Post Pregnancy Low Back Pain Could be Recti Divarication (Abdominal Splitting)

Diastasis Recti/Recti Divarication/Abdominal splitting is a midline separation of muscles of the abdominal wall. A palpable midline gap of more than 2 cm or any visible bulging on exertion is considered as Recti Divarication. This separation is a normal occurrence of pregnancy, which is only a problem if the muscles do not go back to their correct position.

How does it happen?

Diastasis Recti Abdominis commonly occurs around the umbilicus. It is a result of abdominal musculature stretch weakness from maternal hormonal changes and increased tension by the growing uterus. Diastasis Recti can occur in varying degrees during pregnancy and may not resolve spontaneously in the postpartum period.

Why treatment of Recti Divarication is necessary?

Diastasis Recti (Abdominal Splitting) is commonly seen in women who have multiple pregnancies, which will make the muscles weaker.
This separation & weaker abdominal muscle can cause an array of problems, contribute to

• Back pain,
• Coccydynia/Tailbone Pain,
• Bad posture,
• Pelvic floor dysfunctions,
• Urinary Incontinence (Uncontrolled urination)
• Hernia,
• Cosmetic defects.

Back and/or pelvic pains are the most common manifestation of a Diastasis Recti Abdominis. A retrospective study done in 2007 by Spitznagle et al found that 66% of all patients with Diastasis Recti had support-related pelvic floor dysfunction (SPFD) diagnosis of stress urinary incontinence, fecal incontinence, and pelvic organ prolapsed.

How to diagnose this condition?

Ultrasonography (real-time ultrasound imaging) is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.
A small separation of the midline at the abdominals, approximately one to two fingers’ width, is common after most pregnancies, and is not a problem. But if the gap at the midline is:

• More than 2 1/2 finger widths
• Does not shrink as the patient tighten her abdominals or
• A small Protrusion at her midline of abdomen then she probably have Diastasis Recti Abdominis and need to take a few special precautions during exercise and other activities.

What is the treatment for Diastasis Recti Dysfunction?

Conservative management, such as specific therapeutic exercises directed by a physiotherapist, or health care professional well-acquainted with Diastasis Recti.Such exercises are aimed at strengthening the deep core muscles, such as the transverses abdominis and pelvic floor muscles. Poorly executed abdominal exercises can cause an increase in intra-abdominal pressure, this force may cause further recti separation and its accompanying bulge/hernia to worsen.

Hence, it is important to monitor Diastasis Recti Abdominis (and the hernia if any) before prescribing any abdominal exercises. Unsuitable abdominal exercises include sit ups, straight leg raises, Pilates movements i.e. “the 100s” and especially trunk rotation activities, such as criss-cross sit ups which target the obliques, can strain the abdominals excessively.

What are the level of prognosis?

The patient usually does very well. In most cases, recti diastasis usually heals on its own over a postpartum period of 6 weeks to 3 months. However, Diastasis Recti Abdominis may also persist long after the woman delivered. Further intervention may be required if recovery of Diastasis Recti Abdominis does not occur. Specific therapeutic exercise may help improve the condition. Umbilical hernia may occur in some cases. If pain is present, surgery may be needed. In general, complications only result when a hernia develops.

Dr. Mubashira (PT)
Tailbone Pain Clinic
#61,2nd cross, Silver oak street,J.P.nagar
Bangalore.
Mob: +919986632631