There’s no doubt having a baby takes a toll on mum’s body. And the effects of carrying that beautiful new life inside you for nine months can still have an impact months and even years after birth – especially to the tummy muscles.
So what causes the “bulge” after baby? How can you prevent those muscles separating? And why do some mums suffer while others don’t?
Our guts and organs are held in by a few layers of muscles that wrap around us to form the abdominal wall. It extends like a cylinder from the pelvis at the bottom, to our rib cage at the top; from the spine at the back, to the rectus abdominus – ‘six pack’ – muscles at the front. The linea alba is a strip of fibres that joins the two rectus muscles together at the midline, running straight through the belly button.
Ab separation is common for mums of twins or big bubs. | Image: iStock
What is Diastasis Recti?
Diastasis Recti is the fancy medical term given to abnormal separation of the rectus muscles (‘abdominal separation’), resulting from a widening and stretching of those fibres that hold the rectus muscles together.
It’s evident when you lift your head and an obvious bulge appears down the middle of your tummy, usually from the belly button to the rib cage, but if severe it may be all the way along.
For many, abdominal separation goes unnoticed and doesn’t have any impact. For some, it’s a cosmetic concern, with prominent bulges proving unsightly and embarrassing. They are rarely uncomfortable or painful.
What causes abdominal separation?
There are many causes for Diastasis Recti, in fact some people are born with it.
However, it’s usually a condition that develops over time, where the tissues of the abdominal wall are stretched and weakened, leading to separation of the six pack muscles through the middle.
Any condition that leads to increased abdominal pressure will do the trick, such as obesity or chronic constipation.
People with excessive diastasis recti are typically of two types.
Firstly there are the obese older men. Next are the small, fit women who’ve struggled with ‘large’ pregnancies (twins or big bubs). It also tends to pop up more for mums who are older and not surprisingly have multiple pregnancies.
And before all the first-time-mums start panicking – you won’t all develop massive Diastasis Recti. Plus, whatever separation does occur may increase, decrease, or stay the same in the postpartum period.
Fast fact: There’s often more at play than just an increased separation between the rectus muscles. Many researchers acknowledge that general abdominal muscle weakness and laxity all the way around the abdominal wall ‘cylinder’ plays a part.
Ab separation is a painful experience for expecting and new mums. | Image: iStock
How is it diagnosed?
Abdominal separation is easily diagnosed by your doctor with a simple examination. In fact, you can get a very good idea poking around yourself.
Your doctor will lie you down on the bed, then ask you to lift your head off the pillow. Any detectible bulging indicates separation is present, but that doesn’t necessarily mean there’s an issue.
More formal diagnosis comes from ultrasound examination, with exact measurements of separation at specific points along the linea alba. This can help your medical team gauge severity and response to therapies.
How far is too far?
There’s no magical number that defines Diastasis Recti, as many people can have bulges with little separation, whilst large distances between the recti can cause few symptoms or cosmetic concern. But a gap of more that 2cm – about two fingers – is deemed abnormal by most authorities.
Largely issues with Diastasis Recti come down to degree of bulging, ability to reduce the effects with simple measures, and an overall desire to improve how it looks.
Fast fact: Diastasis Recti is often believed to contribute to back or pelvic pain in new mums, however, research shows this is not the case.
Diastasis Recti Treatment: How to prevent it
During pregnancy protecting and preserving what you’ve got is paramount, but there are many mums who despite their best efforts, struggle down the track.
Avoid over activation of the abdominal muscles through the day. This would mean all expectant mums should avoid heavy lifting – no more than about 10kg; skip the crunches in your workout; plus when you’re getting out of bed, always roll onto your side first, then sit up.
Try to stay fit. There’s increasing evidence that exercise during pregnancy can reduced the development of abdominal separation by as much as 35 per cent. That’s a potentially massive reduction.
Now pregnancy is hard work, bloody hard work, so exercise won’t be for every mum at every stage. My advice is to keep as active as possible when you feel up to it, and consider exercising under the guidance of a qualified physiotherapist, exercise physiologist, or a trainer educated in pregnancy issues. They’ll guide you through safe pelvic floor and core exercises that are proven to be safe and effective.
Diastasis Recti Treatment: Dr Sam Hay explains why some pregnant women get abdominal separation and how to treat it. A doctor will formally diagnose you. | Image: iStock
What can I do after baby, especially if I feel some separation already?
The juggle of life is intense for new mums. It can be bloody hard to prioritise a cooked meal let alone your own health. But there are a few things that may make a difference when you’re ready.
Firstly, consider getting some of those super-tight supportive pants. They’re certainly not that sexy, but there’s some emerging evidence that wearing them once baby is born can improve matters. By supporting the abdomen they offload the damaged connective tissue, allowing it to repair itself.
Once the dust has settled, and your routine is somewhat on track, exercise programs have been shown to have some positive benefits, and help regain some midline abdominal strength. Once again, best results come from structured and supervised programs from the professionals, where mums are taught to switch all the abdominal wall muscles on and gradually improve their strength and control.
Unfortunately such exercise regimes are not a guarantee, and despite trying hard, many mums find little benefit at all.
Looking for a more definitive fix? Diastasis recti treatment in the form of surgery is available for mums, especially those who have lost significant muscle tone after multiple pregnancies.
Repair is largely dictated by the degree or size of bulging rather than the width of separation. The type of surgery varies widely. Some are done ‘open’, whilst some are done via laparoscope. If there’s excess abdominal skin hanging round, then the procedure is usually combined with an abdominoplasty to achieve maximal cosmetic results for mum. Sometimes, the surgeon will ‘reinforce’ the linea alba with mesh.
Bottom line, the exact surgery you’ll need would be tailored for you by your surgeon, and would only be considered when you’ve well and truly finished having babies.
Have you undergone a Diastasis Recti treatment before and want to share your experience? Comment down below.
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