Abdominal Separation Post Pregnancy
What is abdominal separation?
Abdominal separation (or known by physiotherapists at Disastasis Rectus Abomdinal Muscle DRAM) occurs during pregnancy most commonly form the 2nd trimester onwards (1). In your abdomen you have your rectus abdominus – or 6 pack muscles, and these are connected down the middle by connective tissue (linea alba) – your abdomen can only stretch so far long ways before the tissue in the middle needs to stretch outwards. It is hormones released by the body during pregnancy that relax this tissue allowing it to stretch.
How do you know if you have it?
A physiotherapist may assess you in hospital, to do this they will press their fingers into your tummy while you perform a small crunch. This is to assess what the connective tissue between your rectus abdominus muscles can do (2).
When the physiotherapist assesses your abdomen, they are looking at two things. One – what the distance between the muscles is when you perform the crunch and two the integrity of the tissue – does it bulge or stay flat.
How do you bring the abdominals back together?
The important thing to keep in mind is that the tissue is not torn (unless there is a hernia present) – the tissue is stretched.
There are a lot of changes in the female body during the first six weeks post partum. During this time the BEST thing you can do your for abdomen is PROTECT it. What does that mean? It means to limit the amount of pressure that goes through your abdomen. In our body, pressure will always take the path of least resistance. So while your uterus is returning to normal size and your hormones are returning to pre-pregnancy levels, the most important things you can do are;
- Use a log roll to get out of bed
- Be very careful with lifting technique
- Avoid constipation and straining when passing a bowl motion
What about pelvic floor exercises
There is some contention in the literature about whether pelvic floor and deep abdominal exercises (these muscles work as a team together) can help bring a separation together or further apart. In my point of view, pelvic floor exercises are important after child birth to help strengthen the muscles, and to help restore function. I feel as though not doing them would be more detrimental.
Ensuring that when you do lift and exercise after child birth that your stomach does not bulge is a great way to know that there is no pressure pushing outwards against your linea alba and making your separation worse.
If you have a bigger DRAM what you should do is
- Follow the three above tips ot protect the abdomen for at least six weeks
- Seek physiotherapist opinion at the six-week mark so you can get an individualized exercise program
Can a brace help?
Braces can be great to help support the abdomen during those first few weeks while ligaments are really laxed throughout the body. It is difficult to find research to support this notion but from clinical practice I have seen success when braces are used in the early post-natal period.Braces can be great to help support the abdomen during those first few weeks. #performbetter @pogophysio Click To Tweet
There are two main options when it comes to compression for your abdomen after childbirth – one being Velcro wrap-around style braces and the other being shape-wear underwear. The style you choose really depends on your lifestyle and what is most comfortable to wear. It is really a personal decision as to which style you choose and each person has a different preference.
Emily Georgopolous (APAM)
(1) Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 1988;68:1082–6.
(2) ] Bursch SG. Interrater reliability of diastasis recti abdominis measurement. Phys Ther 1987;67:1077–9.