MaternalWell Program PT 2

Are you wondering why you still have your post pregnancy “pooch” months after childbirth despite thousands of sit ups?

A postpartum abdominal condition called diastasis recti is the culprit!

Today we will review this common condition of diastasis recti and what you can do.

The abdominal wall is made of the rectus abdominis muscles separated by the linea alba in the middle. The linea alba is a tough band of connective tissue where the oblique and transverse abdominal muscles connect.

Diastasis recti is a condition when the rectus abdominis muscles are partially or completely separated and the linea alba thins out. This can occur anywhere along the linea alba (around the navel or below or above). This can result in a rounded, protruding belly "pooch."

Diastasis recti occurs in 100% of women by the third trimester due to:

• hormonal changes which affect laxity of tissues
• growing uterus which stretches the abdominal muscles

Some women’s abdominals will “snap back” after delivery when pregnancy hormones drop.

But at 6 weeks postpartum, 60% of mothers will still have this thinning of the linea alba and separation of the abdominal muscles.

40% of moms will continue to have diastasis recti at 6 months postpartum.

Although this condition is very common……

…most women have never been checked for this or are aware of this condition.

It is important to be proactive and address this problem within the first three months postpartum to avoid long term changes in posture, pelvic floor dysfunction, and low back pain.

What are some risk factors of developing diastasis recti in pregnancy?

• If you have been pregnancy more than once
• Having twins or triplets or more
• Having a cesarean section
• If you have poor muscle tone or have a swayback posture
• Possibly high prepregnancy weight, larger babies and age over 35 (although 1 study in 2015 did not show an association)

What are the symptoms?

Diastasis recti may or may not be associated with symptoms beyond a visible “mummy tummy” or “belly pooch”.

These abdominal muscles are also connected to the pelvic muscles. So if you have diastasis recti you may also experience pelvic floor weakness which may have symptoms such as urinary incontinence or pelvic pain. Diastasis recti has been associated with pelvic organ prolapse later in life. (when pelvic organic like uterus, bladder and rectum can “drop” from their normal position)

Some women have experienced the following:

• lower back pain
• poor posture
• constipation
• urine leakage
• difficulty in breathing or moving

Yes! It is easy to do. But wait until 6 weeks postpartum!

To do a self-test for diastasis recti follow these steps:

1. Lie on your back, knees bent and feet flat on the floor
2. Place 2-3 fingertips across your midline at your belly button with fingers pointed down
3. Lift your head (keep your shoulders down) while firmly pressing your fingertips down
4. If your fingers sink into the hole or you don't feel the space between your muscles narrowing you may have diastasis recti
5. Move your fingers 2 ½ inches below your navel and repeat steps 2-4
6. Move your fingers 2 ½ inches above your navel and repeat steps 2-4

* Use the 2 finger rule: if two finger breadth separation you have diastasis recti.

Don't rely on belly binders alone. Belly binders may 'hold you in' and offer support to your lower back; however, wearing a binder or wrap will not reinforce or fix the muscles. There is no fast way out….You need to put in the work on strengthening your abdominal muscles.

Don't rely on belly binders alone. Belly binders may 'hold you in' and offer support to your lower back; however, wearing a binder or wrap will not reinforce or fix the muscles. There is no fast way out….You need to put in the work on strengthening your abdominal muscles.

False!

Do be cautious with exercise. It may seem logical that core exercises like crunches, sit-ups, push-ups, and planks should decrease your “pooch” however this actually makes the abdominal separation worse! As do any activities that work the stomach wall against the power of gravity, i.e., downward dog or anything on hands and knees.

Remember, do exercises that squeeze the belly in rather than push it out and make the tell-tale bulge on the midline.

(Are you as happy as I am to finally have a reason NOT to do crunches and planks!)

False!

Do be cautious with exercise. It may seem logical that core exercises like crunches, sit-ups, push-ups, and planks should decrease your “pooch” however this actually makes the abdominal separation worse! As do any activities that work the stomach wall against the power of gravity, i.e., downward dog or anything on hands and knees.

Remember, do exercises that squeeze the belly in rather than push it out and make the tell-tale bulge on the midline.

(Are you as happy as I am to finally have a reason NOT to do crunches and planks!)

TRUE!

Don't put too much pressure. It can exacerbate the situation—constipation and lifting heavy things, including your children, strain that connective tissue.

TRUE!

Don't put too much pressure. It can exacerbate the situation—constipation and lifting heavy things, including your children, strain that connective tissue.

Here are some exercises that may help fix diastasis recti by strengthening those deep transverse abdominal muscles.

If you had a vaginal delivery, you can start these exercises as soon after delivery as you’d like. If you’ve had a C-section, definitely check with your healthcare provider first.

Deep abdominal activation to work your transverse abdominals.

1. Lie on the ground, knees bent and feet planted flat on the floor.
2. As you exhale, draw the sides of your abdominal muscles together with your fingers.
3. At the same time, pull your belly button down toward your spine.

Pelvic tilts -work both your transverse abdominals and your pelvic floor- (who doesn’t love a two for one special!)

1. Lie on the ground, knees bent and feet planted flat on the floor.
2. Press your lower back into the ground, pull your belly button down toward your spine.
3. Keep your lower back pressed into the ground and gently lift your pelvis up an inch and then back down. You can even add in a Kegel as you tilt your pelvis!

No.Your postpartum recovery doesn't have an expiration date! It's never too late to strengthen, restore and reconnect those muscles.

Don't Go too hard, too early. When exercise has a significant impact on your life, waiting for wounds to recuperate can be unbearable – you want to go back to being fit ASAP. Like any other issue, diastasis doesn't heal overnight, and it can take some time before you begin to move and exercise as you once did.

Physical therapists that specialize in pregnancy and postpartum care can be very helpful to get you started on your path to a new and stronger you!

No.Your postpartum recovery doesn't have an expiration date! It's never too late to strengthen, restore and reconnect those muscles.

Don't Go too hard, too early. When exercise has a significant impact on your life, waiting for wounds to recuperate can be unbearable – you want to go back to being fit ASAP. Like any other issue, diastasis doesn't heal overnight, and it can take some time before you begin to move and exercise as you once did.

Physical therapists that specialize in pregnancy and postpartum care can be very helpful to get you started on your path to a new and stronger you!

Now you know why you still may have a little “mummy tummy” and the steps you need to propel yourself to wellness.

Reach out to our MaternalWell care coordinator if you need a pregnancy/postpartum PT specialist or text with any questions!