WHAT IS DIASTASIS OF RECTUS ABDOMINIS MUSCLE?
Rectus Diastasis is the separation of the rectus abdominis muscle (6 pack muscle) that occurs during pregnancy. It may cause a bulge to occur when a pregnant woman attempts to move, especially visible when going from lying to sitting. The connective tissue (Linea alba) joining the two strips of muscles (rectus abdominis) down the middle of the abdomen stretches due to the growing uterus.
SHOULD I BE CONCERNED IF I HAVE NOTICED ABDOMINAL SEPERATION?
Every woman’s abdominal muscles will widen and stretch to varying degrees during pregnancy. This is what the muscles are designed to do. Women may notice discomfort with stretching of the Linea alba at any time throughout pregnancy, however particularly in the 3rd trimester.
Health professionals consider a separation of 1 – 3 cm postpartum ‘normal’. Abdominal separation will naturally decrease from Day 1 up to about 8 weeks post-partum. A mild diastasis is mostly a cosmetic issue for postpartum women – hence the “mummy tummy” term, which is a bulging of a woman’s abdomen that diet and weight loss cannot fix.
Research shows that an abdominal separation greater than 2.5 – 3 cm is related to other support related conditions such as lower back pain, hernia, stress urinary incontinence, faecal incontinence and/or pelvic organ prolapse (because of the relationship between the abdominal wall and pelvic floor). For this reason, health professionals will ensure postpartum woman with significant rectus diastasis receive appropriate treatment to help reduce the separation.
Regardless of a woman’s initial separation width, (without intervention) no further closure is likely to happen after 3 months postpartum.
HOW DO YOU TEST FOR RECTUS DIASTASIS?
A women’s health physiotherapist can assess your rectus diastasis. First the therapist will get you lying flat without a pillow under your head and legs out straight or bent. The therapist will place their fingers just above your belly button and ask you to lift your head as far as comfortable off the bed. The therapist will feel for the closure of your abdominal muscle against their fingers and from this they can estimate the amount of separation. The therapist will also check the condition of the connective tissue and determine if there is any herniation or coning/bulging.
HOW CAN I MINIMISE ABDOMINAL SEPARATION DURING PREGNANCY?
1. Use a compression garment (Tubigrip / maternity belt / SRC shorts) to hold the uterus towards the spine rather than letting gravity pull your tummy forwards
2. Exercise. Several studies have shown that women with no or mild rectus diastasis were more likely to be doing some form of regular exercise than woman with moderate to severe separation.
3. Avoid excessive weight gain during pregnancy. A woman with a normal BMI should strive for a 10-15kg weight gain in her pregnancy.
4. Avoid exercises or activities that exacerbate rectus diastasis after the first trimester and immediately postpartum. Although there is limited evidence many clinicians suggest avoiding sit ups, plank positions, getting up from lying positions to sitting/ standing etc. It is also important to avoid excessive coughing and constipation.
5. Getting started on some deep abdominal and pelvic floor muscle exercises will optimise the function of your ‘core’ as a new mum
6. Check your posture and alignment. A pregnant woman’s centre of gravity shifts forwards due to her growing belly causing the pelvis to tilt forward. This requires the abdominals to stretch even further. Being able to correct & re-adjust this posture during prolonged sitting or standing will decrease the pressure of the uterus against your abdominal wall.
Sometimes, despite our best efforts some woman will be more likely to get a greater degree of separation compared to other woman. Some factors that increase a pregnant woman’s risk of abdominal separation include; excessive weight gain, older maternal age (> 35 y/o), multiple pregnancies, close successive pregnancies, collagen disorders/conditions, pregnancies with multiples, higher tone/well – defined rectus abdominis muscle (ie. 6 pack) & genetics.
HOW CAN I REDUCE MY RECTUS DIASTASIS POSTPARTUM?
An essential part of the management for rectus diastasis in the first 6-8 weeks postpartum is the use of a compression garment (abdominal muscle support) such as, Tubigrip (‘boob-tube’ type elastic fabric band) or SRC shorts.
In addition to a compression garment, it is often a good idea to have a thorough assessment by a women’s health physiotherapist, who will create a specifically tailored exercise program. A variety of ‘core’ exercises can be prescribed depending on which exercises create a satisfactory instant reduction in your separation and if present, minimise herniation or coning/bulging. The therapist will also prescribe how many times you should do each exercise depending on when you reach your fatigue point (the point at which you begin to lose the correct technique). Real-time ultrasound can also be used to assist in determining abdominal-wall functioning and give instant feedback on the quality of deep abdominal activation.
CAN I REDUCE MY RECTUS DIASTASIS YEARS AFTER CHILDBIRTH?
Women’s Health physiotherapists treat rectus diastasis across a variety of ages (children included) & men as well. Your separation can be reduced no matter how long it’s been since you had children. Although your abdominal separation may never quite get to pre pregnancy appearance, it is important to note that rehabilitation of severe rectus diastasis is aimed to improve function and quality of life.
If you are concerned you may have rectus diastasis we strongly recommend you book an assessment with one of our physiotherapist’s with a special interest in women’s health. Call to book and appointment on 5504 7000.