It’s not all about the gap!
Your body goes through a lot of changes during pregnancy and childbirth, which can place a significant strain on the body. The abdominal wall must expand during pregnancy to accommodate the growing baby. The rectus abdominis muscle (“6 pack muscle”) naturally separates during pregnancy as the connective tissue in between stretches and widens, parting the abdominal wall. This is a normal physiological process and a degree of separation will occur in all women. For a lot of women this will improve during the first 6-8 weeks post -natal, but in some cases this gap remains and can lead to dysfunction.
An important thing to remember is your muscles are not damaged and they have not split. A better way to describe it is a lengthening and weakening of the abdominals. Recent research has found that it is not really about the gap itself or the size of the gap, but about the tension that you can create in the linea alba (the connective tissue between the muscles). Women frequently come to see me and ask how big their gap is and if it has reduced in size. I tend to not focus on the measurements, but how much tension they can generate through the muscle, I like to think of it that we are layering the muscle to fill in the gap.
Despite this, having a diastasis recti, or abdominal wall separation can be very distressing for any woman. Hearing the words “when are you due?” when you are no longer pregnant can have significant impact on confidence and self-esteem. Women often find they have a bloated tummy, a doming in the centre of the tummy and an inability to lose fat from the tummy area. It does not only impact aesthetically but it can cause pain and dysfunction. You may notice pain in the abdomen or belly button and lower back and pelvic pain. It may be contributing to your bladder leakage and you may experience stress incontinence with things like coughing and sneezing.
Some women just accept that they have a “mummy tummy” and a “baby pouch” but although it is common, it is not normal. It is unlikely that your stomach is going to look exactly as it did before you were pregnant but it can improve with proper guidance and exercises. As a mum we often fall to the bottom of the pile but it is important that you don’t ignore it and seek professional help.
Some women rush back into exercise too quickly and do things that can prevent improvement and even make it worse. The pressure from social media and seeing all these celebrities springing back into shape is not helpful. There are a lot of post-natal programmes in the media that offer safe return to exercise in the post-natal period. However, I have also come across some that are advising exercises that create too much strain on the abdominals and pelvic floor and may cause dysfunction.
The abdominal wall works together with the pelvic floor, the diaphragm and deep back stabilisers. These muscles together form the ‘abdominal canister’ and all need to be working in harmony to prevent dysfunction. Breathing is so important during pregnancy and beyond. Poor breathing patterns affect the function of the diaphragm which influences the intra-abdominal pressure. The breath is frequently forgotten about and this is always my starting point when assessing a diastasis.
Treating a diastasis is in no way prescriptive but there are certain things to avoid and certain things that may help you. My advice would be to follow these dos and don’ts but also go and see a pelvic health physio who will tailor a programme to suit you!
· Focus on breathing patterns and practice diaphragmatic breathing rather than upper chest or abdominal breathing. Imagine your rib cage is an umbrella and you are opening the umbrella so you get lateral movement at the ribs
· Do your pelvic floor exercises, starting from your back passage and gently pulling in around the front. Don’t forget to breathe normally as you hold.
· Start working your lower abdominal muscles by doing transversus abdominis exercises. This involves normal relaxed breathing and gently pulling the muscles under your belly button towards your spine and holding for 3-5 seconds.
· As you lift anything or exert yourself remember to exhale.
· Drink plenty of water because hydration helps with healing of the tissues.
· When getting in and out of the bed, sit on the bed first and move on to your side then roll on to your back. Do the reverse when getting out of the bed. Gradually you will be able to get back to moving in and out of the bed more normally.
· Give yourself time to rest and recover after birth for the first 8-12 weeks.
· Ensure you are resting and moving in a good posture.
· See a pelvic health physio.
· Don’t do sit ups, crunches, planks, double leg lifts. Or any other exercises that you notice doming at your abdominals until you have good control of your deep core muscles.
· Don’t keep your tummy muscles pulled in at all the times, it will fatigue the muscles and upset the synergy of the abdominal canister.
· Don’t use the sit up position to get in and out of bed if you are getting doming.
· Don’t get constipated and start straining to open your bowels.
· Don’t hold your breath when you exert yourself.
· Don’t return to high impact exercise until at least 12 weeks post-natal and seek advice from a specialist in pelvic health before you start.
My take home message would be to give yourself plenty of time to heal after birth and don’t push yourself. Focus on good breathing patterns and gentle and safe core exercise and seek help from a pelvic health specialist if you are concerned.