There is no magic pill to cure an abdominal separation, also known as mummy tummy and diastasis rectus abdominis (DRA).
Preet, our resident Women’s Health Physiotherapist, answers your questions about diastasis recti in women.
WHAT IS A DIASTASIS RECTI?
It is when the connective tissue (linea alba) that connects the 2 muscle bellies of the rectus abdominis muscle (the 6 pack) stretches and weakens, giving the appearance and feel of the abs being separated.
WHY DOES DIASTASIS RECTI HAPPEN?
There are many reasons as to why this can happen, but it commonly occurs due to:
- Excessive intra-abdominal pressure
- Poor alignment
- Poor technique when performing abdominal exercises
It can happen in babies and men too.
WHAT ARE THE SYMPTOMS OF DIASTASIS RECTI?
The first time many people notice they have a separation is when they sit up from the floor or get out of bed and notice a doming or tenting through the middle of their tummy. If it is a large, thin separation, sometimes the internal organs such as the bowels can be seen or palpated.
You may hear or read that diastasis may be the cause of symptoms such as back or pelvic pain or incontinence. However, the evidence is inconclusive and not always causative.
HOW DO I ASSESS FOR DIASTASIS RECTI?
It is not always easy to self assess for diastasis recti in women. I recommend that a Women’s Health Physiotherapist be engaged to accurately assess this for you, as they will not only assess the magnitude but also look at the factors that may be contributing to the diastasis, provide education to prevent worsening, give a prognosis and prescribe an exercise program to help the healing process.
Lay on the floor with legs straight, arms by your side.
Lift head off the floor and crunch such that the shoulder blades lift off the floor.
Move one hand over to your xiphoid process (tip of the breast bone) and run your fingers along the middle of the 2 rectus abdominus (6 pack muscles) or if present over the linea nigra all the way past the umbilicus (belly button) to the pubic bone.
Feel for the 2 firm edges of your rectus abdominus muscles and the softness of the space between them (‘depth’- soft, mild, mod, firm) and the width (finger widths). Think of it a bit like the skin between 2 knuckles on your hand, where the knuckles are the muscle).
I’VE JUST HAD A 6-WEEK CHECK UP WITH MY OBSTETRICIAN/GYNAECOLOGIST AND HE HAS GIVEN ME THE GREEN LIGHT TO EXERCISE AGAIN. WHAT ARE SOME SAFE FORMS OF EXERCISE?
What I like to remind my patients is that the body is still recovering at 6 weeks. Childbirth itself is one of the most traumatic experiences a female’s body will undergo. In no way should you jump straight back into pre-pregnancy level exercise such as boot camp, F45, Crossfit, etc. at this point in time.
In instances where mums have birthed via C-sections, albeit they may not be in pain, what we know is in fact your scar will not be healed within 6 weeks. Abdominal muscles have only regained ~ 50% of the original tensile strength by 6 weeks. By 6-7 months, only 73-93% of original tensile strength is regained (Ceydeli et al 2005).
Current available evidence recommends that women do not consider running until 3 months post-delivery, following uncomplicated labour.
You don’t shoot a cannon from a boat. We can apply the same analogy when speaking of returning to exercise. Let’s make sure the core and floor muscles are working well and there are no other injuries from childbirth that need to be addressed before performing more strenuous forms of exercise.
If patients haven’t already started on activating their core and pelvic floor muscles, that is where I start them off. I also encourage light exercises such as walking, swimming, post-natal classes, low-intensity gym workouts with an emphasis on posture, breathing, core and pelvic floor activation.
WHEN SHOULD I SEEK FURTHER ADVICE?
In 60% of women, the separation heals itself within the first 2 months after having a baby. But if you find that your gap is more than 3 finger-widths, the midline feels soft and deep and/or you are suffering from ongoing back and pelvic pain, you should have a physiotherapist specialising in women’s health assess you.
WHAT TO DO NEXT?
Follow up with a physiotherapist who can specifically assess and individualise a program for you.
Ladies, if you have any questions about diastasis recti in women, or would like to be assessed, feel free to call/WhatsApp on 9780 7274 or get in touch over email to make an appointment.
You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.
Goom T; Donnelly G; – Brockwell E. Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population March 2019.