Understanding abdominal muscle separation (Rectus Abdominis Diastasis)
Let’s start by clarifying that abdominal muscle separation is a normal physiological change that occurs in 66% – 100% of women by the third trimester of pregnancy. This is basically your belly muscles moving to make room for your baby. It should not be feared, rather embraced. If it wasn’t for our bodies ability to separate the abdominal muscles, our abdominals would be A LOT worse off in the long term. Thank god for abdominal separation!
What is abdominal separation and why does it happen?
To fully understand what is happening in your body, some scientific explanation is good! Diastasis Recti is the fancy title used to describe the change in the abdominal wall that occurs during pregnancy, where the two sides of the abdominal muscles separate from each other to make room for the growing baby.
Essentially, the two sides of the abdominals are connected by a sheath (the Linea Alba) which weakens and thins over pregnancy. Your abdomen muscles will slowly move farther apart due to the Linea Alba to free space for your baby to grow! This is normal, and we want it to happen.
What to look out for
As pregnancy progresses you might start to notice a “doming” in the centre of your tummy during tasks such as getting in and out of bed or off the floor. Some describe it as looking a little like a Toblerone down the middle of the abdominal wall.
If you do notice this, now is the best time to ensure you are avoiding tasks that create this shape. So for example, if you are getting out of bed in a “sit up” way, roll on to your side instead and push up with your arms, this prevents extra strain on the already weakened linea alba.
Why can it be a problem if it isn’t addressed post birth?
The abdominal wall plays a crucial role in the body and can lead to all sorts of issues such as low back pain, pelvic girdle pain, struggles in getting back to working out and pelvic floor problems. In fact, we know that 66% of women that have a RAD will also have stress urinary incontinence or pelvic organ prolapse ( this is when there is a downward dropping of the pelvic organs into the vaginal space)
How many women have Diastasis Recti postpartum?
All women will have some degree of RAD right after birth, but it is the women with the abnormally wide ones that need attention. A separation will generally range from 1–8 cm. As a good rule of thumb, if your abdominal muscles sit wider than 4 cm apart at 8 weeks postnatal, then we know without any intervention you will still have the same degree of separation at 12 months postnatal.
Can abdominal separation be “repaired”
In pregnancy, women can learn how to use their abdominal muscles correctly. If the deep abdominals (not the outer abdominals) are activating well and are strong in the pregnancy, it means that they are in an advantageous position to start the recovery process in the postnatal period. If women aren’t sure if they are activating correctly, a Women’s Health Physiotherapist can use an ultrasound to teach women. It can be a real penny drop moment for women being able to see the deep abdominals on the screen actually slide and thicken when they are activating.
In the postnatal period, there is a lot that can be done and with the right approach the majority of women recover really well, and for some, their tummy is stronger than ever before! It must start by regaining the balance between the deep abdominals, the outer abdominals, the rib cage, pelvic floor, diaphragm and movement patterns. The best time to actually start this process is in pregnancy or the early postnatal period.
Longer-term, there is a small percentage of women who cannot regain control of the abdominal wall due to serious damage, and abdominal separation is a big problem. For these women, we may need to look at surgical options however this is the minority, and only after a specific rehab program hasn’t been effective.
Early postnatal days
There is a lot you can start to reconnect with your abdominal muscles in the early days and weeks postnatal which includes starting with gentle exercises such as pelvic tilts, pelvic floor exercises and 4-point kneel lower abdominal activation (Make sure you learn these in pregnancy).
Many women also find wearing an abdominal support garment useful, as it not only feels supportive but can help women to remember to activate to turn the deep abdominals on with daily activities such as lifting baby.
In the postnatal period, I strongly recommend women get themselves to a women’s health Physio at around 6 weeks postnatal and they can assess the degree of abdominals separation and make recommendations for the exact exercises and rehabilitation approach needed for the individual women.
Here’s what you need to know about exercise in the third trimester
Posture, pregnancy and your pelvic floor
How your changing body impacts exercise during pregnancy