Written by our German physiotherapist friend, Sabrina, this time we are deep-diving straight into the world of core separation. Every mum will experience a level of this nearing the end of your pregnancy, but it's good to keep in mind that recovery looks different to everyone, too. It takes time, but all mums would benefit from a little extra help.
Read on to find out more about diastasis recti, how it isn't just an ailment of pregnant women, and what options you have to regain that core strength!
These are the kind of complaints I hear from mums when they suspect something is wrong with their belly after pregnancy. I am a therapist for pelvic floor problems and diastasis recti. After talking to them and examining their belly with my hands and an ultrasound machine, we often conclude:
"You still have diastasis recti"
Diastasis recti means that the abdominal muscles are still separated after pregnancy, leaving a gap in the middle of your belly.
Developing diastasis recti during pregnancy is normal: the abdominal muscles and the connective tissue between the straight and lateral abdominal muscles (the linea alba) softens during pregnancy and drift apart. This is caused by hormones and the constant growth of the baby in your belly.
This is physiological - in the last trimester of pregnancy, every mom has diastasis recti - the body makes room for your baby.
After pregnancy, the belly needs to re-stabilize, which means that the connective tissue of the linea alba becomes firmer and tighter and the abs come closer together again. We do not know exactly why this occurs naturally in most women and why other mothers still have a larger and, above all, softer gap months after giving birth. However, these reasons might include the following:
- - Hormonal influence and fluctuation
- - Differences in collagen composition
- - Size of the baby and pregnant belly
- - Any previous pregnancies from which diastasis recti already existed
- - Minimally invasive abdominal operations / laparoscopies in the past
- - Everyday behavior especially during the first weeks after delivery that is not appropriate to the body's needs
Even during pregnancy women can prevent the diastasis from opening up too much by being gentle on the body.
Postpartum is also an important period of recovery for the abdominal muscles and let’s not forget the pelvic floor. If, for whatever reason, you do not have the opportunity to take it easy in the first few weeks after giving birth – for example by lying down a lot, focusing on gentle movements and thus give your core the opportunity to re-stabilize and strengthen – problems like a permanent diastasis can arise.
The postnatal period refers to the first 6 weeks after giving birth (although let’s be real, postpartum never ends!). There’s an ancient midwife saying in Germany of "in bed and around the bed" which is where you should operate in and around from for this time. Although, we all know, that this is not always possible in our fast-paced lifestyles where we are often facing a lack of family support and working partners.
Especially at the end of pregnancy and during postpartum, gentle mobilization of the pelvic floor and abdominal muscles and, most importantly, BREATHING techniques can help your system remain active or to become active again.
A support belt can also be a great tool to help you stay active and pain-free at the end of pregnancy, as well as to help you manage your everyday life with your baby during the postpartum period, as moms with larger diastasis often have difficulties carrying their babies, climbing stairs, and so on.
A postpartum belt can provide great support here, if it is used correctly (watch out for pressure on the still soft pelvic floor) – it stabilises the soft abdominal wall from the outside and helps to activate the muscles.
After the postpartum period, the midwife or a specialised mama physiotherapist or postnatal trainer may teach you how to care for, activate and, above all, COORDINATE your core, i.e. your deep abdominal and pelvic floor muscles, as well as your breathing and back muscles. These exercises are so important, although they are often perceived as boring or, possibly, much too intense. I highly recommend the postnatal exercise courses, classes, or even just one-off sessions with a specialist. You should check in advance where and who might offer one near you. You’ll learn the right way to deal with your diastasis and your recovery will likely go much smoother.
How do I know if I still have a diastasis recti or what kind of symptoms does a diastasis recti cause?
Diastasis recti may not cause any discomfort at all, but when it does, you usually experience symptoms like:
- - Mummy tummy – this means you still look pregnant after giving birth
- - Bloating after every meal
- - Lower back pain or pain at bra strap level
- - Pricking in the navel area when lifting or bending over, for example
- - Core instability
- - Visible gut movement through the abdominal wall (through the thin abdominal fascia)
- - The unstable abdominal fascia bulges forward (doming) or pulls into the body/forms a crater (sagging) when abdominal pressure increases
- - Inability or hardship activating the abdominal muscles
Women experiencing postpartum diastasis recti after pregnancy(ies) may feel one or multiple of these symptoms.
Women who haven't been pregnant and men can also develop diastasis recti. In those cases, it may be caused by intensive weight training or abdominal surgery. Diastasis recti can also be seen in small children. It can be physiological and does not need to be treated as such. This can happen until a child is up to about 5 years old – with further growth this condition usually disappears.
Another important thing to note, is that the abdominal muscles or the gap does not have to be closed all the way, even if that’s something you might hear! Before pregnancy, the muscles weren’t touching either with the linea alba allowing about 0.5-1.5cm separation.
So, if you find that you can still put one or two fingers in the gap after the regression class, that's perfectly normal and it might not get any smaller. However, you will notice that with more exercise the tissue in the gap will become firmer over time. Therefore, you will hardly be able to feel a gap anymore, which is our ultimate goal.
If you do feel the gap going forward, there are various training and therapy programs, from apps for your cell phone, to special online courses for moms with diastasis recti, to personal training or individual physiotherapy. In those courses we treat and tape your abdomen manually or provide you with a belt if necessary.
There are also various surgical treatments to stabilise diastasis recti, but that is an extreme intervention that you should discuss with your GP or own maternity physio expert.