DRA refers to the thinning and widening of the linea alba (connective tissue in the midline abdominal wall between the rectus abdominus muscles) with associated laxity of the abdominal wall.

It is often referred to as the “mummy tummy” due to the characteristic pendular appearance of the abdomen after pregnancy.

It is not only associated with pregnancy and can also occur in women who have not had children, as well as men.

Slight separation towards the end of pregnancy should be considered normal and a necessary adaptation for the growing baby.

This separation generally resolves naturally in the weeks after childbirth.

For reasons unknown, it may not naturally resolve in one-third of women. This is where evidence-based information and rehabilitation are important.

Risk factors for developing DRA

There are several factors that we think may influence it, but more research is needed to understand this fully.

These factors include:

Pregnancy, especially multiple pregnancies (twins or triplets).

Genetics – some people may be more at risk due to their connective tissue composition.

IVF (due to potential prolonged hormonal influence).

Exercises that excessively and repeatedly load the abdominal wall.

Prolonged exposure to heavy lifting.

Exercise

Try not to fear movement and exercise. Contrary to what you may read about DRA, movement is not bad or dangerous.

Start with exercises targeting the abdominal wall that do not cause excessive doming, as shown in the picture below. Your physiotherapist will guide you with this depending on the type and style of exercise you enjoy.

There are no set exercises for DRA – everyone is different.

Physical activity – maintaining exercise levels is important and necessary for DRA rehabilitation. Restricting exercise frequency and intensity leads to weakening of muscles throughout the body, including important muscles in the abdominal wall. Exercise is important for overall physical and mental health and DRA should not prevent you from achieving this.

Goal setting – this is important for motivation but also needs to be realistic. No two people with DRA are the same. Rehabilitation aims to progress towards your pre-DRA baseline; however, it will not have any influence over stretch marks or loose skin.

Avoid constipation and straining – this puts unnecessary pressure on the abdominal wall and pelvic floor. Try to modify your diet to optimise stool consistency, for example by increasing water and fibre intake and using a footstool when opening your bowels.

Diet and nutrition – healing tissue requires the necessary vitamins and minerals to carry out repair. Try to eat a balanced diet and avoid foods which cause significant abdominal bloating. If you require individualised advice on what to eat, it may be worth seeking advice from a qualified nutritionist or dietitian.

Strengthen the entire abdominal wall – not just the “deep core” or pelvic floor.

Do not fear the load – abdominal load refers to the difficulty and effort applied to the abdominal wall.

While exercise can overload the abdominal wall, the level of loading plays an important role in DRA recovery. The connective tissue of the linea alba responds favourably to the correct level of load and can stimulate structural changes within the connective tissue in some people.

Achieving the right level of load means being able to carry out an exercise without excessive doming or loss of tension.

Breathing – a good breathing strategy is essential to rehabilitate the core. An ineffective breathing strategy can often cause excessive abdominal pressure.

The main focus of rehabilitation should be restoring co-ordination and function of the diaphragm, pelvic floor and abdominal wall.

Holding your breath during everyday activities, such as standing up from a chair, can place excessive load on the connective tissue.

Over time, this can become too much for the tissue to cope with, leaving you more vulnerable to diastasis rectus.