Handling abdominal muscles separation

Women’s health is the care in relation to childbirth, both antenatal and postnatal. This includes antenatal classes in the treatment of incontinence and in care of women undergoing gynaecological surgery.

All females across the lifespan— from the young athlete, child-bearing woman, the menopausal and elderly receive benefit from physical therapy.

Once a woman has conceived, she undergoes three trimesters before she gives birth. Several changes take place during this time. She may also undergo various complications, for example diastasis recti abdominis and endometriosis, among others

Diastasis recti abdominis

Also known as abdominal separation, diastasis recti occurs when the rectus abdominis—the two large vertical banks of muscles that meet in the centre of your abdomen (known as the “six-pack”)—pull apart from their attachment point, the linea alba that runs down the body’s midline. The largest of the abdominal muscles, the rectus abdominis works together with the pelvis and lower back to help you move and transfer weight through the pelvic area. It also forms part of a wall of muscle that holds the uterus, intestines and other organs in place and lends support to the pelvic floor. Under pressure from a growing baby, these muscles stretch and thin, separating from the connective tissue that binds the abs together.

If you have carried a full-term baby in your belly, chances are you have experienced some degree of separation. “It is definitely the norm as the baby is growing and hormonal changes affect the connective tissue, allowing it to relax. The likelihood of developing a diastasis increases for those who are pregnant with multiples, who have had recurrent abdominal surgery (like a C-section) and who have had more than one pregnancy (the theory being that our bodies are quicker to stretch out and to assume the pregnant form in second and subsequent pregnancies). In rare cases, the separation can be so bad it causes a painful hernia, which occurs when organs poke through the separated abs and push against the skin. Thankfully, this is not the norm.

Diastasis recti symptoms

So how do you know if your abs have parted ways and are reluctant to meet again? Although diastasis is not painful and is not typically obvious until the postpartum period, it can sometimes be detected around the 25-week mark during pregnancy via a physical exam or ultrasound. During late pregnancy, when pressure on the abdomen is at its peak, diastasis is tricky to diagnose.

Elisabeth Parsons, a personal trainer who owns Core Expectations, a pre- and postnatal in-home abdorminal rehab service in Toronto, says the tell-tale (and potentially startling) sign during pregnancy is when the belly takes on a cone- or dome-shaped look when you activate your ab muscles as you are leaning back on the couch or trying to sit up in bed. It can appear as a valley when the body is at rest. This shape often indicates there is too much strain on the abdominal wall.

“The fact that you get a diastasis is not in itself so awful—it is what your body is supposed to do to accommodate the growth of your baby. “It is bringing it all back together and restoring function in those muscles (postpartum) that is important. Women are recommended to see a physiotherapist to have their core strength assessed during pregnancy. Physiotherapists will send you home with some belly-friendly exercises to lessen back pain. In reality the diagnosing of separated abs during pregnancy is not often done. Most women report in weeks or months after delivering, when they notice the protruding belly and a general feeling of weakness in their core. A lot of mothers say it feels weak when they go to pick up something like a laundry basket—“it feels like there is nothing there”. Other signs of diastasis include:

•Incontinence that continues more than eight weeks postpartum (separated abs can often cause pelvic floor dysfunction, which can lead to urine leakage, constipation and pain during intercourse),

•Lower back pain and a four-months-pregnant look (for several months or years after giving birth) or that same dome-like bulge in the centre of the abdomen when you cough or sit up from lying down.

Feelings of weakness and back pain after pregnancy are common, so diastasis is something that often gets missed.

Management of condition Abdominal muscles do not always snap back into place after having a baby, and that belly bulge may be a sign of diastasis. Here is how to knit those abs back together.

•Kegel exercises

•Breathing exercises

•Progressive core exercises

•Body mechanics

•Postural awareness

•Abdominal supports

Precaution: Sit-ups and crunches

Sit-ups and similar exercises can put a strain on the pelvic floor and can increase intra-abdominal pressure which may not be helpful during pregnancy and when restoring the abdominal muscles and pelvic floor in the postpartum period.

Abdominal Binders: Binders may be helpful for some women in the postpartum period, but the wrong or overuse of them can cause more problems. It is best not to use an abdominal binder unless necessary, for example during pregnancy in the third trimester and six weeks after delivery if there is a separation of two fingers or more.