There is general misconception, which if one is not getting back to pre-pregnancy shape after delivering a baby, everyone assumes that, lady is not trying hard enough to fix herself.
These days women are facing lots of body shaming. People even do not consider that lady was pregnant and just created a miracle.
So Ladies, we need to have a talk about the “Mommy Pooch”, “mummy tummy”, “baby belly” or as it is commonly known as “I look pregnant but I’m not” look.
Come across this nice image by twiniversity, which I found very much relevant to this article.
Through all the sleepless nights, stress of having a baby and may be not the greatest food, the tummy is expected to just shrink back to its pre shape.
We see it in the social media or we look at the celebrities or women who bounce back to being perfectly flat are glorified.
Then one think that, this is the standard and “if she can do it, so can anyone!” which is a wonderful mentality, but all bodies are different.
Some cannot physically do it, as tummies might have been stretched beyond the point and despite of doing best efforts to eat good and clean, work out properly and do everything right but one cannot be able to get that flat tummy.
Because amongst many other reason one of the major reason could be the muscles that are no longer able to hold guts in after housing this wonderful little miracles! And the core is essentially weak, so back picks up the slack. This condition is called as diastasis recti or diastasis recti abdominis.
What are diastasis recti?
Fit2B has given very good depiction of diastasis recti in above image.
Diastasis recti or diastasis recti abdominis is a literal separation of the rectus abdominis muscle otherwise known as the six-pack muscle at the linea alba that commonly occurs after pregnancy.
It is important to mention that it can occur to men also as a result of prolonged transverse stresses on the linea alba and also occur in babies or newborn as well, though not as common, because it’s the excessive pressure that causes this. It can also occur in postmenopausal women and during pregnancy also.
Because belly expands during pregnancy, the two sides of the rectus abdominis muscles tends to spread to make room for growing uterus and baby.
Two rectus abdominis muscle runs parallel to each other and are separated by the linea alba, a connective tissue along the midline of the body. The distance between the rectus abdominis muscles is referred to as the inter-rectus distance.
During pregnancy, the linea alba, the tissue in the center of the muscles must soften and enlarge to accommodate the growing fetus, increasing the width of the linea alba or the inter-rectus distance in response to the change in a pregnant mother’s hormone.
Once baby is born the hormones return to normal, and the linea alba improves and muscles are brought back together.
But for some though, it loses its elasticity and becomes over stretched, making it hard to use core properly.
Who are most likely to get it?
Petite women, women with short torsos and women that carry large or multiple babies are more prone to suffer from this, leaving the muscles unable to come back together on their own. Diastasis recti are experienced by most women during their 3rd trimester of pregnancy.
When to think if it is there?
If abs seems to only get worse when doing crunches, sit ups or planks.
If umbillicus is mysteriously comes an outward when it was always an inward.
If lower back is always in pain.
If having history of past abdominal surgery and core connection is cut.
If underwent cesarean section.
If there is always a feel like limp noodle and like have to give effort to stay prop up.
If having any of these symptoms or ALL of they, then might also have weak core which is called as diastasis recti.
How to check and confirm it?
- First lie on back, with knees bent and feet on the floor while keeping shoulders on the floor.
- Put hand palm down over the middle of the belly, with fingers pointing toward toes.
- Press fingers gently into umbilicus area then slowly lift up the head, drawing chin to the chest. This causes rectus abdominis to contract.
- If there is feeling of a gap of at least two finger widths between the muscles as they contract, than it is diastasis.
- A gap as wide as four to five fingers is said to be severe.
- Repeat the procedure below and above umbilicus because the separation may be wider in different places and also to check the different variation of diastasis like below, which is shown already above in the image too.
- Open diastasis
- Open above umbilicus diastasis
- Open below umbilicus diastasis
- Complete open diastasis
Palpation is considered to be sufficient for detecting the presence or absence of diastasis recti, though ultrasound imaging can give more precise measurement.
Precautions to avoid Diastasis Recti!
It is important to get educated about diastasis recti during and after pregnancy.
During pregnancy, awareness of changing body is very necessary. What could feel good one day, might not feel great the next day. Listen to this and listen to the need of body!
Avoid doing Sit-ups, crunches and/or twisted crunches like bicycle or Pilates criss cross and similar exercises as it can put a strain on the pelvic floor muscles and can increase intra-abdominal pressure which may be harmful during pregnancy and when trying to restore the abdominal muscles and pelvic floor in the postpartum period, so omit these straight away.
No planking as it puts all the weight of organs down onto the split.
Instead strengthen core with more isolated movements, like holding a side plank. This will omit the direct pressure off the core muscles and allow the oblique muscles to safely become strong, which need to be strong enough as it is useful to help push during labor.
Around 5th month or sooner avoid any major twisting. This big twisting action put lot of stress on already overstretched abdominals.
It is important to take care while performing activities of daily living to eliminate increasing abdominal pressure, such as rolling out of bed instead of doing a “sit-up” to get up.
Other activities to be careful about is when lifting objects from down and carrying older kids or heavy objects during pregnancy and the early postpartum period. Do exhale as you lift anything from down with proper ergonomics.
Postural awareness must be learn by pregnant ladies, like after pregnancy women get used to stand with an excessive anterior pelvic tilt and push the pelvis forward In order to stand and balance against gravity which leads to muscle imbalance and eventually create hyper lordotic curve in back. So always keep body straight.
In short take out any sort of movement that will put direct internal pressure on your midsection.
Abdominal Binders may also become helpful for some women in the postpartum period, but need to be very careful about the wrong or overuse of it, as it can create more problems. It is best to avoid using it unless necessary.
Belly band can also be worn during pregnancy, the one that are specifically made for pregnant women may help increase proprioception and muscle awareness.
How to fix Diastasis Recti?
Okay, so two finger test is positive and felt that obvious split in abdominal wall. Doctor has confirmed it too. So what is next?
First of all, don’t stress. Studies show that diastasis recti abdominis is incredibly common.
There are some home remedies that can be incorporated into daily life to get this area flat, toned and back together.
Try a few of these highly recommended tips below and see how things go first, before thinking about any surgical option.
1. For smaller separations, women can benefit from focusing on physical exercises to naturally get the core muscles back together.
Kegel’s exercises and Pelvic floor exercises can help strengthen deep abdominal muscles because all the core muscles contract automatically as a group. These exercises are beneficial and can be performed throughout pregnancy and should be started in the early postpartum period.
Core exercises: There are several exercises that can be used to help restore core strength after pregnancy and gradually exercise progression should be done to ensure more strength.
Breathing exercises help the diaphragm to relearn how to descend after childbirth.
During pregnancy, as the uterus grows it pushed the diaphragm upwards and so diaphragm loses its ability to descend during inhalation.
As the diaphragm make the top of the core muscles, it is important to reeducate it to function with a full excursion again. Here are 2 good exercises
Inverted Breathing – To perform this, lie on back and put the pillow edges under the buttock to raise it above chest level. Than perform short, shallow breathing through the diaphragm.
Put one hand just above the pubic symphysis and feel for a minimal up and down movement while breathing in and out. Place other hand on top of the chest to avoid raising the chest with breathing.
Lateral Costal Breathing – In sitting position place the hands on both the lateral sides of the rib cage and breathe along with appreciating the feel with hands for the lateral expansion of the rib cage while inhalation and the movement of the ribcage toward the midline during exhalation.
2. For larger separations, some women like to wear an abdominal binder or splint or wrap. This helps those muscles come back together AND helps to remember to keep core engaged and not move mindlessly.
By wearing one of these, one will stay alert and will not sit up out of bed without engaging abdominals pushing on split and will sit up with control will not twist quickly to look at something, to make the tear worse.
No matter what work but core will be controlled. That, in my opinion, is the best benefit of the binder!
Stay in touch with doctor on this though, if it becomes too extreme that doctor recommends surgical option and you do not plan to get pregnant again, surgery may be an option, especially if you have done all you can with physiotherapy but are still struggling with a weak core.
Surgery to repair diastasis recti includes stitching the abdominal wall muscles back together along the midline.
In some cases, a surgeon may perform the procedure laparoscopically which is via using a small camera and instruments inserted through small incision.
Severe diastasis requires open abdominal surgery through a larger incision.
By the way, if you do plan to have more kids, it is worth the effort to repair a diastasis with physical therapy and not surgery to strengthen core muscles before planning next pregnancy. It may reoccur, but it is likely to be less severe.