Diastasis recti, or abdominal separation, is common among pregnant women and new mothers. Most women will experience some form of ab separation during their pregnancy, which is more evident toward the end. The risk of having more severe ab separation increases with the number of pregnancies or carrying multiple babies in one pregnancy. However, there are things that you can do to lessen the impact during the pregnancy for a better postpartum recovery.
Pelvic physiotherapy is an effective way to treat ab separation during pregnancy. The therapist will work with you to improve your posture and alignment, which can help prevent ab separation from worsening. They will also provide exercises that help to strengthen the muscles around the abdomen, which can support the growing belly and help to prevent ab separation.
You will find everything you need to know about ab separation during pregnancy here. By the end of this article, you’ll understand what it is, how to treat it with pelvic physiotherapy and some self-care tips that can help prevent or lessen its impact.
What is Diastasis Recti?
The linea alba is a strip of connective tissue that runs down the center of your stomach. It separates the left and right rectus abdominis muscles, commonly called the six-pack muscles. During pregnancy, more space is needed for the baby’s growth. As your abdominal wall stretches, this midline connective tissue begins thinning and widening to make room. The process is natural – for some new moms, the linea alba becomes strong again postpartum on its own. However, some mothers will need assistance in closing the gap.
How do I know whether I have diastasis recti?
When pregnant, if you notice a bulge or ridge in the midline around your belly button while lifting your head up, that is a sign of a weakened abdominal wall. During postpartum, you can perform a self-test to check whether you still have diastasis recti and its severity.
Start by lying on your back with both knees bent and feet flat on the floor. Keep your fingers above the belly button, then slowly raise your head off the floor. Look for any gaps in the midline and pay attention to depth and distance. Next, repeat the process with your fingers resting at the belly button.
You will likely have a mild degree of ab separation if you feel a separation of two finger widths. However, if the abdominal wall separation is of three or four finger widths, it is more severe. If your diastasis recti is not resolved after 8 to 10 weeks postpartum, it is best to consult a pelvic physiotherapist for a more accurate diagnosis and individualized treatment plan.
Should I work on my abdominal muscle separation during pregnancy or wait until after birth?
You can do various things during pregnancy to lower the odds of having a significant ab separation and help close the gap after labour. It’s important to remember that the wider the gap, the harder it will be to heal post-birth. You can begin strengthening your deep abdominal muscles, known as the transversus abdominis, while pregnant. A weaker core also contributes to lower back pain. Also, working on your pelvic floor during this period prevents bladder issues, reduces your risk of significant perineal tearing, and helps strengthen your core muscles for a speedy post-partum recovery.
What can I do to prevent ab separation?
Some degrees of abdominal separation are expected and common. However, you can reduce the risk of developing severe diastasis recti by following these simple ways:
Proper posture: Pay attention to your standing posture.
- While standing, try to lengthen your spine and bring your shoulder blades together.
- You can also try to engage your lower abdominal muscles so your ribs don’t flare out.
- If you are overly arching your lower back, try to correct it by stacking your ribcage over your pelvis.
Deep breathing: Practice expanding your ribcage with inhalation and breathing out slowly through your pursed lips. This helps maintain mobility in the ribcage, which is essential to create more space for your baby.
Safe abdominal exercises: You should continue working on strengthening your abdominal muscles; however, choosing appropriate core exercises is essential. Avoid sit-ups and crunches, as these put pressure on your abdominals.
Don’t strain while lifting:
- Gently blow out as you lift things and squat down.
- When carrying, try to keep the load close to your body. This will also help take the strain off the abdominals.
- When bending, avoid rounding your back. Instead, keep your spine in a neutral position and bend at the hips.
Log roll when getting out of bed: This will take the pressure off your belly.
Your body will heal and close the gap within a few months postpartum. Knowing how to engage your abdominal muscles properly will speed up the healing process and allow you to feel stronger faster. Seeing a pelvic physiotherapist for individual guidance and a tailored strengthening program will be extremely helpful.
To brace or not to brace? Belly wraps
There is a lot of controversy around using belly bands and wraps. Some people swear by them, while others find them constricting and uncomfortable. If you are active, it can be helpful to use a belly band during the day to provide extra support to the abdominal muscles and take pressure off the lower back. It is crucial to make sure that the band is not too tight. It should feel snug but not constricting. You should be able to take deep breaths without feeling like it is restricting your movement. You can continue using the belly wrap post-partum for about 8 to 10 weeks while working on core strengthening exercises. However, the band alone is not considered a cure for diastasis recti.
There are many different types of binders and wraps on the market. Do your research to find one that is comfortable for you and provides the support you need.
How to exercise with Diastasis Recti during pregnancy?
It is important to avoid exercises that put a strain on the abdominal muscles. This includes sit-ups, crunches, and any ab work that leads to a bulge or ridge around the belly button. Instead, focus on exercises that engage the deeper core muscles, the transverse abdominis. Exercises that work the glutes and legs are also beneficial. They help take the pressure off the abdominals while involving the deeper core muscles.
Examples of safe and effective exercises to try include:
- Pelvic tilts
- Quadruped exercises such as bird dog, donkey kicks
- Modified plank
- Modified side plank
- Side-lying leg lift
- Hip hinge
These exercises engage the deep core muscles, which help support the lower back and take pressure off the abdominals. For more information on safe prenatal workouts, check out this article.
If you are unsure about how to engage the deep abdominal muscles properly, it is best to consult with a pelvic physiotherapist or a certified pre-natal personal trainer. They can assess and provide a more tailored exercise program that is safe for you to do.
Self-care for ab separation during pregnancy
It is possible to minimize abdominal separation during pregnancy. Here are some simple ideas you can try at home:
Diaphragmatic breathing is a breathing technique that helps engage the deep abdominal muscles. This type of breathing helps to take pressure off the abdominals and lower back and can be used throughout the day.
To practice diaphragmatic breathing:
- Sit or lie down in a comfortable position.
- Place one hand on your stomach and the other on your chest.
- As you inhale, focus on letting your ribcage and abdomen expand like a balloon slowly get filled up with air. You should feel your stomach rise as you breathe in.
- As you exhale, allow your belly to sink as you breathe out. You should feel a gentle contraction of your lower abdominal muscles.
- Repeat this breathing pattern for 10 breaths. This may take some practice to get used to.
Pelvic floor muscle exercises
Along with your abs, you must also learn how to relax and activate the core and pelvic floor muscles. It is the critical piece to creating a functional core.
The pelvic floor is a group of muscles located at the bottom of the pelvis. They support the bladder, uterus, and rectum. The pelvic floor muscles also work with the transverse abdominis, multifidus, and diaphragm muscles to provide stability around the lower spine and pelvis. The pelvic floor can become tight and weak during pregnancy, which can lead to bladder incontinence, pelvic pain, and indirectly contribute to slow healing of ab separation after birth. Performing pelvic floor exercises to maintain flexibility and strength in the area can reduce swelling and improve recovery following childbirth.
To do pelvic floor relaxation:
- Lie down on your back with a pillow under your knees. Alternatively, you can lie on your side with pillows under your belly and between your knees.
- Slowly inhale through your nose and imagine your perineum is expanding like a balloon or lengthening like an opening flower.
- As you exhale, allow the perineum to relax further. Allow your jaw, shoulders, and bum to relax throughout this exercise.
- Repeat this a total of 10 times.
Don’t neglect upper body strengthening
While ab separation during pregnancy is primarily caused by the weakening of the rectus abdominis muscles, it is essential to note that the entire body works as a unit. If one area is weak, the others must compensate and pick up the slack. For this reason, it is important to focus on whole-body strengthening, including the upper body.
Upper body exercises such as lateral raises, rows, and shoulder presses help to strengthen the stabilizing muscles around the shoulder blades and mid-back. These muscles work with the deep core muscles to provide overall stability and support for the spine. As a result, a weak shoulder can cause an increase in intra-abdominal pressure and affect your ab separation healing.
How Physical Therapy Can Help with Diastasis Recti
We strongly recommend seeing a pelvic physiotherapist after your first trimester to learn how to up your core strength. You should also get a consult if you notice that the ab separation is getting worse at any stage of the pregnancy. It is important to see a pelvic physiotherapist who received specialized training in pregnancy care and diastasis recti rehabilitation. The pelvic physiotherapist will assess your current level of function and identify any movement patterns contributing to your ab separation. They will then advise you on which exercises and activities are safe for you to do and provide you with a tailored exercise program to help you get stronger.
If you’re pregnant and experiencing ab separation, don’t worry! There is help available. At InvigoPhysio, we combine Yoga and Pilates with the latest evidence-based research to help you heal your ab separation and get stronger. We will work with you one-on-one to create a personalized treatment plan that meets your specific needs. Book an appointment today to get started on your journey to healing!