Have you ever wondered if that bulge in your belly could be diastasis recti or a hernia? You might want to know that these conditions are related to one another, but they are quite different. In this two part blog, we’ll dig into the nitty gritty details on what causes this bulge, as well as the anatomy, symptoms, how you can be diagnosed, risk factors, hwat to do if you have one, and ways to prevent it.
Understanding Diastasis Recti vs a Diastasis Recti Hernia
So, what is diastasis recti? It’s the long-winded medical term for separation of the abdominal muscles down the middle line of your rectus abdominal muscles (some people call this your six pack), This can occur after pregnancy and/or heavy lifting.
However, a diastasis recti iss different from a hernia. A hernia is where an organ or tissue inside the abdomen cavity presses through a weak point in the abdominal wall which can cause a bulge out on the other side. Though they are similar and can occur at the same location, they are not the same. Thannkfully, not all hernias require surgery. So, to clarify, a diastasis recti and a diastasis recti hernia are two distinct conditions that are not treated in the same way.
So, like a two-fer special, diastasis recti hernia comes with an order of diastasis recti and a sneaky little hernia as the side. It’s most likely to occur in new moms, but it can happen to anyone who’s been lifting heavy weights or who’s had some abdominal surgery in the past. If you have a hunch you may be living with a diastasis recti hernia, it is best to see your physician for a check-up and guidance on what to do next.
Anatomy and Causes of Diastasis Recti
Let’s get technical and talk about anatomy for just a minute: a diastasis recti results from a weakness or excessive separation of connective tissue between the left and right rectus abdominis – ie, your six-pack, or abdominal muscles. This leaves a separation and sometimes a bulge, and can even allow some shifting around of abdominal wall contents. There is a line of connective tissue that runs vertically down the middle of your belly muscles, called the linea alba. This can become stretched out and thinned; the tissue is essentially weakened, thus letting your muscles ‘separate’ from one another. This can stem from pregnancy, obesity, age, or other reasons that can hinder your connective tissue from holding strong.
Anatomy and Causes of Hernias
A hernia is the bulging of an organ or body tissue through a weak area or hole in the abdominal wall. A hernia can develop when the muscles are weak or damaged, such as when you lift a heavy item, or after having surgery. Your groin, belly button and other parts of your body are just some of the places where hernias can occur. But remember, a diagnosis of diastasis recti can weaken the abdominal wall sufficiently to cause a hernia too. When this occurs it is called a diastasis recti hernia. But remember, not all cases of diastasis recti lead to hernias.
Symptoms and Diagnosis
If you have diastasis recti, one of the first things you might notice or feel is an abdominal separation. This could present as an outpouching or a doming around your belly button when you try to sit up, cough or lift something heavy. Some also report mild tenderness or pain, locally over the abdomen or even into the lower back. Often people with diastasis recti also report feeling like their posture is poor and core strength is compromised, which makes any daily activity such as getting up from bed or the sofa feel harder than it should be.
If the symptoms of diastasis recti sound familiar, it could be a good idea to give your doctor or pelvic physical therapist a shout to get properly assessed. If your pelvic physical therapists feels you may have a diastasis recti hernia, she will refer you to a physician. Your doctor should perform a physical exam and then, depending on theirdoctor’s approach, you might have to have some imaging performed of the abdominal area such as an ultrasound or CT scan to check if and to what extent there is a separation and/or hernia.
Sometimes hernias can quietlyshow up as a small swelling and bulging. They can also occasionally cause belly pain or even cause blockages in your organs. . Your doctor might pick up on a hernia during a physical exam, but sometimes it takes an imaging test to make a clear diagnosis. If you have a feeling that you might have a hernia, talk to your doctor and get it examined.
Risk Factors and Prevention
Why do these occur in some people and not others? Nobody is really sure, but it has been shown that a few things can up your chances of having them. It has been estimated that up to 57 per cent of adults have diastasis recti and many don’t even know it. Things like multiple pregnancies, carrying twins, triplets and the like, diabetes, obesity, age and lifting heavy things can all up your risk.
As far as prevention goes, there is nothing that can prevent 100 percent of all cases of diastasis recti and/or hernias from occurring, but the good news is that there are some things that can be done to lower your risk factors – maintain good posture and core integrity, keep a healthy body weight, avoid excessive heavy lifting, and always exercise with correct technique. If you’re pregnant, discuss with your physical therapist some exercises and techniques that may help in preventing the development of diastasis recti down the road.
Treatment and Management
So, if you have a bulge that is diagnosed as Diastasis Recti and/or Hernia, you have a number of intervention and management options. In part 2 of this blog, we will discuss some of the non-surgical and surgical interventions.
Non-Surgical Options
If your diastasis recti is not severe, and you start by seeing your primary care provider. They will likely suggest non-surgical options to help manage your signs and symptoms. This should start with pelvic physical therapy.
Other ways to help you manage a diastasis recti include:
Physical Therapy for Diastasis Recti
Great news! For most people, pelvic physical therapy is an excellent, non-surgical approach to treating your Diastasis Recti – your pelvic physical therapist will create a custom core stability exercise plan that targets these areas for each person such that the exercises are very specific and not aggravating the separation in any way.
In pelvic physical therapy, it is important to learn ways to manage your intra-abdominal pressure, while also learning things like avoiding movements that push the abdominals outward, minimizing overall stress, maintaining good posture, avoiding heavy lifting, and more.
For some, weight gain can strain the abdominal muscles and make diastasis recti worse. Because of this losing some abdominal weight can also be helpful.
Your pelvic physical therapist might also use other modalities, including manual therapy or breath work, and more to help manage your symptoms.
Surgical Interventions
If your Diastasis Recti Hernia is severe, you may also require surgery. There are a lot of surgery choices available, including:
Abdominoplasty: This surgery is where excessive skin and fat is removed from the abdomen and the abdominal wall is tightened.
Laparoscopy: A minimally invasive procedure that involves insertion of a laparoscopic small camera into the abdomen to repair the hernia in a minimally invasive fashion without requiring a large incision.
Mesh: A surgeon may use mesh to reinforce the abdominal wall so that it doesn’t allow the hernia to recur.
Tummy tuck: Same as abdominoplasty, but additionally cuts out extra skin and fat around the hips and lower back.
Since we mentioned some medical and surgical treatments, please note the content in this blog shouldn’t be construed as medical advice, nor is it meant to be a substitute for professional medical care or treatment. Surgical intervention is a medical decision that involves consultation with your physician to determine the best course of treatment for your individual diagnosis and condition.
Recovery and Rehabilitation
After the surgery, make sure to follow the instructions of your healthcare provider for follow-up care and rehabilitation. This will likely involve some physical exercise and lifting limitations, and also meeting with a pelvic physical therapist for exercise instructions to help you improve your core muscle function safely.
There you have it – diastasis recti, is a condition where your tummy muscles decide to call in sick and split, causing a bulge and sometimes pain. Caused by pregnancy, heavy lifting or other factors, for some a diastasis recti can make getting through the day that much more difficult. For most people, the strongest consequence is how their belly looks. With education from an expert healthcare provider like those found at ITR Physical Therapy and consistent support from your pelvic physical therapist, you can manage and treat it, and get your life back on track feeling strong and comfortable in your own skin.