Abdominal muscle separation (or Diastasis Recti) is a completely normal and necessary part of pregnancy. As your baby grows your abdominal area accommodates by stretching the skin, muscles and connective tissue. During this process the line down the middle of your abdominals (known as your Linea Alba) stretches also and this increases the distance between the two sides of your rectus abdominis muscles, known as abdominal separation.
Most women will notice some abdominal muscle separation in their third trimester or towards the end of pregnancy and this is part of the reason that we recommend that you cease exercises that load the rectus muscles (also known as your 6 pack muscles!) during pregnancy, like sit ups and planks. Before pregnancy, the rectus muscles are in 2 fairly straight lines down your abdomen (see image above). During pregnancy, as the linea alba stretches and separates (again, this is normal) these muscles are now on more of a curve and therefore their mechanics and how they help your body move, have changed!
The research isn’t quite there yet but it makes sense not to load muscles when they are stretched over a growing baby/not in their optimal functional position!
There are many factors that we think might affect how large your abdominal separation may be during/after pregnancy, including:
- How many babies you were carrying (eg, twins, triplets!)
- Maternal BMI
- Narrow pelvis
- How many pregnancies you have had in your lifetime
- How strong/weak your core and pelvic floor was pre-pregnancy (as your muscles support the linea alba) and how active/inactive you were during your pregnancy (as this has an affect on your general strength and abdominal control)
- Genetics; connective tissue varies between individuals and we believe some of this is based around genetics
Again, these are very much factors that remain to be further researched but we think they might have some influence on Diastasis Recti.
What does this mean as a mum?
After you have had a baby you may notice that your abdominal muscles do not feel or look the same as they did before pregnancy. Approximately more than half of women will have abdominal separation at 8 weeks post birth which means that this is a very common issue postpartum and something that we see a lot of in the clinic.
So what is the biggest issue with this? Abdominal separation post pregnancy is linked to lower back pain and pelvic pain, as the abdominal wall is part of the structures responsible for keeping your pelvis strong, as well as protecting and supporting your spine. Whilst aesthetically your abdominals may look different or you notice a gap, or a doming in the centre, there is also the possibility for the physical strength in your abdominal muscles to have been reduced (with or without abdominal separation being present!).
Abdominal separation can vary from 2-3cm wide and 12-15cm in length to 12-20cm wide and the full length of the abdominal muscles. Some of these gaps reduce quickly, some don’t. Some of these gaps are supported by great functioning TA (transverse abdominis muscle) and core muscles, some are not.
What can a Physiotherapist help with?
A physiotherapist can assess your core function, assess basic pelvic floor control and function, assess pelvic control and strength and postpartum posture. All of these components have an affect on pain, control, return to exercise and fitness activities so it is very important to get assessed so that you can get strong for all the varied activities of motherhood and for your active lifestyle!
A physiotherapist can help to educate you on your abdominal wall function, help you strengthen and improve your pelvic floor control and support your daily activities. Generally this is done through learning proper breathing mechanics, posture, activation and of course – exercises!!
Although numerous studies confirm the positive effects of exercises on reducing abdominal separation after giving birth, there is no specific set of exercises that must be followed. This is great because it means we can tailor the approach to the types of exercise or movements that you enjoy without impacting upon your recovery.
The most common types of exercise programs used for Diastasis Recti are:
- Abdominal-specific exercise programs such as strengthening of the transversus abdominis muscles and/or rectus abdominis muscles
- Postural training
- Mobility and movement exercises
- Lifting technique and education
- Pilates and other types of functional training
Along with exercise therapy, adjunct treatments which help to support your abdominals and spine may include manual therapy techniques such as soft tissue massage, myofascial release, abdominal bracing and taping, and the use of tubigrip for compression.
Another common symptom of abdominal separation is doming, bulging or sinking during exercise or excessive loads. It is advised to avoid exercises which cause this bulging of the abdominal wall as this places more pressure on the separated or thinned out connective tissues.
Although we want to avoid excessive doming or bulging, it is a common occurrence with Diastasis Rect. It is not something to be feared, just something to be aware of and monitor, especially with exercises that use your abdominal muscles, require raising your legs above the ground while lying on the back, abdominal sit-ups or crunches, as well as lifting heavy objects. It may also occur during coughing and sneezing as these also increase abdominal pressure.
As physiotherapists, we can help to identify when this doming or bulging may be occurring and help to teach you ways to reduce it through exercise and daily activities.
Will I need surgery for Diastasis Recti?
This is a really common question and not one that we can answer easily. Surgery is potentially indicated in large diastases or when severe dysfunction is present. It is something that should only be considered once non-operative measures have been taken and exercise rehabilitation has been attempted. Research at the moment also indicates that this decision of whether surgery is to be considered should be based primarily on the assessment of the protrusion or bulging rather than the diastasis itself. If there is separation of the abdominal muscles but no loss in strength or function, surgery should not be considered.
Regardless of the decision, it is really important to start learning how to build strength and tension in the anterior abdominal wall, so physiotherapy management pre-surgery and post surgery is also recommended. This means that you can begin your rehabilitation and know that even if surgery is something that should be considered for you, you have already started doing the right things by seeing a Physiotherapist and getting started on your exercises.
Get assessed!
It’s best to come and see the experts for assessment rather than fretting on your own as to what might be going on (or consulting Dr Google). Come and see our expert team in the clinic to put your mind at ease and have you on the road to recovery today!
