©2018 #pelvicroar

rectus diastasis awareness

by gráinne donnelly

1.

— Approximately 1/3 of women are thought to have Diastasis Rectus Abdominis (DRA) 


— Research on DRA is sparse however what does exist highlights that it can lead to negative body image implications, reduced self-efficacy and quality of life (Keshwani et al. 2018; Benjamin et al. 2018)


— It has also been demonstrated to impact upon abdominal function, particularly rotational and "sit up" strength of the trunk (Hills et al. 2018)


— It remains unknown whether DRA impacts significantly on pelvic floor function with conflicting outcomes from limited research. A recent systematic review suggests a weak link between the presence of DRA and pelvic organ prolapse (Benjamin et al. 2018) however more research is needed to verify this.


— Physios specialising in women's health are well placed to assess and guide rehabilitation for DRA  (Donnelly, 2019).


— If you think you have DRA seek a referral with a physio & start your rehabilitation. Your nearest womens health physiotherapists can be located via the @squeezy directory


— If you are a physio who suspects your patient has DRA but you are not experienced in managing it, contact a specialist physio and collaborate in order to address all factors of rehab required

2.

— There is a lot of conflicting info on the internet surrounding DRA. Much of what's out there can be fear inducing & limiting in guiding women about what they CAN do for improving day to day function and exercise. Much of what is out there is not evidence based.

 

— Did you know that 100%....that's right...100% of women are thought to experience some degree of DRA towards the end of pregnancy (Fernandes da Mota et al. 2015)
— This suggests that temporary separation related to pregnancy should be considered absolutely normal   

— If excessive DRA that continues months after having a baby is impacting your abdominal strength/function, self-confidence or quality of life seek assessment from a specialist physio who can evaluate whether DRA is an issue & what management is best. If you are unsure how to access a physio for this issue speak with your GP or check out the @squeezy directory of physio specialising in women's/pelvic health.

3.

— Several factors are THOUGHT to increase our risk of developing DRA. In reality, the research is sparse and we still have MANY unanswered questions. Suggested risk factors (from the limited evidence base & clinical experience from physios treating women with DRA) suggest factors in the infographic above may play a role.

 

— Many of these factors centre around excessive intra-abdominal pressure e.g. holding your breath when doing strenuous activities, straining due to constipation or excessive high level exercises especially during pregnancy. 

 

— HOWEVER not everyone will experience ongoing DRA even if they do hold their breath, experience ongoing constipation, or carry out high level abdominal exercise in pregnancy. Could this be where genetic predisposition comes in?

 

— What we do know is that we need to be able to consider & vary all activities. 

 

— A new publication "Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study" acknowledges similar risk factors & highlights the importance of activity modification to decrease excessive load on the connective tissue of the abdominal wall including avoiding straining ON THE TOILET!


— Simple changes to ensure you are not constipated & have a normal bowel motion consistency (see Bristol Stool Chart highlighting what normal motions should look like in today's @pelvicroar story) & using a footstool to open your bowels can make a significant difference.


— If you have DRA & want to find out more about what activities you could modify or vary seek the expertise of a specialist physio.

4.

— Did you know that no set exercises or protocol has been proven to heal DRA


— Conflicting information & prescriptive programs are aplenty on the internet often making huge misguided claims


— There is no ONE-SIZE-FITS-ALL approach


— Physios experienced in treating DRA understand that rehab needs to be as individualised as each individual. 


— Rehab goals depend on what each person wishes to achieve & what activities/work/sport they are looking to get back to


— It can also depend on what factors may be contributing in each woman's presentation


— If you are unsure what rehab you need to follow, seek the expertise of a specialist physiotherapist

5.

— The main message of this weeks @pelvicroar #DRA campaign = Diastasis doesn't have to be disastrous. 


— It shouldn't be feared & should be recognised as a potentially normal, prevalent issue
Improved info & understanding about DRA can help alleviate fears & guide both public and health pros on what to do about it.


— As mentioned yesterday, no set exercise(s) has been proven to be the go to exercise for rehab. This means that no exercise has been proven to be the wrong exercise either. Women should be facilitated to get back to the exercise/activity/sport that they want.


— Each individual benefits from assessment & tailored exercise prescription (Dufour et al. 2019)


— Physios are experts in exercise prescription. There are also lots of fitpros with specialised training in pre/postnatal fitness who can help guide suitable exercise progression for DRA too. Often physios & fitpros work together to ensure a woman achieves optimum recovery


— We do not know (yet) what factors, if any, exist to prevent DRA. Potentially considering the suggested risk factors e.g. constipation or poor lifting techniques may have some influence. However some women are likely to be genetically predisposed meaning that there is nothing they can do to prevent DRA & it ISN'T THEIR FAULT. 


— Self-management & behavioural factors have a role to play in recovery (Dufour et al. 2019)
Thankfully awareness & management for DRA is improving & it is becoming increasingly recognised in the medical world as more than a "cosmetic issue". 


— Let us know how this campaign has impacted you. Has it improved your understanding of DRA? Has it changed anything that you do? Have you any more questions after following the campaign?

#pelvicroar #mythbusting #Diastasis #DiastasisRecti #abdominalseparation #mummytummy #DRA #individualisedtreatment #physioworks #DiastasisDoesntNeedToBeDisastrous

written by

gráinne donnelly