You’ve just had a baby, congratulations!
It’s 8 weeks down the track, you are bone tired, there never seems to be enough hours in the day, and you wonder how such a small and helpless bundle can dictate every moment of your life.
You’ve also noticed that your baby belly doesn’t seem to be reducing in size.
When you lift your head and shoulders to get out of bed you notice a midline protrusion which might even triangulate upwards in the shape of a Toblerone. That’s if you even have the strength to lift your head and shoulders. You feel vulnerable if you get an elbow or kick to the belly. Someone even made the mistake of asking when your baby is due.
You’ve read about abdominal muscle separation or diastasis recti abdominis and you wonder if you have one, or worse, maybe a hernia.
Whether you had your baby 3 weeks ago, or 30 years ago, your physio can assess the gap to see how significant it is.
Physiotherapy for Abdominal Muscle Separation
Your physio can assess the gap with palpation (touch), calipers, or even ultrasound.
If there are concerns about a hernia, you may be referred to your GP for investigative imaging. Common sites for a hernia are just above the belly button, just below the belly button, and down in the groin. A typical hernia bulges out more when you cough, sneeze, raise your head to get out of bed, or strain to lift something.
A hernia only needs urgent surgery if the protruding tissue doesn’t reduce and is very painful, if you have nausea and vomiting, or if the skin starts looking red or inflamed.
You will most likely be advised to wait until you have finished having children before contemplating any abdominal hernia or diastasis surgery. In the meantime, see your women’s health physiotherapist, who can safely guide you back to strength and help you avoid further injury.
Your physio can show you how to generate tension in the midline in a way that is safe, makes you stronger, and helps the collagen to heal. Only once you can generate this tension can you expect the gap to start to close. You will get some natural spontaneous closure occurs up to 8 weeks post-partum- after that, you will need to work at it!
Your women’s health physio can teach you the best loading strategies for your individual situation. As well as targeting the abdominals themselves, you may have to work on your pelvic floor muscles, or strengthen, lengthen or mobilise more remote areas of the body to prevent forces ballooning into the midline of your belly.
If you have had a caesarean, your physio can advise on safe return to activity, graded exercises, and scar management. A 6-week postpartum check of your abdominal scar and abdominal muscle tone after a caesarean section is just as important as a 6 week check of your vagina and pelvic floor muscles after a vaginal birth.
I’m pregnant, how can I prevent an abdominal muscle separation?
The best way to avoid a DRAM is to move well during the pregnancy.
Watch your posture and keep your torso long. The longer the abdominal wall, the less it needs to stretch outwards to accommodate the same size baby. Lengthen as you strengthen!
The gap between the midline abdominal muscles is made of collagen fibres. Collagen needs to be loaded in order to stay robust and strong. The right kind of abdominal exercise provides the loading needed to lay down lots of strong collagen bonds, which helps the abdominal wall to ‘bounce back’ more quickly and completely after delivery. Speak to us for advice about how best to train your abdominals during pregnancy to prevent an abdominal separation.
Avoid holding your breath when you lift, lower, push or pull. A breath in causes the diaphragm to descend. The pressure has to go somewhere, so it can either be pushed down into the pelvic floor, or it can push outwards in the midline of the belly. In a loaded situation, neither is ideal. Exhale gently with effort, including when you exercise, so the diaphragm lifts up away from the abdominal contents and pelvic floor. Be careful though, forcing the breath out can cause straining which isnt ideal either!
Think of the linea alba (the connective tissue which runs down the centreline between both halves of the six-pack muscle) as being a kind of relief-valve. It is beneficial for the whole system to have a little ‘give’ in it, to dissipate pressure. In fact, it is considered normal to have a separation of up to 2cms by the end of pregnancy (Mota 2015).
To receive the best guidance and support, you can see a women’s health physiotherapist to help you assess abdominal muscle separation. Your physio can also advise on how to prevent this and guide you through the proper ways to manage it. Schedule your check-up today by contacting us here to get started.