What is RAD?
Rectus abdominis diastasis (RAD, or otherwise known as abdominal separation) refers to the separation of the rectus abdominis muscles (a.k.a. ‘the six-pack muscles’) from the midline of the abdominal wall. During the later stages of pregnancy, it is common for the six pack muscles and the connective tissue between them to separate. This is due to the increased stretch placed on the muscles by the growing bub and as a result of pregnancy hormones that weaken soft tissues throughout the body.
Am I at risk of RAD?
The risk factors include:
· Large babies
· Excessive weight gain in pregnancy
· Caesarean section
· Multiple pregnancies
· Excessive amniotic fluid
· A long second stage of labour
Is it common?
Yes!! We expect your belly to grow during your pregnancy so it is not surprising that studies have found that over 66% of women will have a RAD immediately after delivery.
How do I know if I have a RAD?
A RAD can be checked by your nurse, obstetrician or physiotherapist in hospital. The test for a RAD is fairly simple and involves the clinician placing one or multiple fingers on your abdomen between the six pack muscles to feel for separation. You may even be asked to lift your head off the bed to assess the gap further. You will need to be lying on your back with your knees bent to get an accurate measure of the abdominal separation.
If you are not assessed in hospital you can check your own abdominals with the same test or you can have it checked by a physiotherapist with experience in Women’s health.
What should I look for?
It is extremely common (and almost expected) to feel a gap between the six pack muscles after having a baby. It can even be present in women and men who haven’t been through pregnancy!! It is only when a RAD in considered ‘significant’ that you need to modify your everyday activities and perform exercises to reduce it.
A significant diastasis is when:
The separation is more than 2 ½ finger widths
The gap does not reduce in size when you lift your head (and therefore use your abdominal muscles)
A raised mound or a large dip appears in the midline of your abdomen when you lift your head.
I have RAD, will it go away on its own?
RADs can spontaneously improve as your stomach reduces in size after pregnancy. Usually, the greatest improvements are seen in the first 8 weeks following delivery. After 8 weeks, this progress tends to plateau unless you do specific exercises to reduce the gap.
Previously it was thought that diastases were nothing more than a cosmetic issue but recent research has found that significant diastases may be linked to pelvic girdle instability, lower back and pelvic pain and uro-gynaecological conditions such as prolapse.
Management of RAD
Conservative management is usually the first line of intervention.
Your nurse may provide you with tubigrip, an elasticated bandage that is to be worn for the first 6 weeks after childbirth
Avoid having a large arch in your lower back as this will stretch the abdominal muscles further. Aim to sit and stand up tall with your tailbone tucked under.
Avoid activities that increase intra-abdominal pressure such as lifting and straining. Try to perform a gentle lower tummy tuck with a pelvic floor contraction to increase trunk stability when lifting your baby, capsules, prams, etc.
Avoid sit ups (this includes the sit up action to get out of bed) and abdominal exercises such as planks and bridges
Exercises- prescribed by a health professional
Exercises are aimed at strengthening the deep stabilising muscles of the pelvis, abdomen and spine such as the pelvic floor and transverse abdominis muscles.
Unfortunately the research tells us that only 50% of post-natal women know how to do a correct pelvic floor contraction, even if they have researched how to do it! That is an alarming statistic!!
If you are unsure whether or not you have a significant RAD or you don’t know whether you’ve got your pelvic floor contraction right it is worth a consult with a Physio with Women’s Health experience. Your recovery will be much speedier as a result!
ABOUT THE AUTHOR
Kelly McGinnity graduated with a Bachelor of Physiotherapy from The University of Notre Dame, Western Australia in 2007. After a short stint in the public health sector, Kelly began working in a highly reputable Sports and Musculoskeletal Physiotherapy Clinic. Kelly’s caseload included a variety of sports, musculoskeletal, gender health and continence and post-surgical patients. Kelly was also the senior physiotherapist that managed the inpatients on a busy maternity ward which is where her passion for obstetrics and women’s health began.