Abdominal Separation
Also known as Diastasis Recti...
Diastasis Recti Abdominus Muscle, or DRA(M), is the name given to the widening of the linea alba, the connective tissue joining the two sides of the abdominal wall together, through the middle of the abdomen.
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DRA is often described as the abdominal wall splitting or separating. Although this description can sound as if something is wrong, it's in fact completely normal for the linea alba, and the whole abdominal wall to widen and thin as your pregnancy goes on. This widening and thinning happens in all pregnant women by the 3rd trimester.
DRA only becomes a problem when the abdominal muscles become vulnerable through thinning and stretching and cannot cope with the pressures and strains the body goes through during day-to-day activity.
Signs that the abdominal muscles may not be working properly include:
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A bulging or doming in the centre of your tummy when sitting up (see picture).
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Discomfort along the centre of your tummy, particularly during times of increased activity.
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Feeling a gap, or having your fingers sink into a gap when you feel along the middle of your tummy.
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Lower back pain.
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Symptoms of incontinence, heaviness, or dragging in the pelvic floor.
Activities that put particular strain on the abdominal muscles are:
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Heavy lifting or straining which causes you to hold your breath or ‘valsalva’
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Sit-ups (these should be avoided after 16 weeks of pregnancy)
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Excessive coughing, sneezing, or vomiting
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Activity that causes a feeling of pressure through the pelvic floor or visible doming of the abdomen
To help support the abdominal wall through pregnancy you can:
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Continue to exercise through pregnancy but modify your programme; seek professional advice if you are unsure.
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Wear an abdominal support if your bump feels particularly big, or uncomfortable, or if you spend a lot of time on your feet.
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Listen to your body and rest when you need to.
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‘Switch on’, or engage, your abdominal muscles before strenuous activity such as lifting. To engage your muscles: stand tall and lengthen your spine; place your hand under your bump; switch on your pelvic floor and gently lift your bump off your hand.
Your abdominal wall is at its weakest and most vulnerable around 6-8 weeks post-pregnancy.
Most of the narrowing of the linea alba occurs during this time, so it's really important to prioritise your body's healing.
To support recovery, follow the tips below -
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Eat nutritious, protein-rich foods. Protein is essential for good healing so if you are following a vegetarian or vegan diet, ensure sure you are getting enough. My best tip is to plan ahead during pregnancy to stock your freezer full of deliciously nutritious batched cooked meals.
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A soft, elasticated support band can help to alleviate discomfort and take the strain off your abdomen during healing. Avoid wearing anything corseted, or tight enough to cause you to feel pressure on your pelvic floor, or restrict your breathing.
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We know life is busy, with the temptation to return to 'normal' as quickly as possible. It's important to allow your body to heal with adequate rest. Sometimes the temptation is to get back to normal as quickly as possible. Take this time to heal and to avoid any activity that causes your linea alba or abdomen to bulge.
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Avoid straining on the toilet; stay hydrated and eat plenty of fruit and veg to help prevent constipation.
After 2 months or so most women will recover their abdominal wall integrity and be able to start to increase their exercise and activity with no problem. Some women may find they still have a tummy that looks pregnant, or notice the symptoms listed earlier, especially when trying to increase activity. In this case, it is advised to seek the advice of women’s health physio. They will be able to help you regain your abdominal strength and function.
Which exercises are suitable post-pregnancy?
The truth is, it's different for each woman.
Below is a quick guide, but If you are unsure whether an exercise is right for you, please pop us a message.
Complex exercises won’t remain out of reach forever but you'll need to build upon your routine. When thinking about postpartum recovery you need to plan for the ‘long game’. Muscle strength can take just 6-8 weeks to improve; however, connective tissue can take up to 2 years to strengthen and remodel.
0-8 Weeks
Recovery and core connection.
Pelvic-floor exercises, optimise breathing pattern and posture, gentle stretches.
8-14 Weeks
Progress core exercises, begin cardiovascular work & introduce strength.
Yoga, Pilates, walking, light weights, modified circuits
14-48 Weeks
Increase intensity, build strength, return to activity.
Walk/run programme, increase weights.
When exercising, ask yourself...
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Can you do the exercise without pain?
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Can you do the exercise without leaking or feeling extra pressure in the vagina/ pelvis?
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Do you feel you have control over your body and can maintain your form?
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Can you maintain tension in your linea alba without excessive doming or bulging?
If the answer to these questions is no or something doesn’t feel right, then please pause & book a Mummy MOT to build a plan.
Working together will help you to find a safe way back to fitness, with just the right amount of exertion.