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Do you think you are dealing with Diastasis Recti? Here are all the best tips to understand and treat those uncomfortable Diastasis Recti symptoms.
What is Diastasis Recti and How to Treat it
Is it just me or after birth do you always hope that your belly will magically be gone as soon as you see your little one’s face?
Our bodies are so amazing, but carrying and delivering a baby will be sure to leave a mark! It takes some time for our stomachs to return to their former glory. If time has passed and you feel like your stomach won’t go away, you might be dealing with Diastasis Recti.
What is Diastasis Recti?
So what exactly is Diastasis Recti? It’s when the tissues that hold your abdomen muscles together separate down the center or your torso creating a large gap. It’s most commonly seen in pregnant women.
It makes sense that this happens during pregnancy to make room for that cute baby. But the gap should naturally come back together as your body regains its strength. For some moms, though, the gap sticks around, leaving a lasting little belly bump.
Do you still have this gap after 8 weeks post delivery? If the answer is yes, it may be time to check to see if you have Diastasis Recti! The good news is there are lots of easy Diastasis Recti treatments you can do right at home.
How to Tell if I Have Diastasis Recti
There is a simple test that you can do at home to see if you have Diastasis Recti.
While lying on your back with your knees bent, lift up your head to create tension in your abdomen. Use your fingers to press into the center of your abdomen muscles. Move them from the top of your belly to the bottom.
If you feel a large gap with several fingers that can go way down into your belly, you likely are dealing with Diastasis Recti.
Keep in mind, though, you should always seek the advice of your doctor to confirm before trying any treatments.
It’s also been known that Diastasis Recti tends to be more likely for moms who have multiples, moms who are more petite, or moms who have previously had Diastasis Recti.
Diastasis Recti Symptoms
The most noticeable symptom is the protruding belly that won’t seem to shrink no matter how much you try. But there are several other symptoms that you can look out for.
Diastasis Recti can cause back pain resulting from the poor posture likely to happen with this separation in your abdomen.
You may also be dealing with constipation, bloating, or other stomach issues due to the increased pressure on the organs in your belly.
It, unfortunately, does have some severe cases where moms may deal with more permanent pelvic floor issues, back and hip pain, or other uncomfortable Diastasis Recti Symptoms.
How to Fix Diastasis Recti
Knowing how to fix Diastasis Recti really depends on the severity. In more intense cases, surgery or physical therapy may be necessary. But in most cases, there are things you can do right at home to help ease your symptoms and close the gap.
The best thing you can do is to try to prevent Diastasis Recti symptoms from lingering by making sure to stay active and strengthen your core during your pregnancy.
But if you do end up with Diastasis Recti, start by taking it easy and being patient. It won’t heal overnight, and it’s very possible to make it worse by working out your body too hard.
You can try rolling out of bed carefully, avoiding lifting heavy objects, and remembering to stay balanced during your daily routines. The best thing, though, is to try some Diastasis Recti exercises.
Diastasis Recti Exercises
Using Diastasis Recti Exercises is the best way to combat those symptoms because strengthening your core will tighten those tissues and seal up that gap!
Be careful as you do exercises, and make sure you talk to your doctor before starting any workout routine to make sure that your body is ready and that the routine will help and not hurt your Diastasis Recti.
When choosing Diastasis Recti Exercises, focus on things that can help your body relax and strengthen your body without working out too aggressively. Even some simple pelvic floor exercises can be so helpful for healing Diastasis Recti!
One exercise you definitely want to avoid is crunches. It’s our go-to simple workout for moms at home, but unfortunately, it can aggravate Diastasis Recti and may make your symptoms worse. Instead, try incorporating some of these simple exercises into your workout routine:
Try these exercises
- Breathing: Breathe deeply and focus on using your diaphragm to breathe instead of your chest. You can do this while sitting, standing, or even lying down.
- Pelvic tilts: While lying on the floor with your knees bent, gently lift your pelvis up and hold for a few seconds, making sure to activate those pelvic floor muscles.
- Kegels: Kegels aren’t just for during your pregnancy! Keep them going after your baby is born to improve symptoms of Diastasis Recti as well as improving your bladder control.
- Side plank: Balance on your side using your feet and your forearm for support. Hold the position for 30 seconds, take a break, and try to repeat a few times. For an easier version, use your knees instead of feet for support.
- Pillow squeezes: Lying on the floor with your legs bent, place a pillow or yoga block between your legs. Use your abdomen muscles to lift your feet and lower back off the floor, squeezing the block as you do.
- Heel taps: Lying on the floor with your legs bent, gently lift one leg, and tap your heel back on the floor, alternating back and forth between legs.
- Leg lifts: While laying on the floor with legs flat, keeping your legs straight, raise them to a 45-degree angle and slowly lower than back down.
- Hip extensions: While on your hands and knees, raise legs one at a time backward or to the side, using your core muscles to help you balance.
- Heel Slides: Lay on your back with your legs bent and slowly slide each heel down so your leg is straight, alternating between your legs.
- Yoga poses: Many yoga poses focused on balance can gently help strengthen your core. Try holding the tree pose for a few minutes or as long as you are able.
I hope these exercises can bring you some relief from your Diastasis Recti symptoms! Be sure to talk to your doctor if you ever have any concerns. Share other treatments that have helped you in the comments!
Rectus diastasis, diastasis recti, and ab separation. This condition goes by many names, but they all mean the same thing: a partial or complete separation of your abdominal muscles in the middle of your stomach.
Rectus diastasis is a condition that can affect anyone. It’s particularly common during pregnancy because your abdominal muscles may separate to accommodate your growing baby. Other possible causes include lifting heavy objects or performing unsafe abdominal exercises.
Rectus diastasis creates a visible bulge in your abdomen, but it’s more than just a cosmetic concern. Untreated rectus diastasis can weaken your abdominal muscles over time, leaving you with chronic lower back pain and reduced mobility.
The good news is that rectus diastasis treatment can make a big difference. Rachel Alt, MD , Brian Prebil, DO , and our team at the Center for Minimally Invasive and Robotic Surgery offer the latest in rectus diastasis surgery .
If you’re not sure what to do about the painful bulge in your abdomen, we’re here to help.
Conservative treatment for rectus diastasis
When you come to the Center for Minimally Invasive and Robotic Surgery for rectus diastasis care, we start with a comprehensive physical exam. Dr. Alt and Dr. Prebil review your medical history, assess your symptoms, and evaluate the severity of your condition.
Some people experience only partial tears of the abdominal muscles. In these mild cases, the abdominals may strengthen and heal on their own after a few months.
Nonsurgical treatment for rectus diastasis can include wearing a supportive binder or belly band to give your abdominal muscles extra support as they heal.
A physical therapy program can enhance recovery by strengthening surrounding muscles. If you have rectus diastasis, it’s important to avoid lifting heavy objects and performing targeted abdominal exercises while you’re healing.
Minimally invasive rectus diastasis surgery
Our team often recommends conservative treatment options first. But if your abdominal muscles have completely separated, or you’re still dealing with pain after trying nonsurgical options, it could be time to consider minimally invasive surgery.
Dr. Alt and Dr. Prebil may recommend surgery for people who have severe abdominal separation, significant lower back pain, or find it difficult to participate in daily activities. Whether your condition was caused by pregnancy or an injury, surgery can repair the separated muscles.
During surgery, our team makes a few small incisions around your abdominals. We reattach the separated muscles and close the incisions.
Because we use minimally invasive techniques, the procedure boasts several benefits over traditional open surgery, including faster recovery times, smaller scars, and reduced risk of infection.
You don’t have to live with the discomfort and embarrassment of rectus diastasis. Find out if you’re a candidate for minimally invasive surgery with a consultation at Center for Minimally Invasive and Robotic Surgery. Contact us online or call the office for an appointment.
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During pregnancy, many women experience a separation of their abdominal muscles. Fortunately, the right kind of exercise can help your body heal.
During pregnancy, your body goes through a lot of changes. And despite what celebrity tabloids may have you believe, for new mamas, giving birth doesn’t exactly mean everything snaps right back to normal. (It also isn’t realistic to bounce right back to your pre-pregnancy weight, as fitness influencer Emily Skye proves in this two-second transformation.)
In fact, research suggests anywhere from one- to two-thirds of women suffer from a common post-pregnancy condition called diastasis recti, in which your left and right abdominal muscles separate.
“The rectus muscles are the ‘strap’ muscles that extend down from the ribcage to the pubic bone,” explains Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University. “They help keep us upright and hold our bellies in.”
Unfortunately, with pregnancy, these muscles have to stretch quite a bit. “In some women, they stretch more than others and a gap is created. The abdominal contents can ‘poof out’ between the muscles, much like a hernia,” she says.
The good news is that unlike a hernia, where your bowel can come out into the hernia sac and get stuck, that doesn’t happen with a diastasis, Dr. Minkin explains. And a diastasis is not usually painful (though you might feel low back pain if your ab muscles are stretched and not working the way they normally would). Still, but if you’re suffering, you might appear pregnant even months after having your baby, which can clearly be a confidence killer for new moms.
This is exactly what happened to Kristin McGee, a New York–based yoga and Pilates instructor, after giving birth to twin boys. “A few months after giving birth, I had lost a majority of the weight I gained, but I still had a pouch above my belly button and looked pregnant, especially toward the end of the day.”
Dr. Minkin notes that women who carry twins can be at an increased risk for diastasis recti, as the muscles can get stretched even more.
How to Heal
The good news? No matter your situation, there are certain steps you can take-both pre- and post-baby to help avoid (or deal with) a diastasis.
For one, to keep stretching to a minimum, try to stay as close to your ideal body weight as possible before your pregnancy and try to stay within the weight gain range that your doc recommends for you during your pregnancy, suggests Dr. Minkin.
If you’re still suffering from a diastasis after a year, Dr. Minkin notes that you can also think about having surgery to stitch the muscles back together-though, she notes this isn’t 100 percent necessary. “It’s not a health hazard, so there isn’t significant harm in ignoring it. It really comes down to how bothered you are by it.”
Fitness can also help. Many ab exercises (before, during, and after pregnancy) work to strengthen the rectus muscles, fighting against potential stretching. With the right arsenal of exercises, McGee says that she was able to heal her diastasis without surgery.
You just have to be careful to focus on moves that will help strengthen and heal you in a safe way. “While you’re healing your diastasis, you want to avoid any exercises that put too much strain on the abdominals and can cause the belly to cone or dome,” says McGee. “Crunches and planks should be avoided until you can keep your abs held and avoid any pooching out.” You also want to avoid backbends or anything that can cause the abdomen to stretch any further, she notes.
And if you have a diastasis, concentrate on drawing your abs together even during daily activities (and be careful if you notice that certain movements bother you), says McGee. But after getting the green light from your ob-gyn (usually around four to six weeks post-baby), most women can start doing gentle hip bridges and these moves from McGee that are aimed at firming up the midsection and healing a diastasis in an easy, effective way.
Diastasis Recti (aka DR) … is probably something you have come across before. Maybe it was on Pinterest as you were searching for postpartum workouts, or from a personal trainer on social media, possibly your friend brought it up at your last playgroup, or maybe your doctor mentioned it to you. Was what you heard about diastasis recti recovery positive? Or were you told the narrative that surgery is the only option or that diastasis recti is just something you have to deal with?
Well, we are going to set the record straight on diastasis recti recovery. We will drop some truth bombs on common misconceptions and give you the truth you truly need to know when it comes to healing diastasis recti and reclaiming your strength and confidence. Let’s drop some truth bombs!
Truth Bomb # 1
Misconception: If I have diastasis recti that means my muscles tore
Truth: Your muscles do not tear with diastasis recti. If there is a tear in the connective tissue this is called a hernia. What actually happens when you have a diastasis is the connective tissue (this runs vertically down your midline and holds your rectus muscles together) thins and weakens- causing the natural width between your rectus muscles to become an unnatural width. This widening, weakening, and thinning causes instability of the core structure which leads to symptoms and issues.
Diastasis recti recovery through restorative movement and exercise is possible because there is NOT tearing of the muscles. Rehabbing the muscles and the core system through the right kinds of exercise is incredibly effective in healing DR.
Truth Bomb # 2
Misconception: If I have diastasis recti during pregnancy that is bad
Truth: Diastasis Recti is actually a normal and natural part of pregnancy. Our bodies are incredibly smart- they were designed to have babies! When a woman gets further along in her pregnancy the body will start to naturally separate the rectus muscles to make room for the growing baby. How cool is it that the body creates more room?! This is so important to understand because it really changes the narrative around diastasis during pregnancy and diastasis recti recovery postpartum. Instead of worrying and obsessing over whether you get DR during pregnancy, you can realize that your body is just doing what it needs to do to create life! How empowering!
Most women have some level of diastasis in late-term pregnancy and in the immediate weeks postpartum but the body naturally heals that separation. When there is still a separation and symptoms accompanying 3+ months postpartum, that is when it becomes so important to address DR specifically to aid the body in healing. It is good to note that being proactive in protecting and supporting your core and pelvic floor during pregnancy and immediately postpartum is very beneficial and can prevent longer-term issues from DR.
Truth Bomb # 3
Misconception: Diastasis Recti can only be fixed through surgery
Truth: This is simply just not true. At one point when DR wasn’t as understood as it is now, it was thought surgery was the only way. The most frustrating thing is that with all we now know about diastasis recti recovery and how effective restorative exercise is for healing, there are some doctors and providers who have not caught up with the times and are unfortunately still pushing a narrative that is outdated.
To be fair- there are some cases that surgery is the best way to restore function. When connective tissue reaches a point of no tensegrity or responsiveness, no amount of exercise will be enough. But this is a reality for only a minority. For the majority, surgery is not needed and amazing healing can come through movement and full-body/lifestyle approaches. If you have been told that surgery is the only way to heal DR I challenge you to challenge that! Advocate for yourself by educating yourself, getting a second opinion, and add restorative movement aimed at healing DR into your routine and see what happens.
Truth Bomb # 4
Misconception: Diastasis Recti is healed when there is zero separation left
Truth: Let’s do a very brief anatomy lesson- your rectus muscles are not 1 single muscle. They are two separate muscles. You have a right rectus muscle and a left rectus muscle that are held together by connective tissue (this goes back to truth bomb #1 and how your muscles do not tear with DR). No one actually has ‘zero separation’ because that is not how we are anatomically. When muscles are functional and connective tissue is firm and strong, it can feel like there is no separation, even though there technically is. Having a ‘1 finger’ or ‘2 finger’ separation can be completely normal. This is all relative to each individual. If someone has always had a 2 finger separation between their rectus muscles, got pregnant and had a baby, then read about DR and feel they have a 2 finger separation… is that really a diastasis to be concerned about?
There is so much more to diastasis recti recovery than just simply the width between rectus muscles. What issues and symptoms do you have? How is the connective tissue down the midline? Someone who has a 2 finger separation with no issues and has strength and function vs someone who has a 2 finger separation with urinary leakage, back pain, and doming in the core are in two different categories although if you were to just look at separation between the rectus muscles they would both technically be in the ‘diastasis recti’ category.
Are you starting to see the bigger picture? I hope so! So no, DR is not healed when there is NO separation left. DR is healed when the core is functional, strong, and you have no symptoms that are getting in the way of you living your life!
Truth Bomb # 5
Misconception: Diastasis Recti is not something that can heal years later
Truth: Throw out all arbitrary timelines you have been told and believed about your body’s capacity to heal. Just because it has been 5,10,15+ years since you have had children doesn’t mean you are past the point of being able to address and heal your diastasis recti.
When you give your body the right tools and the right environment, healing can happen. Diastasis recti recovery is not just for newly postpartum women. Check out these amazing stories from Debbie (a grandmother) and Jenni (a mom of 12.. Yes 12) to inspire you and give you hope that healing is never out of the question!
And last but not least….
Truth Bomb # 6
Misconception: As a mother, issues like leaking, back pain (pssst… if you have back pain check out THIS video!), diastasis, and more are just ‘what happens’ once you have kids
Truth: You deserve the dignity of a body that works right, that you feel amazing and confident in, without guilt! If you are struggling with DR and symptoms please know that you do not have to just deal with those. Diastasis recti recovery is possible and there is so much that can be done to free you from symptoms that are holding you back.
Experiencing a вЂњbulgeвЂќ after baby especially with bigger bubs? Here’s how to tackle it.
ThereвЂ™s no doubtВ having a babyВ takes a toll on mumвЂ™s body. And the effects of carrying that beautiful new life inside you for nine months can still have an impact months and even years after birth – especially to theВ tummy muscles.
So what causes theВ вЂњbulgeвЂќ after baby? How can you prevent those muscles separating? And why do some mums suffer while others donвЂ™t?
Our guts and organs are held in by a few layers of muscles that wrap around us to form the abdominal wall. It extends like a cylinder from the pelvis at the bottom, to our rib cage at the top; from the spine at the back, to the rectus abdominus – вЂsix packвЂ™ – muscles at the front. The linea alba is a strip of fibres that joins the two rectus muscles together at the midline, running straight through the belly button.
Ab separation is common for mums of twins or big bubs. | Image: iStock
Diastasis Recti is the fancy medical term given to abnormal separation of the rectus muscles (вЂabdominal separationвЂ™), resulting from a widening and stretching of those fibres that hold the rectus muscles together.
ItвЂ™s evident when you lift your head and an obvious bulge appears down the middle of your tummy, usually from the belly button to the rib cage, but if severe it may be all the way along.
For many, abdominal separation goes unnoticed and doesnвЂ™t have any impact. For some, itвЂ™s a cosmetic concern, with prominent bulges proving unsightly and embarrassing. They are rarely uncomfortable or painful.
There are many causes for Diastasis Recti, in fact, some people are born with it.
However, itвЂ™s usually a condition that develops over time, where the tissues of the abdominal wall are stretched and weakened, leading to separation of the six pack muscles through the middle.
Any condition that leads to increased abdominal pressure will do the trick, such as obesity orВ chronic constipation.
People with excessive diastasis recti are typically of two types.
Firstly there are the obese older men. Next are the small, fit women whoвЂ™ve struggled withВ вЂlargeвЂ™ pregnanciesВ (twins or big bubs). It also tends to pop up more for mums who are older and not surprisingly have multiple pregnancies.
And before all the first-time-mums start panicking вЂ“ you wonвЂ™t all develop massive Diastasis Recti. Plus, whatever separation does occur may increase, decrease, or stay the same in the postpartum period.
Fast fact: ThereвЂ™s often more at play than just an increased separation between the rectus muscles. Many researchers acknowledge that general abdominal muscle weakness and laxity all the way around the abdominal wall вЂcylinderвЂ™ plays a part.
Ab separation is a painful experience for expecting and new mums. | Image: iStock
Abdominal separation is easily diagnosed by your doctor with a simple examination. In fact, you can get a very good idea poking around yourself.
Your doctor will lie you down on the bed, then ask you to lift your head off the pillow. Any detectible bulging indicates separation is present, but that doesnвЂ™t necessarily mean thereвЂ™s an issue.
More formal diagnosis comes from ultrasound examination, with exact measurements of separation at specific points along the linea alba. This can help your medical team gauge severity and response to therapies.
ThereвЂ™s no magical number that defines Diastasis Recti, as many people can have bulges with little separation, whilst large distances between the recti can cause few symptoms or cosmetic concern. But a gap of more that 2cm вЂ“ about two fingers – is deemed abnormal by most authorities.
Largely issues with Diastasis Recti come down to degree of bulging, ability to reduce the effects with simple measures, and an overall desire to improve how it looks.
Fast fact: Diastasis Recti is often believed to contribute to back or pelvic pain in new mums, however, research shows this is not the case.
During pregnancy protecting and preserving what youвЂ™ve got is paramount, but there are many mums who despite their best efforts, struggle down the track.
Avoid over activation of the abdominal muscles through the day. This would mean all expectant mums should avoid heavy lifting вЂ“ no more than about 10kg; skip the crunches in your workout; plus when youвЂ™re getting out of bed, always roll onto your side first, then sit up.
Try to stay fit. ThereвЂ™s increasing evidence that exercise during pregnancy can reduced the development of abdominal separation by as much as 35 per cent. ThatвЂ™s a potentially massive reduction.
Now pregnancy is hard work, bloody hard work, so exercise wonвЂ™t be for every mum at every stage. My advice is to keep as active as possible when you feel up to it, and consider exercising under the guidance of a qualified physiotherapist, exercise physiologist, or a trainer educated in pregnancy issues. TheyвЂ™ll guide you through safe pelvic floor and core exercises that are proven to be safe and effective.
Diastasis Recti Treatment: Dr Sam Hay explains why some pregnant women get abdominal separation and how to treat it. A doctor will formally diagnose you. | Image: iStock
The juggle of life is intense for new mums. It can be bloody hard to prioritise a cooked meal let alone your own health. But there are a few things that may make a difference when youвЂ™re ready.
Firstly, consider getting some of those super-tight supportive pants. TheyвЂ™re certainly not that sexy, but thereвЂ™s some emerging evidence that wearing them once baby is born can improve matters. By supporting the abdomen they offload the damaged connective tissue, allowing it to repair itself.
Once the dust has settled, and your routine is somewhat on track, exercise programs have been shown to have some positive benefits, and help regain some midline abdominal strength. Once again, best results come from structured and supervised programs from the professionals, where mums are taught to switch all the abdominal wall muscles on and gradually improve their strength and control.
Unfortunately, such exercise regimes are not a guarantee, and despite trying hard, many mums find little benefit at all.
Looking for a more definitive fix? Diastasis recti treatment in the form of surgery is available for mums, especially those who have lost significant muscle tone after multiple pregnancies.
Repair is largely dictated by the degree or size of bulging rather than the width of separation. The type of surgery varies widely. Some are done вЂopenвЂ™, whilst some are done via laparoscope. If thereвЂ™s excess abdominal skin hanging round, then the procedure is usually combined with an abdominoplasty to achieve maximal cosmetic results for mum. Sometimes, the surgeon will вЂreinforceвЂ™ the linea alba with mesh.
Bottom line, the exact surgery youвЂ™ll need would be tailored for you by your surgeon, and would only be considered when youвЂ™ve well and truly finished having babies.
Have you undergone a Diastasis Recti treatment before and want to share your experience? Comment down below.
This article was first published inВ Kidspot and was republished with permission from theAsianparent В
Wham, bam, let’s fix my DRAM!
Diastasis recti, also known as DRAM or abdominal separation, is a common occurrence during pregnancy and in the post-natal recovery period.
What is Diastasis Recti?
Diastasis recti happens when the midline of the abdominals starts to stretch, causing a separation where your abdominal muscles should meet.
The increasing weight during pregnancy combined with hormonal changes and altered posture can increase the load on the abdominal wall and result in stretching of the linea alba.
The linea alba is the connective tissue that connects the rectus abdominus muscles (the 6 pack) into the midline of the tummy and once stretched can cause a bulging/doming appearance of the tummy.
Stretching of the linea alba. Image credit: newhealthadvisor.com
Having diastasis recti can disrupt the transfer of pressure through the abdominal canister and result in issues such as low back pain, incontinence or prolapse.
Diastasis recti wider than 2 fingers are considered abnormal.
However it is not just the width of the linea alba that we are concerned about, the depth is important as well as how the core muscles are functioning under load.
For example, Woman A may have a 3-4 finger width separation, but have no doming/bulging and core muscles that are able to transfer load very well in different positions.
On the other hand Woman B may only have a 2 finger width separation but significant doming/bulging and poor transfer of load through the core ie. when performing movements such as lifting one leg off the bed.
Bulging through the midline during pregnancy. Image credit: deliciouslyfitandhealthy.com
Some women are aware of this separation during their pregnancy, however most don’t realise until after birth.
How will I know if I have abdominal separation?
- Belly bulge or doming appearance of the tummy
- Low back or pelvic pain
- Pelvic floor weakness ie. incontinence
- Feeling of “core” weakness
What can I do to fix it?
- Strengthen your pelvic floor and deep abdominals (transversus abdominus)
- Wear compression garments over the abdomen. Tubigrip bandages or maternity compression garments should be available at most physiotherapy practices
- Practice good posture. You should be upright and tall, with a small curve in your lower back. Your ribs should sit on top of your pelvis. Make sure you don’t have an excessive sway in the lower back and try not to push your hips forward.
Leaning back too much!
Too much lower back sway can increase the load on your abdominal separation!
What should I avoid?
- Sit up type motions ie. when getting out of bed. Try rolling to the side and then pushing up as a safer alternative
- Constipation and straining on the toilet
- Heavy lifting
- Crunches or planks
If you think you might have abdominal separation, book in to see your local women’s health physiotherapist for a thorough assessment and management to ensure you prevent worsening during pregnancy and make a full recovery after birth.
Does DRAM get worse with each successive pregnancy?
Not necessarily. It will depend on how well you recover in between each pregnancy. This includes how much you close the gap and how strong and functional your core is. Each pregnancy is also different so it will depend on size of the baby, weight gain and how you carry.
Do belly binding garments help?
They do! They help to support the abdomen and reduce pressure on the midline. They will not prevent a DRAM but they can help to minimise the separation. Wearing a belly band should be used as a compliment to exercise, postural education and minimising risk factors such as straining, heavy lifting and constipation.
Does wearing compression make a prolapse worse?
Potentially. A belly band will slightly increase intra-abdominal pressure as it compresses the abdomen. For some women with prolapse this may make you more symptomatic. If it does, my recommendation would be to check in with your physio to make sure your pelvic floor exercises are going well and in the meantime stop wearing the belly support.
Can you prevent abdominal separation?
You can’t prevent it, as all pregnant women will have some degree of abdominal separation by the end of their pregnancy. However you can minise your risk factors so that your separation is not wider than necessary. This includes avoiding constipation, heavy lifting, poor posture and heavy abdominal exercises such as sit ups and planks.
Should you bother working on your separation during pregnancy or just wait until after birth?
There is so much you can do during pregnancy to optimise your recovery afterwards. Being mindful of your posture, keeping yourself fit and strong, avoiding the risk factors (as mentioned above) and wearing a belly bandage. This will all help you to recover better after birth!
Will the gap ever completely close?
Nope. It is not normal to have “no gap” as the 2 sides of your six pack muscles have to join together in the midline and naturally won’t be stuck right on top of each other. What is considered “normal” is a gap that is less than 2 fingers wide, which doesn’t bulge and allows you to function well without pain or discomfort. So in short, the aim shouldn’t be to have “no gap” but instead to have a less than 2 finger gap which doesn’t bulge and functions well!
What are the best exercises to do to repair a DRAM?
Great question! Check out my blog on abdominal recovery after birth for all the exercise goodies.
It has been 6 months now since my diastasis recti surgery. Many people have read my previous posts about how the decisions I had to make to have the operation, the struggles, the fear, and the diastasis recti recovery. Yet, I haven’t written a post about how I am doing now. So, I wanted to share life post-surgery.
(If you want to then read about how I am doing 3 years later, click here.)
Diastatis Recti Recovery
I won’t sugar-coat it and make it seem like everything was easy these past six months. It was not. It was emotional when I could not pick up my pre-schooler when he wanted a hug, and to coordinate people to be around me 24/7, so I could not lift anything over 10 pounds for 8 weeks (including my own baby.) It was hard to see a huge scar, it was hard to have a lot of swelling, and it was frustrating to be in a lot of pain.
Even without lifting things over 10 pounds, I got tired easily those first two months. My body had a 10-hour surgery, and there was a lot to get back in regard to energy. Even when I was given the go-ahead to walk upright, it took me a full month to stand up straight. I finally went to a chiropractor specializing in ART (active release techniques) to help me, and it was a huge help.
Umbilical Hernia Surgery Recovery
Yet, I still didn’t have full range of motion until mid-May. Though, to be honest, I am not sure how much was physical vs. mental in that respect. I had such a fear those first couple of months that I was going to pull my stitches, rip a hole, or a myriad of other calamities that my brain was envisioning, that I was fearful of doing anything. While that fear is lessoned, I still take care (and then worry after) when I have to lift a box in the garage or a suitcase at the airport, or even when I sneeze. Any time I am playing with the kids, I take extra care to protect my torso from a kick or being used as a seat cushion when they try to sit on me.
I also had a lot of swelling. I have spoken to friends who have had standard tummy tucks who have had swelling too, but not as severe and for not as long. While everyone’s recovery is different, an abdominal reconstructive surgery as severe and complicated as mine, probably results in side effects for a longer period of time. So I mention it because it can be very frustrating. However, the swelling lessens each month that passes, and I do see a big improvement from last month to now, let alone now and that first post-surgery month last February.
Diastasis Recti Recovery from Surgery
It has also been interesting to adjust to a new torso after my Diastasis Recti surgery. I have gotten used to not having my belly button, and more of a makeshift one. I have gotten used to my huge scar (and just wear high-cut underwear to hide it.) There were many weeks where I could not sleep in my favorite position, even when I got clearance to be able to lay down flat again.
While the swelling is going down, the one unique thing I am also dealing with it the numbness. It has gotten dramatically better, but even as I write this post, I can feel my hand touch my stomach, but the full sensation is not there. It is not a bad thing per se, it is more of a “huh, that’s interesting” reaction. I’m told that it is also something that improves over time, but it is a side effect of the surgery and it may never improve. So I am not sure which camp I will ultimate fall in, in that regard.
I am sure you are wondering the ultimate question. Would I do it again? The answer is yes. I would do it again even knowing how hard it has been, the challenges I knew were coming and the frustrations I did not know would impact me. Why? Because I am so much happier. I feel better than I did. I can go running again (even though I have had to start from scratch.) I can go for long walks, I can take an aerobics class and not feel pain. I can also put a dress on, and have it not be a maternity one. I can wear a normal pair of pants, and don’t need elastic ones. I no longer have everyone from a child to a senior citizen ask me when I’m due.
I can’t tell you if you should have it though. So many factors about your lifestyle come into play. There are a lot of risks, and everyone’s health varies. There are recovery limitations that may not be something you are able and willing to take based on family and work obligations. I will say that if you do decide to have it, don’t have it in the heart of winter. I know it seems like the perfect time to recover since you’re still stuck indoors, but I got a cold with a hacking cough right before my surgery. Luckily, it went away, like, the day before, but I was so scared of coughing afterwards. The same could be said of other seasons if you have bad allergies. Since I do have a tendency to sneeze everyday, the doctor told me to crunch myself up into a ball when I needed to sneeze. It was a way to protect all the stitches (internal and external.)
For some, personal training may be the solution. For me, it was not. It was too severe and the hernias too numerous that I didn’t bother trying. Yet, for some of you, it may be enough to avoid surgery. For others, the cost of paying $75 a session for a personal trainer may be better spent on surgical costs. You just have to weigh the pros and cons of them all.
The advice I can give, is at least see what your options are. Find a good plastic surgeon who is Board Certified. Find one that is willing to repair hernias and your diastasis recti together so you don’t have to have two surgeries. Find a plastic surgeon who repairs diastasis (and get references) vs. one that just does standard tummy tucks. Talk to your ob/gyn and perhaps get referrals from them. Speak to a personal trainer about a treatment plan, and what is the possibility of successfully reducing your muscle separation. Remember, however, that only surgery can repair it, but for many, the personal training can lesson the severity enough that you are happy.
While I miss the freedom of lifting and moving things anyway and anywhere I wanted to move them, it is a small sacrifice to make knowing I have my self-confidence back. But more so, is that fact that I don’t have to be in pain anymore and can go to Disney World with my kids. That, my friends, is priceless for me.
What is Diastasis Rectus Abdominis?
Diastasis Rectus abdominis, tummy muscle separation, or tummy gap, are terms which describe the widening and thinning of a small connective tissue which runs down our midlines, dividing our lovely six pack muscle into two halves. This connective tissue is called the linea alba and it runs all the way from the bottom of our sternum to our pubic bone. As the tissue widens, the two halves of the six pack muscle move further apart, and this is where the term ‘tummy muscle separation’ comes from.
Who gets Diastasis?
The widening and thinning of our linea alba is a normal part of pregnancy and during the third trimester 100% of pregnant women will have some degree of diastasis. This is a totally natural part of pregnancy and is actually really important because it enables our bellies to expand and make space for our growing baby. Pregnancy hormones play a large role in this process as they help to soften our connective tissues and ligaments. Along with helping the linea alba to become more pliable, pregnancy hormones will also help to soften the ligaments around the pelvis, preparing your body for labour.
For the majority of women, the linea alba will naturally regain tension within the first 2-3 months postpartum. However, around 1/3rd of women may notice some ongoing tummy gap. This is okay, because it’s not all about the gap and importantly exercise can help you to regain tension and strength.
Although we tend to hear the term diastasis or tummy gap with regards to pregnancy and in postpartum women, it can also occur in men, often in relation to obesity, in elite athletes, and in children too.
It’s important to know that everyone has a linea alba and it’s deemed normal to have a gap of 1-2.5cm between the two halves of the rectus abdominis muscle.
How do I know If I have Diastasis?
If you have diastasis, you may notice a doming or bulging of the tummy muscles at the midline, especially when performing movements that create pressure within the belly, such as a sit up, lifting a heavy object, straining on the toilet, or when doing strenuous exercise. You may also notice a dropping down into the tummy like a valley, or feel that when you push on your tummy, your hand sinks in a little and there’s just not much resistance. You might also feel a gap with your fingers if you press into your midline while lying on your back and lifting your head and these sensations can be felt anywhere along the length of the linea alba.
Is it all about the gap?
Recent studies have helped us to understand that it is less about the size of the gap, and more importantly about whether or not you are able to generate force across the linea alba and control pressure within the abdomen.
You may have been told, or read on the internet, that if you have diastasis, you will never be able to do movements like a sit up or a plank. I’m here to let you know that is just not true! If you have a gap but do not have any bulging, or sinking, and can generate good tension and control during strenuous activities, then there is no reason why you cannot get back to doing any and all of the activities you love.
What should I do If I have Diastasis?
If you think you may have diastasis you should seek help from a pelvic health physiotherapist or a trainer with experience working with postnatal women. These professionals can help to assess whether or not you have a diastasis and determine which activities and exercises you should begin with to help generate good tension and control to safely regain your strength.
Can I exercise with Diastasis?
It’s important to know that no one size fits all. Everyone generates tension across their linea alba differently and in different positions. As physios, if we think you have a diastasis, we will look to assess you in many positions including a curl up, a plank, a side plank and even squats and lunges. We are typically looking for the positions that you can best generate this tension and will then create a programme that includes strengthening exercise in these positions. This will give you the best chance of building strength in the initial phase of rehab and as you progress, we will look to challenge these positions and increase the resistance or impact.
As a result, there is no right or wrong exercise for diastasis, and as physiotherapists we are looking to find positions and exercises that are best suited to you. As you get stronger, you will be able to perform different and more challenging exercises, but it’s always important to nail the basics first!
Once you have made it past 3 months postpartum, and are able to generate good force across the linea alba, and control pressure within the abdomen during impact movements, you will be able to begin a return to running and sport programme.
Can I prevent Diastasis?
Unfortunately there are few things you cannot change when it comes to your risk of developing diastasis. Your genetics play the biggest role in whether or not you will develop a larger gap, as well as pregnancies with multiple babies.
However, to some extent you may be able to reduce your risk. During pregnancy, especially as you progress, try to:
- Avoid heavy or poor lifting techniques such as breath holding
- Avoid straining where possible, this includes prolonged coughing, constipation or vomiting – speak to your doctor and seek treatment if this is occurring.
- Avoid excessive abdominal loading with exercises including sit ups or heavy weight training
It may be helpful to try to use the log roll technique to help you sit up from bed, and make sure you keep breathing during lifting tasks or even movements like sit to stand.
Someone commented on a post I made earlier this week on Instagram asking about coning and why it was such a big deal. Honestly, it’s a good question because I think there’s a lot of messaging out there to avoid coning, but explanations are not really given. Just giving it a quick Google, I see lots of articles on preventing and treating a diastasis – but no explanation as to what’s going on. I’ve had a draft of this blog post in the works for months but never had the time/motivation to finish it until now.
First off- a diastasis rectis is pretty much guaranteed to occur with every pregnancy that makes it full-term. It’s the body’s natural response to the growing baby and keeping it from smushing all your organs.
I had never heard of a diastasis until I was in physical therapy school, and I think it was only brought up because one of my classmates was pregnant, so our instructor assessed her for one. Because of my lack of knowledge up until shortly before I became pregnant, I expect many other individuals are quite unfamiliar with this naturally occurring process and it as a dysfunction.
Diastasis refers to “separation”. Recti refers to the rectus abdominus muscle. Diastasis recti is the separation of the recus abdominus.
Image from the Baby Center.
This separation occurs along the linea alba, as pictured above. The linea alba is the line of fascia that divides the sides of the “six pack”.
For pregnant women, as the fetus is growing inside of them, space is needed so that baby doesn’t smush all the vital organs in the abdominal cavity- so the abdominals stretch and eventually split. THIS IS NORMAL AND OCCURS IN 99.9% OF WOMEN WHO MAKE IT TO THE END OF THEIR 3RD TRIMESTER. Read that again. The reason why I don’t say 100% is because there could be some insane outlier out there, but it is completely normal for a woman to have a diastasis at the end of her pregnancy. This is the body’s way of dealing with that growing baby.
So ladies, don’t freak out about a diastasis. However, it is important to avoid activities and movements that cause “coning”. For those that are unfamiliar with coning or “doming”, here’s a picture of it occurring during my pregnancy.
Source: TheMovementMinistry on Instagram
Coning is pressure not being managed by our body. Intra-abdominal pressure or IAP is normal and many lifters use it to lift heavy, utilizing breath holding or valsalva techniques (post to come on that). However now there’s a fetus growing in your uterus, taking up space and causing your belly to grow outward- completely normal. If you try to do something that requires too much abdominal contraction and they can’t contract well because there’s something growing inside, coning can occur. Sometimes coning can be managed with breath and strategy. Sometimes not. If you experience coning that you cannot make go away, please stop that movement.
After giving birth, some women’s diastasis may heal in a few days or weeks. Others may take months. I’m personally in the months group. It is important after giving birth to give our body time to rest, heal and adapt to the new lifestyle as a mother. Many women want to get back to working out, however that healing time/”4th trimester” is so critically important. Giving birth, whether vaginal or cesarean, whether it went well or not as good as one would’ve hoped, is traumatic. We give people weeks and months to heal from orthopedic surgeries and injuries, but for some reason social media likes to pressure moms to “bounce back”.
Unfortunately we don’t just “bounce back”. Our bodies underwent massive changes over 9 months, muscles were overstretched and it all doesn’t magically resolved in a few days (though it would be wonderful if it did). Hormones are going crazy, which certainly doesn’t help. After allowing time to heal, we have to consciously work to get everything working together again- and by that I mean the core: rectus abdominus, transverse abdominus, obliques, pelvic floor, diaphragm, multifidi and erector spinae. Most of the time, this conscious effort is necessary, just slowly easing back into things isn’t enough if the system is not functioning quite right.
As a physical therapist and Pregnancy & Postpartum Athleticism coach, I highly recommend going to see a pelvic floor physical therapist upon being cleared by a physician to return to working out/activity. They can formally assess and accurately measure a diastasis, in addition to checking pelvic floor function. They can then give exercise recommendations and strengthening/stretching to do to address any dysfunctions.
Coaches and trainers, it is important for you to be looking for and monitoring this in pregnant and postpartum clients. A majority of women cannot feel coning, myself included. The only way I know if I cone is if I watch my abdominals, or have someone else watch. This should go without saying, but I’m going to say it just in case- you should not be working with a client who has not received the all-clear from her physician to begin exercise.
So we know that coning during pregnancy is something we want to avoid, as we don’t want to further stress an already stressed & stretched system of tissue. But what about postpartum? Is coning still something we need to monitor? Yes and no.
It does take time for a diastasis to heal- everyone is different in the amount of time needed. As I stated above, mine has taken months (10.5 months postpartum currently) & it’s pretty closed. It’ll probably close a little bit more once I’m no longer nursing. As the tissue was healing & the linea alba was rebuilding, I didn’t want to do things that consistently caused coning. This would have delayed the healing and/or prevented healing from occurring.
If there’s some coning with movement, BUT it can be decreased or go away completely with adjusting posture, breath, activating deep core muscles, then it can be okay to do. Stressing the system in a small, controlled amount is ok- that’s what we do every time we workout.
But why do we need to watch out for coning postpartum?
Coning can be a sign of decreased trunk/core strength. Decreased strength of the core can be linked to impairments such as low back pain, pelvic pain.
The stress that coning puts on the abs can cause/continue to have weakness in the core noted. Consider this, if there’s a separation of abdominal muscles, they’re not able to generate as much force as if they were able to contract together with minimal to no abdominal separation.
Due to the stress that coning puts on the linea alba, an umbilical hernia can develop.
Coning can cause a distorted pull on the fascia. Take a look at the pictures below from “Anatomy Trains”. You can see how the rectus abdominus ties into the hip flexors and even the pecs- it can affect both the shoulders and lower body.