Leah Dwyer – Lismore Osteopath
Post pregnancy Diastasis Recti Abdominis
Diastasis Recti Abdominis simply means that your abdominal muscles have separated.
This is a very common issue among women during and post pregnancy. In fact, it is estimated that approximately 50% of all women will experience Diastasis Recti at some stage during their pregnancy years, being more common in second or subsequent pregnancies.
Diastasis Recti often occurs due to the core not functioning optimally, leading to misalignment, instability and weakness, some describing this manifestation as “mummy tummy”.
Diastasis Recti is a sign of excessive intra abdominal pressure, which is also a precursor to hernia and prolapse. It is therefore vital that the issue is treated as such, restoring core stability and strengthening musculature, rather than focusing on closing the gap itself.
Some women may never even be aware that they have some degree of separation, some may benefit from core training, where as others may require a surgical procedure to repair the damage, however this is very rare.
Therefore, it can be said that most women will recover by firstly being diagnosed with a degree of separation, being informed and educated on various do’s and don’ts regarding exercise and general daily living, and finally seeking physical therapy.
What causes Diastasis Recti and what can I do to avoid it?
During pregnancy, your abdominals suffer from an enormous amount of stress. Just the same as a balloon will expand and stretch to accommodate for enlargement, so too will the linea alba-A fibrous structure extending from the lower breast bone to the pubis, straight down the midline of the abdomen. Not only does a growing baby stress the abdominal region, so too does the increase of the hormone Relaxin. This hormone allows all tissues within the body to relax. This is often a good release, allowing those all important abdominal muscles to stretch, accommodating for an ever growing uterus through pregnancy, though it can often leave those tissues weakened, vulnerable, unstable and over stretched.
When pregnant, it is important to firstly consider your activities of daily living and how you could better perform these activities to avoid excessive strain on the abdominal region.
Even when you believe your abdomen is a lost cause, Diastasis Recti can quite often be reduced or even fixed with the use of corrective core strengthening exercises.
So what should you avoid during pregnancy/post partum?
Stretching the abdomen- Try to avoid exercises that stretch the already overstretched abdominal region, various examples of these exercises can be seen below.
Sit ups/crunches- Try to avoid flexing against gravity.
Heavy lifting- should only be performed when absolutely necessary. Always use your legs and hips when lifting heavy objects to avoid excessive strain on your back. If your core is already unstable, heavy lifting should be avoided all together, especially in the later stages of your pregnancy/post partum.
Try to avoid any activity that forces your abdomen to bulge. Bulging often indicates that your core is not switched on, in which case it may be causing more hard than good. If you begin to notice your belly bulging, stop and focus on contracting your core before continuing the exercise. If you cannot control these muscles, it is best to completely avoid the exercise, until you have better control over the region.
Coughing/Sneezing without first engaging your core.
Heaving yourself from a supine (laying on your back) position to a seated or standing position within seconds. Firstly roll to your side, using your arms to help yourself into an upright position.
How do I know if I have some degree of separation?
You may notice that you have an abdominal protrusion, poor posture, back pain, a weak bladder, gastrointestinal disturbances such as constipation or bloating, or you may just generally feel like your musculoskeletal system is falling apart. If you notice any of these symptoms, it is best to see your osteopath, or physical therapist for a more accurate diagnosis/treatment.
What can you do to strengthen your core without increasing the Diastasis?
Some professionals advise using a splint, binder or wrap to bring the diastasis closer together, however in my opinion, this will only mask the problem (an increase in abdominal pressure) and will not make the healing process any faster. These devices cannot simply be used as a substitute to engaging the core and repairing an entire system of muscles and fascia long term, however they may act as a lower back support, and may increase abdominal awareness, which may be useful in conjunction to actual core strengthening.
In order to increase core stability, you first need to isolate your transverse abdominis muscle. The sequence is outlined below:
Lying on your back, draw your belly button towards your spine whilst slowly exhaling. This exercise should be done without tensing/moving your chest, shoulders and pelvis (your body should not rise off the floor at all). Here, you are not sucking in, holding your breath or making any exaggerated/forceful movements at all.
Aim to engage the transverse abdominis/pelvic floor when exercising, lifting, sneezing or twisting.
Once you have learnt to engage and isolate this muscle, you should try to strengthen this muscle, which will eventually draw your rectus abdominis muscles back together, making your belly stronger over time.
Below, you will notice some illustrations outlining some simple exercises that will become useful in strengthening your core, without causing further damage to the abdominal separation.
To sum up:
In order to improve a Diastasis Recti, one needs to learn/relearn how to engage the core properly-no sucking in, no bulging, no spine flexing, no abdominal stretching, and no pushing out. It is important to learn to use your breath and move using proper posture and alignment. This is not only about exercising, this is about how you hold yourself throughout the day, how you sneeze, how you cough, how you sit, how you rise from a seated position and how you lift objects. Overtime, you will notice that consciously working on your core strengthening throughout the day will eventually become second nature.
Core engagement is especially important during pregnancy and in the following months, due to the hormone Relaxin, which sticks around for up to 6 months post partum. This is why it is extremely important to fight the instability that it creates in your musculoskeletal system.
Visiting a therapist before pregnancy, during pregnancy and post pregnancy can be very beneficial in preventing this process from occurring in the first place, but can also assist in the diagnosis/healing process and will help to realign your body before, during and after birth.
Until next time… Core, Core, Core!!!!
Dr Leah Dwyer
(Osteopath)
