During pregnancy, as your belly expands to accommodate your growing uterus and baby, your abdominal muscles naturally separate. This is normal and expected but can cause issues after the birth if the muscles don’t come back together and women experience what is known as a diastasis recti.
Having a significant diastasis recti (the gap measures 3cms or more) can mean that even if you lose all your pregnancy weight, you still have an odd looking pouch. That pouch is where there is no muscular abdominal wall to hold your organs in place; only a thin layer of connective tissue, known as the linea alba, therefore your organs protrude through giving you a paunchy looking mummy tummy.
When diastasis recti generally becomes a problem after birth when there’s a gap between the abdominal muscles measuring more than 2 finger-widths AND adequate tension cannot be generated along the linea alba with proper activation of the pelvic floor, muscles in the back and abdomen and diaphragm. Many women still have a gap at 8 weeks postpartum, and without treatment, that gap tends to still be present a year or more after pregnancy.
Until recently, it was thought that the gap between muscles was the problem that needed addressing. Most treatments for diastasis recti involved tightly binding the core muscles, resorting to exercises such as sit-ups, crunches and planks and using a cross over hand technique to pull the two rectus abdominal muscles together, even resorting to surgery.
It is now known that these techniques can aggravate or worsen the gap between your abdominal muscles. Diastasis recti is a symptom of too much pressure in the abdomen, because the transverse abdominis isn’t doing its job and supporting the internal organs. Increasing that pressure through exercises like sit ups, or through the front loading in plank position, can be painful or injuring. After all, hernias are caused by the same excessive pressure.
More recent studies have shown that the gap is just another symptom of the problem. The reason the diastasis recti gap isn’t closing is that there is underlying weakness in the deep abdominal musculature mainly the transverse abdominis. Around two thirds of women with diastasis recti have problems with incontinence, pelvic organ prolapse, and pelvic and back pain. The new thinking is that you don’t need to close the gap completely in order for the core to function properly. As long as the transverse abdominis is effectively contracting to produce tension in the linea alba and achieve stability down the centre of your torso, then the fact that a small gap still exists isn’t as much of a concern.
So how do you know if you have diastasis recti?
You can feel for this yourself by laying on your back with your knees bent. Place your fingers over your belly button area and relaxing your abdominal muscles, lift your head and shoulders off the floor. You may feel a dip, or see your belly move into a dome shape. If this occurs then you have abdominal separation. For a full assessment you should see a postnatal specialist in core restore rehabilitation.
What can you do to protect your abdominals and core strength in pregnancy and the early postnatal period?
Sit up/crunch type movements increase pressure in your abdomen which puts pressure on your organs, pelvic floor and low back. This pressure can lead to a diastasis, incontinence, and pelvic organ prolapse, low back and pelvic pain. Take note if you do this type of curl up movement in/out of bed or sofa. Instead practice turning fully onto your side, then push up with your arms as your legs swing off the bed. Also do the reverse when getting into bed. This ensures less intra-abdominal pressure being created in your core and down onto your pelvic floor during pregnancy and whilst it’s healing post birth. It’s an easy but really important strategy that really does make a difference to your recovery.
(Images courtesy of Burrell Education 2013)
Ensure you are practicing pelvic floor exercises correctly.
So many women don’t do pelvic floor exercise correctly, and their pelvic floor muscles are weak and can be too tense or loose. It’s assumed that the pelvic floor muscles become loose, stretched out and weak during pregnancy but women can have tight pelvic floors, just like tension in any other muscle of the body. A tight pelvic floor can cause leaking and contribute to vaginal tearing during childbirth. See a specialist in postnatal rehabilitation for the correct way to do these exercises.
Work with your core breath as you practice pelvic floor exercises.
Your core breath is what you may think of as a pelvic floor exercise along with a deep breath. Your diaphragm muscles and pelvic floor muscles work in synergy along with your other two core muscles (transversus abdominis and multifidus). Start by lying or sitting and with your hands on your hips tilt your pelvis forward and back until you have a small curve in your lower back called neutral spine. Inhale wide into the sides of your ribs, exhale and visualise picking up a raisin with your vaginal and rectal openings. Inhale wide again to release the raisin back down. The added bonus of using core breath during pregnancy is that this is exactly the exercise you should begin doing within twenty four hours of giving birth (regardless of whether you had a vaginal or caesarean section birth). You are then gently restoring your core from the inside out.
Avoid planks/ front loaded exercises
Planks and hands & knees type exercises can be appropriate if you’re not pregnant, don’t have a diastasis, and know how to engage your deep core properly. If you are pregnant and/or have a diastasis, these positions can increase pressure in your abdomen which can aggravate your diastasis, making your abdominals stretch apart too much. We have become engrained that we need to do planks, crunches and sit ups in order to ‘work our core’. Instead if you use your core breath with every repetition of weights, each squat, every wall push up, and whilst stair climbing are other efficient ways of engaging your core during pregnancy and after birth.
Avoid high impact exercise
Activities such as running or jumping cause your core to work overtime during pregnancy, with all the force going through your pelvic floor during each landing. When you add the fact that your ligaments and joints are looser and more unstable as a result of the pregnancy hormone Relaxin, high impact exercise is generally best avoided. This is also the case for early postnatal exercise and buggy running and other high impact exercises with a weakened core are best avoided to reduce or indeed exacerbate further physical health problems.
Options for high intensity exercises that are not high impact include: aqua aerobics, stair climbing, swimming laps and weight circuits. Before engaging in high intensity exercises, be sure to speak with your primary health care provider to be sure they are appropriate for you during pregnancy.
Practice optimum nutrition and hydration for health and healing.
Changing your usual eating habits and eating a wide variety of fresh, organic, super healing foods and drinking filtered water will help to nourish the muscles and connective tissue that are potentially stretched and torn during pregnancy and birth. This helps speed up the recovery process and promote better healing. This sets a better foundation for eating well, passing on these nutritious practices to your children, reducing diet related illnesses such as cancer, diabetes and heart disease, and therefore, being healthy for your lifetime.