with more therapy after is a good idea.
Pelvic floor physical therapy is an extremely important part of prenatal care and can help moms decrease severity and risk of developing DRA, as well as act to initiate early postpartum rehabilitation of the abdominal wall.
Physical therapy will improve function, strength, and decrease other risk factors associated with DRA. You can be strong even with a gap. You can even have a flat stomach with a gap!
You don't have to have a separation of abdominal muscles to have a "mommy tummy," because dysfunctional recruitment patterns will cause this as well.
If an Abdominoplasty is chosen for addressing DRA, physical therapy should be integrated before and after surgery to improve surgical outcomes and decrease reoccurrence of DRA post op.
If you are dealing with Diastasis Recti, or mommy tummy, make sure you book your session today!
Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988 Jul;68(7):1082-6. doi: 10.1093/ptj/68.7.1082. PMID: 2968609.
Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008 May;13(2):112-21. doi: 10.1016/j.math.2006.10.001. Epub 2007 Jan 5. PMID: 17208034.