Why is there a gap in my abdomen post-partum??

Why is there a gap in my abdomen post-partum??

During pregnancy as your uterus grows and belly gets bigger, your abdominal muscles must separate to accommodate this growth.  You have many layers of abdominal muscles and the main muscle that separates is the rectus abdominus.  The medical terminology for this splitting is Diastasis Rectus.  Diastasis meaning ‘separation’ and rectus referring to the rectus abdominus muscle.  Now before you freak out know that this is a normal physiological process and necessary for the growth of baby.  What you need to know is how do I move during pregnancy to prevent a higher degree of separation and how do I heal in the post-partum period.   

            Separation usually starts around the second trimester and by the end of your third trimester nearly all pregnant women have developed some degree of separation.  Depicted below are examples of separation.  It can be above or below the belly button or both. Why does this matter? We all know having a strong core is important so when part of your core is separated this can lead to decreased trunk and core stability resulting in back or pelvic pain. 

Let’s look at the signs and symptoms. 

·      Visible bulge or “pooch” that protrudes above or below the belly button

•       Softness around belly button

•       Coning or doming when crunching abs

•       Difficulty lifting objects or walking

•       Pain during sex

•       Urine leaking when you sneeze or cough

•       Constipation

•       Feeling weak in your abdominals

In the office we test and evaluate the degree of separation and your overall pelvic function.  We want to test diastasis rectus 6-8 weeks post-partum. You don’t always have pain or signs and symptoms initially post-partum.  In one study 4/10 women started having signs and symptoms half a year post-partum. Now let’s talk about what to do when pregnant and post-partum.

What do I do when pregnant?

            There are several movements to focus on when pregnant.  I call these Mindful Movements and they include lifting with proper biomechanics and the Log Roll.  Lifting with “proper biomechanics” means using your legs and squatting when bending to pick things up.  The Log Roll technique is how you get out of bed or any lying down position.  You want to avoid crunching up like you normally would when you weren’t pregnant.  You’ll notice that when you do that ab crunch you get coning.  That will increase the force of separation.  What you want to do is first, turn to your side.  Next, drop your legs down together and use your arms to push your upper body up.  This movement will activate your side core and not cause coning.  Simple but effective ways to move and prevent significant separation.

What do I do now after I’ve had baby and have separation?

            Your OB or provider might tell you there is nothing you can do.  As we discussed you might have signs and symptoms or dysfunction or these might set in later down the road.  So being evaluated is important regardless. There are dos and don’ts to recovering quickly and research shows that doing rehab 3x/week significantly increases your healing time. The healing times varies from woman to woman. The good news is that we have the tools to equip you with and improve your health.  Assessment and rehab exercises are done in office but we can monitor your health via telehealth visits.  Call and schedule today and start your healing process!

Dr.KS