Abdominal muscle separation

Evidence  

https://www1.racgp.org.au/ajgp/2022/march/exercise-after-pregnancy 

Philippa Inge, Jessica J Orchard, Rosie Purdue, John W Orchard   

Diastasis recti abdominis - The rectus abdominus is the most superficial of the four abdominal muscles and consists of two separate muscle bellies enclosed by a fascial layer, joining at the midline to crease the linea alba. Diastasis recti abdominis (DRA) occurs as a result of stretching of the linea alba during pregnancy, separating the muscle bellies of the rectus abdominus. This expansion is a natural adaptation during the later stages of pregnancy and childbirth, although many women experience longer-lasting dysfunction, with an incidence of 60% at six weeks and 32.6% at 12 months postpartum. 

Education 

During pregnancy your body releases the hormones to soften your ligaments and abdominal muscles to allow for your growing baby. There is always a small gap between abdominal muscles, but this becomes larger during pregnancy. 

An Abdominal Muscle Separation is the separation of the long muscles of the abdomen. It is also known as a diastasis recti or DRAM - diastasis of rectus abdominis muscle. 

A combination of factors during pregnancy can cause a separation of the abdominal muscles to occur. These include:  

• hormonal changes  

• weight gain  

• abdominal muscle weakness and stretching of the muscles as your baby grows 

The long muscles of your abdomen (rectus abdominis) run from your chest to your pelvis. They lie just under the skin, down the middle of your belly.  

Abdominal muscle separation is when these 2 long muscles separate from each other. 

Abdominal muscle separation may start in the second half of your pregnancy. It’s a natural adaption to your growing baby. 

How can I strengthen my abdominal muscles? 

Doing abdominal exercises every day after you give birth can help you regain your strength and help with back and stomach support. Don't do sit-ups for at least 12 weeks after giving birth. Instead, it's best to do pelvic tilts and abdominal bracing exercises. 

To perform pelvic tilts: 

• lie, stand or sit with your knees bent and your feet flat 

• gently flatten the curve of your lower back by tilting your pelvis backwards 

• hold for 3 to 5 seconds 

• repeat 5 to 10 times 

To perform abdominal bracing: 

• lie, sit or stand 

• gently draw your belly button in towards your spine 

• hold for 5 to 10 seconds 

• repeat 5 to 10 times 

How is abdominal separation after the birth treated? 

Try these tips to stop your separation getting worse: 

• don’t lift things that weigh more than your baby 

• roll onto your side when getting out of bed or sitting up 

• choose exercises that strengthen your deeper stomach muscles 

• skip activities and movements that can make abdominal separation worse, such as sit-ups (crunches), oblique curls and some yoga poses 

There is a good chance that with time and care, your muscles will come back together. 

If you have abdominal muscle separation, your doctor may refer you to a specialist physiotherapist. They will give you a special exercise program. 

You can also wear a supportive brace or special underwear to help support your back. 

If you notice that your stomach muscles feel different you can check with your doctor, midwife or physiotherapist. 

You can search for a list of women's and pelvic health physiotherapists on the Australian Physiotherapy Association website and on the Continence Foundation Australia’s service directory. 

Empowerment 

A separation of your abdominal muscles is a normal way for your body to make space for your growing baby. It only becomes a problem if the muscles stay separated after your baby is born. When these muscles are stretched and separated, they can't fully support your back, which can lead to more back pain. 

Most of the time, abdominal muscle separation improves within the first 6 to 8 weeks after giving birth. However, about 1 in 3 people still have some separation a year after their baby is born. 

Useful Links  

Fiona Stanley Hospital 

https://fsfhg.health.wa.gov.au/Our-services/Maternity/Caring-for-you-after-birth/Physiotherapy-after-pregnancy/Manage-abdominal-separation-after-pregnancy 

Pregnancy, Birth and Baby  

https://www.pregnancybirthbaby.org.au/abdominal-separation 

Australian Physiotherapy Association 

https://australian.physio/inmotion/exercise-diastasis-recti-abdominis 

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