Abdominal muscle separation, medically known as diastasis recti, is a common condition affecting many women after childbirth. While it is a natural adaptation during pregnancy, it can sometimes persist postpartum, leading to various physical symptoms.
Understanding Abdominal Muscle Separation
The rectus abdominis muscles, often called the “six-pack” muscles, are a pair of long, parallel muscles that extend vertically along the front of the stomach. These muscles are joined in the middle by a band of connective tissue known as the linea alba. During pregnancy, the expanding uterus places significant pressure on the abdominal wall, causing the linea alba to stretch and thin, which can lead to a gap between the rectus abdominis muscles.
When this separation occurs, it can manifest as a visible bulge or “pooch” in the belly, often just above or below the belly button, which may become more noticeable when engaging abdominal muscles or sitting up. This separation can contribute to symptoms such as lower back pain, pelvic or hip pain, and pelvic floor dysfunction, including urinary incontinence. Some individuals might also experience a feeling of weakness in their core or digestive issues like constipation.
Causes and Contributing Factors
The growing uterus exerts outward pressure on the abdominal wall during pregnancy. Concurrently, pregnancy hormones like relaxin and estrogen cause connective tissues, including the linea alba, to soften and become more pliable. This combination allows the abdominal muscles to stretch and separate to accommodate the developing baby.
Several factors can increase the likelihood or severity of diastasis recti. These include multiple pregnancies, carrying larger babies or multiple births, advanced maternal age, being petite, and certain pushing techniques during vaginal delivery.
Identifying the Separation
A simple self-check can help determine if abdominal muscle separation is present. To perform this, lie on your back with your knees bent and feet flat on the floor. Place one hand behind your head for support and the fingers of your other hand, pointing towards your pelvis, across your midline at your belly button. Gently lift your head and shoulders slightly off the ground, as if performing a mini-crunch, keeping your chin tucked.
As you lift, feel for a gap or separation between the abdominal muscles. If you can fit two or more finger-widths into the gap, it may indicate diastasis recti. It is also important to note the depth and tension of the tissue, as a soft, squishy feeling may suggest a more compromised linea alba. If a separation is detected or if you experience associated symptoms like pain or dysfunction, seeking a professional diagnosis from a healthcare provider is recommended.
Approaches to Healing
Non-surgical interventions are the primary approach for healing abdominal muscle separation, with specialized physical therapy playing a central role. A physical therapist can guide individuals through specific exercises designed to strengthen the deep core muscles, such as the transverse abdominis, and improve the function of the linea alba. These exercises often involve proper breathing techniques and gentle engagement of the core while avoiding movements that put excessive pressure on the abdominal wall.
Certain exercises and movements should be avoided, as they can worsen the separation by increasing intra-abdominal pressure. These include traditional crunches, sit-ups, planks, and any exercise that causes the abdomen to bulge or dome. Heavy lifting without proper form and high-impact activities like jumping or running may also be detrimental until core integrity is restored. Consistent practice of targeted exercises under professional guidance can significantly improve the condition.
For severe or persistent cases where conservative measures have not yielded sufficient results, surgical options, such as abdominoplasty (tummy tuck), may be considered. This involves stitching the separated muscles back together to close the gap. Surgery is often considered six to twelve months postpartum if the diastasis recti has not resolved with physical therapy.
Minimizing Future Risk
Proactive measures can help reduce the likelihood of severe abdominal muscle separation or its recurrence. Maintaining good posture throughout pregnancy and postpartum is beneficial, as proper alignment can reduce strain on the abdominal muscles. Practicing proper body mechanics for daily activities, such as rolling to the side when getting out of bed, helps protect the abdominal wall from excessive pressure.
Avoiding excessive straining, especially during bowel movements or lifting objects, is also important. Engaging in appropriate, gentle core exercises under the guidance of a healthcare professional during pregnancy and early postpartum can support abdominal wall integrity. These exercises focus on deep core activation rather than traditional abdominal movements that can exacerbate separation.