When you read the title belly bulge did you think “here we go again another article about the size of my waist and how bad it is for my health?” Thanks for reading past the title because this column is going to discuss a medical problem called diastasis recti that affects both men and women.
Diastasis recti is a medical condition in which separation occurs between the right and left sides of the most superficial abdominal muscle, the rectus abdominis. The rectus abdominis muscle is most notably known as the “6 pack.” The muscle runs in a vertical direction attaching from our pubic bone to our sternum/ribs and its job is to flex or bend the spine as when performing a sit-up or a crunch. The right and left sides of the muscle are connected by a strong band of tissue called the linea alba. Diastasis recti occurs when the linea alba becomes stretched out or even tears causing a hernia.
Who is at risk for Diastasis Recti?
Most common group with this condition are women and in particular moms. In fact one study showed that up to 1/3 of moms develop diastasis recti within a year after giving birth. Having more than one child makes this condition even more likely. Men are not immune to the problem. In men the separation typically occurs over a long period of time and is noted by a protruding bulge down the middle of the abdomen. In men the causes may be multifactorial including incorrect exercising, excess weight or family history.
Here is a simple test to determine if you have diastasis rectus:
Lie flat on your back with your knees bent up. Place your fingers just above your belly button and gently press down. Next lift your head about an inch, keeping your shoulder blades on the ground. If you have diastasis rectus you will see the middle of your abdomen bulge or you will feel a gap (greater than one inch) between the right and left sides of the muscle.
Other issues that can develop with diastasis rectus include low back pain, constipation and even a leaky bladder.
Last month Diastasis Recti received some national attention when it was featured on National Public Radio (NPR). The article received so much response that NPR ran a follow-up story to provide more information. One such response was from the American Physical Therapy Association Section on Women’s Health (SOWH). SOWH pointed out their concerns in a letter to NPR that perpetuating the idea that a “single daily 10 minute exercise” was probably “too good to be true.”
While the research continues, here are some exercises that are safe and have shown promise in decreasing the size of the gap in Diastasis Recti.
“Drawing In” (DI): Lie on your back with your hands on your belly. Take in a deep breath breathing into your belly. Exhale drawing your belly toward your spine and hold. Continue holding the belly sucked in and take small breaths pulling your belly in tighter each time. Practice this exercise for 2 minutes, taking breaths without letting go of your belly tension. See if you can draw in tighter with each additional breath. Work up to practicing this exercise 5-10 minutes per day.
Curl-Up: Once you are able to “draw-in” consistently then add a curl-up. Perform the drawing in, then with your hands at your sides tuck your chin, lift your head and shoulders up, then slowly lower down maintaining good abdominal tension the whole time. Perform 2-3 sets of 10 curl-ups daily.
The DI exercise is something we use in physical therapy on a daily basis especially with our low back pain patients. Ultimately you need to learn to manage abdominal tension in multiple positions such as sitting, standing, moving from sit to stand, walking etc… Our abdominal muscles should be active at all times. You can progress the DI exercise and perform it in different positions. We recommend starting lying on your back, then progressing to drawing in while on your hands and knees. This is a great position to practice as the abdominal muscles have to work against gravity in this position. From there practice the DI exercise in sitting, in standing progressing to maintaining the tension in your belly with more dynamic movements such as going from sitting to standing or with walking.