You watch what you eat and exercise regularly, but you simply can’t seem to ditch your baby bump. This may be due to a condition known as diastasis recti, an excessive widening or separation of the rectus abdominus muscle. With some professional help, you can ditch the hundreds of sit-ups you’re diligently tackling – the truth is, they’re actually doing your bulging tummy more harm than good. This condition is common in pregnant and postpartum women, though not many know much about it. “As it doesn’t always correct itself after delivery and may even worsen with age, or as a result of a misguided exercise regime, it’s worth getting a grip on it before hitting the gym,” explains Tessa Loftus, a physiotherapist with a special interest in women’s health.
What is diastasis recti?
Your rectus abdominus, or six-pack muscles, run up and down the front of your abdomen and consist of two sides – a right and left. They connect in the middle at a central seam known as the linea alba. During pregnancy, as your uterus expands and your abdominal muscles stretch, the linea alba can become stretched or torn. Hormonal changes during pregnancy also cause the connective tissue between these two muscle halves to weaken and separate. This separation usually starts recovering on its own from day one post birth and will be fully recovered in four to six weeks. However, for almost 40% of women postpartum, if the separation hasn’t recovered by eight weeks, it’s healed as much as it’s going to without help. The consequences can be more than aesthetic. In addition to ‘mommy tummy’, lower back pain and bowel and urinary incontinence are also possible side effects.
How to tell if you’ve got it?
The likelihood that you will experience diastasis recti increases with each of your pregnancies and whether you are carrying multiples. It also depends on how many abdominal surgeries you’ve had, as well as how old you are when you fall pregnant – women who fall pregnant after 35 are at greater risk of abdominal muscle separation. To check if have this condition, you can be assessed by a women’s health physiotherapist or check yourself fairly easily. To do so, lie on your back with your knees bent and your feet flat on the floor. Curl your head, neck and shoulders off the floor and check what happens around your belly button. If your abdominal muscles dome up like a ridge, and you can sink more than two fingers into the gap between them, the chances are good you have diastasis recti, says Tessa.
What makes it worse?
If you find you do have the condition, the average ab workout could be doing more harm than good, explains Colleen Everitt-Penhale, a women’s health physiotherapist. Sit-ups, planks, crunches and oblique twists will only widen the gap. In short, you need to avoid any exercise that increases the pressure in your abdomen until you’ve healed. This includes many of the exercises done in yoga and pilates classes that pregnant and postpartum women are encouraged to take to tighten and tone. Lifting heavy objects, and straining when going to the toilet during and after pregnancy. may worsen the condition. The correct way to pass a stool – especially while pregnant and when trying to heal postpartum diastasis recti – is to ensure you are sitting with your knees higher than your hips, says Colleen. Also, be careful of inadvertently doing a sit-up when getting out of bed. Rather roll onto one side and then use your hands to push into a sitting position.
What makes it better?
“The good news is that you can close the gap with specific exercises that draw your belly in and by avoiding the factors that aggravate it until you have healed,” says Colleen. Any rehabilitative exercises are best prescribed by a women’s health physiotherapist, who will spend time teaching you to correctly activate your pelvic floor and control the pressure in your abdomen as you go about daily life and then, eventually, when exercising.
IS SURGERY NECESSARY?
“Surgery, or a tummy tuck, is only indicated after a year if the diastasis recti is severe and patients have tried an extensive rehab program with no improvement,” says Colleen. It’s important to keep in mind that almost all women who have been pregnant will have a small degree of separation. Seven to eight millimetres (around two fingers) is considered normal, she explains. The key factor is how much tension the linea alba is able to generate. As your diaphragm, pelvic floor, abdominal and back muscles all work together to ensure your lumbar pelvic stability and continence, if the gap is so severe that the linea alba can’t generate the tension to work properly, then lower back pain and faecal and urinary incontinence may result. l&l