Essentially 100% of women suffer from diastasis recti abdominis, or abdominal separation by the third trimester of pregnancy, the condition develops when severe pressure on the stomach muscles forces them to separate and the abdominal wall loses elasticity.
However, many women are left struggling with the condition long after they’ve had their baby. The condition, which is usually characterized by a constantly protruding belly, might trigger unwanted health problems like urinary incontinence, back and pelvis pains, hernia, and constant bloating and might reduce self-esteem due to a changed physical appearance.
So what does diastasis recti look like, and is there any way to prevent it? Women’s physio Elaine Barry reveals what you need to know about diastasis recti from the symptoms to treatment.
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What is diastasis recti?
The two sides of the abdominals ( the rectus abdominals) join together centrally through a thinner piece of connective tissue called the line alba in the middle. This piece gently stretches and the two sides of the abdominals will stretch apart to allow for growth of your baby. You may begin to see some natural changes occurring in your abdominals down along the centre line in your second and third trimester as it expands to accomodate your baby. It can be natural too to see a dark line occur due to hormonal changes called the line nigra and fades once a baby is born.
What does it look like?
You may notice doming or coning in the centre of your stomach particularly during actions that ask a lot of your abdominals. Your belly button may become more prominent as the belly expands.
Can I reduce how much my abdominals stretch?
Some women seem more prone to an increased diastasis more than others. It can be to do with the amount of babies you have carried, the size of baby, your specific collagen type and also your torso length.
However, you can reduce the effort the abdominals have to go through by balancing how much strain you put on the tummy muscles with gently keeping them strong and assisting them in their stretch during pregnancy.
Elaine’s Four Tips To Help Prevent and Reduce Adominal Separation
- Avoid constipation: when we are bunged up, which can certainly occur with hormone change and then also if we are taking an iron supplement during pregnancy, our tendancy may be to strain downwards on the pelvic floor , holding our breath while we do so. This can not only put strain on our pelvic floor but also our abdominal muscles. This is because when we hold our breath we increase that internal abdominal pressure possibly putting too much effort through already stretching abdominals. Instead, use a foot stool, eat a high fibre diet and stay on top of hydration.
- When moving out of bed: avoid what we call ‘ jack-knifing’ as your pregnancy progresses and overloading your already hardworking abdominals. Roll to your side and push yourself up using your elbow. This can be useful to do the first few weeks postnatal too as everything is getting stronger.
- Keeping strong and continuing to exercise during pregnancy but modifying as you grow to progressively deload as opposed to increasing weights and level of intensity as the pregnancy progresses. There are many who keep up a good exercise programme right until the end. Your physio and specialist prenatal trainer can help modify exercises like sit ups and planks.
- Don’t hold back on strengthening the core. Pilates is an excellent way to continue maintaining strength and length in the muscles as a compliment to other cardio and gym based exercise. You can stay strong and active, though you may need to check in with a women’s health physio if you are unsure of what you can and can’t do and it will vary with every individual during their pregnancy journey.
Will the diastasis go away after I deliver my baby?
It’s very interesting to observe the effects post delivery. Many women by the time they arrive for a 6 week check with me are on their way to full recovery of the central stretch of the abdominals. Their abdominal muscles will still be lengthened and weak but this is totally normal.
The research would say that by 8 weeks most women are fully recovering so that the two sides of the abdominals are coming back together and tension in the line alba between the rectus abdominus is recovering. At 6 months postnatal there is a 35-39% prevalence of diastasis recti and these women will benefit from optimising their rehabilitation through a physiotherapist ideally.
Many women worry about ‘fully closing’ over but as I always tell them in some people there actually can be natural gaps there of up to 2 cm and it doesn’t necessarily have to be any issue for women both functionally and aesthetically.
How to Treat Lasting Abdominal Separation Post Baby
In the early stages postnatally breathing and using your pelvic floor muscles, good nourishment and rest are your starting points. Some women will need some abdominal support and can speak to the physiotherapist in their hospital if they are worried about their abdominals about using a tubigrip support. Don’t automatically belly bind. You are best to get guidance on this one as it isn’t for everyone.
Continue to use your foot stool to pass a bowel motion and avoid constipation to prevent putting undue pressure on your pelvic floor.
Approximately one third of women may need assistance to get strong in their abdominals again so that the the diastasis becomes smaller. A women’s health physiotherapist, who is a Chartered Physiotherapist that has specialised in pelvic health is the best place to start to get guidance, an exercise programme and support while returning to exercise.
There will be a smaller percentage of women that stretch significantly and will need intensive physiotherapy and in some cases surgery to recover the stomach muscles. This is a very big operation and it is always worth talking to your women’s health physio first before worrying about anything like that.
Can I exercise with an Abdominal Separation and Should I try Ab exercises?
I often see women many months after their delivery that may have a diastasis recti and they are scared of exercising. They often ask me questions like can I do a plank in an exercise class, can I run and can I lift weights?
We can and do return to being strong after having our babies, despite having diastasis recti so it’s important not to avoid exercise with a fear of making it worse. If in doubt though always check with a professional.
Will my diastasis recti affect my pelvic floor?
Most recent research in this area looking at women up to one year postnatal has not found a connection with diastasis recti and incontinence. However, anecdotally and with experience the abdominals do serve an important role in managing pressures downwards onto the bladder and pelvic floor, and in my opinion may play a role in incontinence later in life. There has been a connection between diastasis recti and low back pain which makes sense too as the core helps support our posture and offers our low back support.
Can collagen supplements help recovery?
The research is not there to support taking collagen supplements for recovery of diastasis recti just yet. However it makes sense to eat protein rich and college rich foods, soups and smoothies postnatally to aid overall recovery. If your body is giving to your baby it has less energy for recovery so make sure to account for this, especially when breastfeeding.
For more information or to get more women's physio tips and support visit www.elainebarryphysio.com
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