Every 6 weeks or so I have the privilege of meeting a group of new moms inside AMC’s Postnatal Recovery class. These new—1st, 2nd, 3rd time— moms come to class with a list of questions about their postpartum bodies.
The most common question I get asked is about an abdominal wall separation, also known as diastasis recti. This blog is intended to help educate you about the facts so that you can become your best advocate.
What it is?
Plain and simple, it is functional core weakness. The inability of the muscles of the core to effectively function and support the body for everyday physical demands without pain or dysfunction.
An abdominal wall separation, also known as diastasis recti, is the separation of the abdominal muscles. Diastasis is a common feature during pregnancy, or after birth –approximately 66% of women have an abdominal muscle separation immediately following delivery. During pregnancy your muscles need to expand to accommodate the growing uterus. During this expansion, in some cases, the connective tissue (linea alba) holding the muscles together thins and weakens. It doesn’t hurt, and you may not even be aware that it exists.
A separation reduces the integrity and functional strength of the abdominal wall and thereby can affect the back and pelvic stability – think low back pain, and/or urinary incontinence. A separation also cause the ‘baby pooch’ appearance.
What Does It Feel Like?
Here’s how woman may describe what it feels like to have core weakness and/or Diastasis Recti postpartum:
- body feels really disconnected
- you keep injuring yourself without knowing why
- chronic back pain (low, mid, and even upper back)
- a bulging, pouchy tummy that won’t go away
- you see a trench down the midline of your belly when you sit up or cough
- you have a hard time sitting or standing tall
- lifting/carrying your kids feels really hard
Although some of this may seem like a typical postpartum recovery, it does not have to be this way. All of these symptoms indicate functional core weakness and risk for diastasis recti.
What causes a separation?
A separation can occur to any pregnant woman. It doesn’t discriminate between fit, strong mamas, or mamas who may not have the option to exercise during pregnancy. Health professionals agree that women carrying multiples, age, joint elasticity, and number of births can be strong influencers for a separation to occur.
How do I know if I have it?
Ask your healthcare provider to assess you after having your baby. You can self-assess after birth, but it is recommended to wait 14 days after birth before you start.
- Lie on your back with your knees bent and feet on the floor
- Put your fingers at the midline of your tummy
- Lift your head slightly with your abs relaxed
- As you rise and lower slightly in this position, you may feel that your fingers sink in slightly and can feel the ridge of muscle on either side as you rise
- If you rise up in a full sit up type movement, and see your tummy rise in a ridge or cone shape, this is a sign that you have a diastasis also
- If you feel a painful bulge in the diastasis consult your doctor
Once identified, diastasis can be measured for its length, width and depth. (Depth is most telling of severity, followed by width then length.) A women’s health specialist can help you with an assessment if you are concerned and would like a thorough assessment and treatment plan
When is surgery necessary?
Unlike what most people are told, diastasis recti does not require surgery and can be corrected with functional core rehabilitation. In the dozen years I’ve been working with prenatal and postnatal women, I have only seen two severe cases of a separation that required surgery.
What can I do to get stronger?
With dedication to basic functional core training you can begin to rebuild core strength. You have a group of core muscles that are primarily responsible for holding you up. The main muscle in this group, the transverse abdominis, is beneath your other abdominal muscles. It is the only muscle that wraps completely around the body to have a front, back, right, and left aspect all in one. It is essentially a natural corset designed to elongate the torso and balance the entire body by securely connecting the upper and lower body. When this muscle is strong and active, it is your largest postural muscle, holding your organs up and in, and provides stability for your spine.
For every woman wishing to return to exercise after having a baby, these functional core exercises should be your starting point. Rushing into other forms of exercise without functional core strength is not advised (and extremely common in the pursuit of weight loss and pre-pregnancy physique).
An important step to heal a weak core is to avoid exercises (crunches, V-ups, side planks, oblique sit-ups, Pilates 100’s) and DAILY MOVEMENTS (sitting up straight to get out of bed) that can hinder your progress.
What Active Moms’ Club programs are available to assist me?
- “From the Core: Postnatal Recovery”
This mom and baby class meets twice a week for five weeks. Since the class is designed to work with your recovering body targeting issues such as abdominal wall separation, weak pelvic floor, cesarean section – the exercises get progressively more intense. By the end of the five weeks, you’ll feel stronger and more confident about what your post-baby body can do.
- Post-Baby Body Express Training
Busy mama? PBBE offers three one-on-one training sessions and a series of customized at-home workouts to build functional core strength. You’ll learn corrective exercises to address your post baby body.
Yikes, my baby is over 1, is it too late for me to heal it?
No. It is never too late to rehabilitate your abdominals and start rebuilding a strong core.
Why does advice out there differ so much?
Sometimes you will find fitness professionals prescribing unsafe exercises due to lack of knowledge or because they themselves or their clients have utilized those exercises without ill effect. This is because every physical body is different. Every woman’s physical strength and condition, the size and shape of her muscles are different. Every woman’s pregnancy is different. Therefore, the advice above of what to avoid is general advice that is cautious and sensible for the general population. Become knowledgeable on the condition, get to know your own body, and you can then make an informed decision about what is best for you.
Knowledge is power. Please share this article if you know others who would find it helpful.
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