abdominal separation

Posted on October 21st, 2015 by

from teaching yoga to dozens of postnatal ladies I have been shocked to discover how many of them tell me that they don’t know what abdominal separation is or whether they have it.

it is worrying to me that ladies are being given the all-clear to exercise at their 6-week check-up without the GP or Health Workers actually even checking whether their abdominals are properly healing. Yet it is this 6-week check that often women rely on as guidance to recommence exercise.

often women then take themselves off to all kinds of fitness classes supposedly for new mums. I was disappointed to frequently hear of and experience first-hand for myself, exercise classes including buggycise, mums and baby fitness and even postnatal yoga classes that did not check the ladies’ state of abdominal separation yet invited them to partake in exercises that could cause some serious damage. There was always very often a distinct lack of emphasis on activating the deep core muscles (Traversus Abdominus and Pelvic Floor) which is essential postnatally as far as I am concerned! 

here I hope to offer some clear information on abdominal separation. 

the rectus abdominis muscles are the most superficial layer of abdominal muscles that run down the centre of the stomach. The centreline is called the linea alba. It is made of connective tissue that joins the left and right side of the abdominal muscles.

AbdominalAnatomy

what is abdominal diastasis?

a woman’s abdominal muscles are designed to widen and stretch during pregnancy. Diastasis recti is a condition that occurs when the abdominal muscles actually separate away from the linea alba or don’t properly close postnatally. A gap wider than 1.5 – 3 cm is likely to suggest diastasis. Studies have shown that between 35 – 62% of women have diastasis recti postpartum.

Diastasis-Recti-Example

how does it happen?

Diastasis recti usually can happen in the 2nd or 3rd trimester of pregnancy due to the force of the uterus pushing against the back of the abdominal wall.

Factors that increase the risk of abdominal separation in pregnancy include:  

1. excessive weight gain during pregnancy
2. maternal age is greater than  35 years old
3. had multiple pregnancies
4. close successive pregnancies (within one year),
5. twins/triplets/etc
6. anterior pelvic tilt (front side of the pubic bone protrudes at an angle more than the hip bones)

why is it bad?

a diastasis recti of more than 2.5 cm can cause health implications.

1. lower back pain
2. hernia
3. incontinence (due to the relationship between the abdominal wall and the pelvic floor)
4. cosmetically speaking, a sticky out, pooch type belly that diet and exercise can’t get rid of

how to fix it?

prevention is always better than having to treat it afterwards. Try these tips:

1. exercise during pregnancy. Several studies have shown that you are way less likely to get it if you exercise. One comparative study in the Women’s Health Journal of Physical Therapy reported that 90% of the women within the group of non-exercising pregnant women attained diastasis recti compared to just 12.5% of the pregnant women group that did exercise. 

2. avoid excessive weight gain during pregnancy. A woman with a normal BMI should aim for a 25-35 pound weight gain in her pregnancy.

3. maintain postural awareness. Especially when lifting heavy things, i,e children or when strength training. Also be aware that if you have a tilted pelvis, this is a risk factor as it can add pressure because it can push your uterus against your abdominal wall.

4. avoid exercises that exacerbate diastasis recti after the first trimester even up until 6 weeks postnatally until you have checked that your gap away from the linea albla is less than 2cm. Exercises to avoid includes sit-ups, crunch movements, oblique twists, and plank-position exercises such as full plank, push-ups and burpies… These may seem obvious but all of the ‘mums fitness’ classes that I personally went to, included all of the above without any kind prior individual abdominal assessment or guidance on how to protect the abdominals. Always be sure to seek consultation from a qualified specialist regarding your abs before embarking on your postnatal recovery and make sure that if you do attend open level fitness classes, you rely on your own knowledge of your body rather than just trusting the trainer to know whats best for you.

5. regularly practice TVA activation and pelvic floor exercises. These are effective both during and after pregnancy. I found that doing my simple activations as rehab pretty much the day after giving birth, were really helpful for me. I started my postnatal exercise officially 5 days after giving birth.  There is plenty of stuff to do that is safe and important way before your 6-week check so don’t wait until then to address the issues of pelvic floor and abdominal wall stability and healing. When you are feeling stronger, have less separation and are closer to 6 weeks postpartum, check out my postnatal yoga video, my postnatal pilates video and my mums and babies yoga video for safe effective practices that actively seek to close the abdominal gap. 

watch the method of diagnosing diastasis recti