The short answer to this question…
No.
You cannot prevent or completely avoid DR during pregnancy. This because some degree of DR is a normal and necessary pregnancy adjustment to leave room for your baby to grow. Hence, virtually All experiences some degree of DR during pregnancy. In fact, some studies show that 100% of pregnant women are dilated during the 3rd trimester.rd quarter (Sptiznagle et. al., 2007).
Having said that, you definitely CAN reduce the severity of DR and prepare yourself for a faster postpartum recovery. Many of the things that can worsen DR—and therefore prolong the postpartum recovery process—are behaviors that are within your control. So, in this article, we’ll help you understand what DR is, what types of activities or behaviors can make it worse, and what you can do to mitigate the degree of DR you experience during pregnancy.
What is Diastasis Recti?
DR is a “wider than usual” separation between the left and right sides of the rectus abdominis (or “6 pack” muscle). A commonly used definition is a separation 2.7 cm (about 2 finger widths) the biggest in the navel (Rath et a., 1996). The word “dimension” means separationand “recti” refers to the rectus abdominis muscle. You can see an image of what this might look like below.
DR can often appear as a “torpedo-like” bulge in the abdomen. It is often easier to see this during any movement that engages the abdominal muscles, such as in the images below. What you see is the abdominal contents protruding through the septum.
What causes dilation during pregnancy?
DR is your body’s natural way of making room for your growing baby. To show how it appears, see the diagram below. The left side shows a person who is not pregnant. Here, you can see that there is a tissue that runs down the midline of the body – from the sternum to the pubic bone – connecting the left and right sides of the rectus abdominis (“6-pack”). This tissue is called linea alba.
As the belly grows during pregnancy, it increases the pressure within the core, otherwise known as intra-abdominal pressure (IAP). This increased pressure pushes outward on the abdominal wall — stretching the linea alba (as you see in the image to the right) — which thins and weakens the linea alba. When this happens, the left and right sides of the rectus abdominis begin to expand. 
This shifting and stretching is not “bad” by any means. It’s a normal and natural part of pregnancy so your little one (or kids!) have room to grow and can come out when the time is right.
That said, there are certainly activities and behaviors that can increase the severity of DR during pregnancy (or any other time, for that matter). These are factors that are within your control, so let’s discuss them now.
Additional Factors Exacerbating DR
While pregnancy is a (physiological and natural) causative factor that can cause thinning and stretching of the linea alba, the following activities or behaviors place even more pressure on this tissue, which can worsen DR.
- Pregnancy Alignment Changes: Neutral Alignment it’s key to reducing stress on your soft tissues (including the linea alba). Unfortunately, the physical changes of pregnancy tend to take a toll on the body outside of neutral alignment. You can see how the audience anterior pelvic tilt (front edge pelvis) creates an excessive arch in the lower back, which puts more pressure on the linea alba (and back muscles).
- Breath holding during exercise: This is also known as the Valsalva maneuver and is often used by weightlifters when lifting very heavy loads, as you can see in the top image below. You may find yourself doing this when trying to lift a heavy object as well. Breath holding during exercise lifts IAP (intra-abdominal pressure), which does leads to greater force production. However, it has the side effect of putting too much pressure on your abdominal wall. This is also why DR can be experienced by powerlifters and athletes. Another example of holding the breath is that holds up in the toilet during a difficult bowel movement. While this can be an effective strategy if constipation is present, if used consistently over time, it can lead to problems with DR.
- Weak or “strained” deep core muscles: One of the many functions of the deep core muscles is to regulate intracore pressure (IAP). If these muscles are weak — or overworked by the stress of pregnancy — they can’t regulate the pressure as well. They are also less effective at resisting the alignment changes discussed above.
- Engaging in “traditional” core work with a bigger belly: As the abdomen grows (and increases IAP), performing “traditional” core exercises – such as the types of movements shown below – could worsen DR because further increase IAP beyond that caused by the growing abdomen.
Tips to minimize the severity of DR during pregnancy
Now that you know what factors contribute to worsening DR, let’s focus on ways to minimize these behaviors and speed up your postpartum recovery.
- Get into neutral alignment: Sit, stand and move your body inside neutral alignment helps relieve pressure on the linea alba.
- Master the “#1 Most Effective Core Exercise”: As mentioned above, your deep cores are responsible for setting IAP (and Too many other things). The best way to activate and strengthen your deep core muscles is through optimal breathing techniques. You can achieve this with mastering 360° Breathing (aka the “#1 Most Effective Core Exercise”).
- Exhale on effort: After mastering 360° breathing, incorporate it into your movements by ‘exhaling the effort’. In other words, inhale through the easiest part of the movement (such as lowering into a squat or extending your arms for a bicep curl) and exhaling to perform the most challenging part of the movement (like getting up from a squat or curl). Exhaling during effort allows you to generate the necessary force for a movement in a much safer way than holding your breath during exercise. If you are someone who traditionally uses the Valsalva maneuver to lift heavy loads, we advise against doing so in the perinatal period, given the increased IAP during pregnancy and weaker core tissues in the early postpartum period.
- Try to limit “protection” to the toilet. This is another example of breath holding during exercise, which elevates IAP. We appreciate that this may be easier said than done, as constipation is a common side effect during pregnancy. For help with this, see these 10 Tips to Reduce Constipation in Pregnancy. If possible, seeing a pelvic floor physical therapist is another great option to help with constipation, which can be a consequence of an overactive pelvic floor.
- Step back from traditional core work as pregnancy progresses: As the abdomen grows and IAP increases, it is necessary to back off traditional core exercises to help manage this pressure. See below for some resources to help you understand when you should start avoiding or scaling back certain exercises and why.
- Watch for “coning” in the abdomen: This is an incredibly useful tool. As we discussed above, abdominal hump is a telltale sign of Diastasis Recti. If you see this during a move, it means that the current challenge is too big for you right now. It doesn’t mean you will never can make the move again. Just reduce the challenge until you no longer see the coning.
Additional resources
Explore the resources below to help you prevent DR during pregnancy and treat it effectively afterward.
- Your Guide to Diastasis Recti: This guide gives you more information about DR — including how to more accurately assess it and how to effectively treat it through postural adjustments and specific core rehabilitation exercises ($27).
- Movements to avoid during the quarter: This guide details the types of moves to avoid or retreat by quarter and Why. It also clarifies what types of movements (that you may think you should avoid) actually are completely safe throughout pregnancy. Finally, since every body is different, it explains how to recognize when a move is not appropriate you ($27).
- Prenatal Self-Guided Education Programs: These programs lead you through a complete training program (tailored to your stage) with safe and effective exercises to help you alleviate DR (and other pregnancy aches and pains), move with energy and ease, experience a smoother childbirth and recover faster after birth. All plans are one-time purchases with lifetime access ($99 – $229).
- Become a certified ProNatal coach: If you’re a health and fitness professional interested in learning how to train prenatal and postpartum clients, explore our industry leaders Pre-Postnatal Fitness Specialist Certification. In this comprehensive class, you’ll get in-depth information about Diastasis Recti (and many other common pregnancy aches and pains) and learn a detailed protocol to heal your postpartum ailments and build a truly strong and functional core ($699 – $799).
Sources:
Rath, AM, Attali, P., Dumas, JL, Goldlust, D., Zhang, J., Chevrel, JP (1996). The abdominal linea alba: an anatomic-radiological and biomechanical study. Surgical and Radiological Anatomy. 18, 281-288.
Spitznagle, TM, Leong, FC, & Van Dillen, LR (2007). Prevalence of rectus abdominis in a urogynecological patient population. International journal of urogynecology, 18(3), 321-328.
