At some point during your pregnancy or postpartum, your care provider (midwife, physiotherapist, GP and/or OB) may ask to assess you for abdominal separation or “DRAM.” Here’s what you need to know.

What is it?

DRAM stands for ‘Diastasis Rectus Abdominis Muscle.’ What it describes is the widening of the space between the two bellies of your Rectus Abdominis.

Let’s do a quick A&P lesson.

The Rectus Abdominis muscle runs in two distinct bellies superficially down the anterior abdomen, connected longitudinally by a very strong band of connective tissue called the Linea Alba. During pregnancy, the Linea Alba stretches and thins due to pressure from the growing uterus and baby underneath. This causes a “separation” of the two muscle bellies from each other but not from the Linea Alba itself.

What are the signs and symptoms?

As your pregnancy progresses or during your postpartum, you may notice a little bulge on your tummy when moving from lying or reclined to sitting and feel a gap or soft space between your Rectus Abdominis muscles.

As the structure of your abdominal muscles has changed, so too has their function. As a result, you may feel unable to engage your core properly when necessary (e.g. during heavy lifting) and experience low back and/or pelvic pain & pelvic floor dysfunction such as urinary incontinence.

How is it assessed?

With your consent, your care provider will gently palpate the space between the Rec Ab bellies with their index, middle and 4th finger. They may assess for separation in a few different spots along the Linea Alba, usually at your belly button, slightly above and slightly below. They will make note both of the width of separation (i.e. how many fingers they can fit between) and the depth (how much of their fingers fit in the space). Your care provider will likely assess your separation both at rest and with core activation.

Does it only affect pregnant/postpartum people? Am I at greater risk?

DRAM is VERY common during and after pregnancy, with some sources stating that by the end of the 3rd trimester, 100% of pregnant people will be affected.

Factors that increase your risk of DRAM include older maternal age, multiple pregnancies, twin/triplet pregnancies and higher BMI.

However, it is not a condition confined to those that bear children.

DRAM can also be observed in the older population, especially males. This is likely due to age related changes in connective tissue and increases in intra-abdominal pressure placing excessive stress on the tissues. This increase in pressure may be from increased weight gain in the abdominal region, repetitive heavy lifting or core/abdominal exercises with poor technique, persistent coughing from smoking/chronic respiratory illness and frequent straining during bowel movements.

How do I manage it?

Once assessed, your physiotherapist will provide you with an exercise program to increase your core strength and stability to address the separation. They will also educate you on management strategies such as different ways to get in/out of bed and on/off the couch and other means to reduce unnecessary strain on your abdominal muscles while you rehab them. If there are any pelvic floor concerns, your Physio will also discuss seeing a Pelvic Floor Physiotherapist for further assessment.

Is the goal to completely reduce it?

As the two Rec Ab bellies are never fully connected in the first place, it is normal for someone who’s never been pregnant to have roughly 1cm of separation on assessment.

While rehab will focus somewhat on reducing the separation where possible, what’s just as important is ensuring correct and adequate deep core muscle recruitment to manage intra-abdominal pressure and support the spine and trunk to ensure proper body function and fitness for all stages of parenthood.