Abdominal separation or diastasis recti (DRAM) is a common condition of pregnancy and postpartum, when the right and left halves of your abdominal muscles spread apart at the body’s mid line. During your pregnancy your abdominal muscles are stretched, due to the growth of your uterus and baby. During this time, your abdominals become compromised due to hormonal changes, and often separate to allow room for your baby. Following the delivery of your baby your abdominals will not automatically re-join, and resume their pre-pregnancy strength (unfortunately).
Once you have delivered your baby your doctor or physio will often assess the level of separation between your abdominals. A mid line of more than 2-2.5 fingers widths or more than 2.5-3cm can be considered problematic. Should you feel that you have a separation that is greater than 2.5-3cm, it is important that you visit your local women’s health physio to discuss appropriate exercise prescription to optimise the closure of this. A small amount of widening occurs in all pregnancies, and is very normal. Disastasis recti is thought to occur in approximately 30% of all pregnancies, and unfortunately separation in a previous pregnancy significantly increases the probability of the condition in subsequent pregnancies.
Unfortunately for some women the separation can result in them requiring surgery to close the gap between their abdominals. However this is in situations where the gap is large and all attempts at rehabilitation under women’s health physio have been unsuccessful.
What does DRAM mean to me?
A separation is a safety mechanism of the body to avoid the muscles tearing during pregnancy. However it can become a problem postpartum should the muscles stay separated. Stretched and separated muscles do not provide full support for your back and may increase incidence of back pain, back injury, pelvic instability and other injuries due to compromised core control.
What can I do to fix reduce my separation??
A variety of things can be done to reduce the separation following the birth of your baby. The sooner you act on this issue, the better the results will be. Some of the following can have a significant impact on reducing the separation:
- Exercises to strengthen the deep abdominal muscles.
- Wearing an abdominal support belt, such as Tubigrip™, or firm compressive underwear following the birth of your baby
- Avoiding sit-ups or abdominal crunches until the separation resolves.
- Rolling when getting into or out of bed.
- Minimising lifting anything heavier than your baby or anything that causes your tummy to bulge with strain.
Deep abdominal muscle strengthening exercise – postpartum
- Begin your exercise in one of the following positions; side lying, lying on your back, sitting, standing or 4 point kneeling.
- Draw your lower tummy in towards your spine.
- Hold for 5–10 seconds while breathing normally.
- Rest and repeat 8–12 times. Repeat this set of exercises 4 times each day.
- To make your exercises harder, over the next 6 weeks do them in a sitting or standing position and increase your effort as you are able.
Monitoring the recovery of your abdominal muscle separation
- Lying on your back with your knees bent place your fingertips across your belly at the level of your belly button.
- Lift your head away from the floor (a mini curl-up) and feel for the sides of your abdominal muscles coming together.
- If you can feel a gap wider than one finger then you may still have a separation.
Exercise to avoid
- Any exercise that causes your abdominal wall to bulge out upon exertion
- Lifting and carrying very heavy objects
- Intense coughing without abdominal support
- Movements where the upper body twists and the arm on that side extends away from the body, such as “triangle pose” or lifting a toddler into a car seat
- Exercises that require lying backward over a large exercise ball
- Yoga postures that stretch the abs, such as “cow pose,” “up-dog,” all backbends, and “belly breathing”
- Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, oblique curls, “bicycles,” roll ups/roll downs, etc
- Pilates mat and reformer exercises that utilize the “head float” position, upper body flexion, or double leg extension
Sources: http://www.thewomens.org.au/AbdominalMuscleSeparationorDiastasis, Hold It Mama – The Pelvic Floor & Core Handobook, Mary O’Dwyer