Postnatal Care 2: Understanding Diastasis Recti (Abdominal Muscle Separation)
We often spend time with ladies discussing their concerns surrounding Diastasis Recti of Abdominal Muscle (DRAM) or abdominal muscle separation.
Did you know abdominal separation is one of the most common conditions that physiotherapists see in pregnant and postnatal patients? As many as two in three pregnant women have some degree of abdominal separation. As a result, it is essential that abdominal exercises in the childbearing years be carefully considered and modified.
Abdominal muscle separation refers to the widening of the space between the rectus abdominus muscles running along the centre of the abdomen (the 'six pack' muscle). This often involves stretching of the connective tissue which lies between these muscles known as the linea alba. This is very common during and after pregnancy.
Separation occurs as the abdominal wall adjusts to allow room for the growing baby during pregnancy, and this can occur any time from the first trimester. You may notice you have DRAM when you sit up or get up from the floor and notice a ‘doming’ or ‘tenting’ through the middle of the stomach.
As a result, DRAM can have a number of implications for pre and postnatal women. The separation of the collagen tissue results in excessive intra-abdominal pressure which can lead to back pain, pelvic pain and incontinence as the abdominal muscles have weakened and are not supporting the trunk adequately, resulting in a destabilized support system. It can affect the stability of the trunk and may contribute to pelvic floor dysfunction (66% of patients with DRAM have reported to have pelvic floor dysfunction).
The transverse abdominis (TA) muscle is the deepest of the abdominal wall and represents the front of your ‘inner core’. Activating TA creates tension across the collagen tissue of the linea alba allowing for optimal loading through the abdominal wall.
A few things to check in your first few weeks postpartum.
1. Use support such as braces or tubigrip (thick stretchy band from a physiotherapist) to provide support for your abdominals and back. If you have had a C-section avoid putting tubigrip or braces over the wound.
2. It is important to regain proper function of you core muscles after delivery. Because your TA and pelvic floor are both a part of your core and work together, contracting one of these will stimulate the contraction of the other.
3. Continue deep breathing exercises and gentle movement which will assist in functional training of your abdominal muscle wall. Don’t start high intensity abdominal workouts immediately postpartum.
4. Get in contact with a Women’s Health physiotherapist if you are unsure you haven’t been assessed thoroughly in hospital and for ongoing exercise progressions.
Our advice would be to manage your individual recovery by getting in touch with a physiotherapist who has a special interest and experience in pre and postnatal exercise. This way they will be able to assist you with a thorough assessment and give appropriate individual advice for management and exercise. At Body Align Physio we specialise in rehabilitation of DRAM and can provide you with a safe return to exercise.
