Coning refers to a visible ridge or dome shape that appears along the midline of the abdomen during pregnancy. This bulge often extends from the breastbone to the belly button. It typically becomes noticeable when engaging abdominal muscles, such as when getting out of bed, performing certain exercises, or coughing.
Understanding Coning
Coning occurs when increased intra-abdominal pressure pushes outwards against the linea alba, a connective tissue band running down the center of the rectus abdominis muscles. This tissue thins and stretches during pregnancy due to hormonal changes, accommodating the growing uterus.
The expanding uterus places significant strain on the abdominal wall, altering how the body manages internal pressure. Coning indicates that core muscles are not effectively managing this pressure during specific movements.
The Link to Diastasis Recti and Other Concerns
While coning itself is generally not painful, it serves as a strong indicator of diastasis recti, the separation of the rectus abdominis muscles. This occurs when the linea alba stretches too much. This separation is a common and necessary adaptation during pregnancy to make space for the growing baby.
Coning demonstrates insufficient support from the core muscles and can worsen diastasis recti during pregnancy and postpartum. It can also be associated with lower back pain due to inadequate abdominal support, pelvic or hip pain, and core weakness. Pelvic floor dysfunction, such as urinary leakage or pelvic pressure, can also be linked to poor intra-abdominal pressure management and core instability.
Strategies for Minimizing Coning
Managing intra-abdominal pressure is important for minimizing coning. Diaphragmatic breathing is a technique that can help, where you inhale and allow your lower ribs to expand, and then exhale with a gentle activation of the pelvic floor and abdominal muscles. Exhaling on exertion, especially during the more challenging parts of a movement, can also help manage pressure effectively.
Mindful movement patterns can also reduce strain on the abdominal wall. Using the “log roll” technique to get out of bed involves rolling onto your side and using your arms to push yourself up, to avoid direct abdominal flexion that causes coning. Activities like traditional crunches or sit-ups, planks, and heavy overhead movements can increase intra-abdominal pressure and should be modified or avoided if coning occurs. Maintaining a neutral spine posture during daily activities and exercise, where ribs are stacked over the pelvis, can also help manage pressure.
Engaging the transverse abdominis and the pelvic floor muscles through gentle exercises like pelvic tilts and cat-cow stretches can provide internal core support. While supportive garments like maternity belts can offer external support, they are not a substitute for engaging the internal core muscles. Proper lifting mechanics, such as bending knees and keeping objects close to the body, also reduce strain.
When to Seek Expert Guidance
While coning is common during pregnancy, professional guidance is advisable in certain situations. If coning persists or worsens despite implementing pressure management strategies, a healthcare professional can offer further assessment. Significant abdominal pain or discomfort, not typically associated with coning, warrants medical attention.
Symptoms of pelvic floor dysfunction, such as urinary leakage, pelvic pressure, or difficulty with bowel movements, should also prompt a consultation. If there are concerns about the severity of diastasis recti, particularly if the gap is wider than two fingers, a doctor or physical therapist can provide a diagnosis and recommend a tailored treatment plan. A women’s health physical therapist or pelvic floor physiotherapist can offer personalized exercise guidance and strategies to support core health during and after pregnancy.