Abdominal separation - separating fact from fiction...
Updated: Jun 24, 2018
Welcome to the Mother Nurture Pilates blog!
I’m going to start with a topic that comes up frequently amongst new Mums, and I know causes a lot of worry - #abdominalseparation, or Diastasis Recti Abdominus (#DRA). I get 2 or 3 enquiries about Pilates classes each week from ladies panicking about their ‘split’ or broken tummies......let’s debunk some of the myths, do away with the scaremongering and discuss the FACTS and FICTION of DRA.
FACT - recent research (2017) has identified DRA occurs in 100% of pregnancies in the third trimester. WHAT?!?!?!
So basically, this is PHYSIOLOGICALLY NORMAL for pregnant women!! The rectus abdominus muscle HAS to thin out down the middle to allow room for baby to grown and your tummy to stretch. Our bodies undergo massive changes in pregnancy and a widened gap between the left and right rectus muscle is as normal as having a bump!
FACT - there is a degree of spontaneous recovery within the first 8 weeks, so if you were told on the postnatal ward 3 days after having your baby you have a split tummy muscle - that’s ok!
It’s normal, and really not something you need to worry about at this time as similar to other soft tissue injuries, it will heal to some extent on its own...,BUT we know that after 8 weeks the gap will not change any further without intervention. This is a whole-body problem which requires a whole-body approach to recovery so not a question of ‘which is the best Pilates exercise to close the gap’.....that is not a strategy that will offer much help!
FACT - there is a strong association between DRA and postnatal pelvic floor dysfunction, for example stress urinary incontinence or pelvic organ prolapse.
If your tummy gap has not improved adequately after the initial 8 weeks and you are leaking urine or have symptoms of prolapse (eg vaginal ‘heaviness’ or bulging), you should consider seeing a women’s health Physiotherapist for specific guidance on your postnatal recovery. Ignoring the pelvic floor symptoms whilst trying to ‘fix’ your tummy likely won’t work for you....
MYTH - “You just need to do more sit ups to sort your tummy out!”
Well known ‘abs’ exercises that you may have enjoyed pre-pregnancy can actually be unhelpful at this time in your life. Sit ups, planks, crunches etc can all cause a rise in ‘intra-abdominal pressure’, which is the pressure in your belly. This pressure will bear down on your pelvic floor and push outwards on your abdominal wall - neither of which is what you want at this time!
Exercise is definitely PART of the recovery from DRA (but only one element!) - it’s important to select appropriate exercises, which will not add load or further stretch the abdominal wall.
MYTH - "Surgery is your only option" (if the sit ups didn’t work)
I refer to my previous comment....go easy on the sit ups (unless you’ve already built the foundation and have appropriate guidance in the suitability of this as an exercise for you)
In most of the conditions I treat as a Physio - surgery IS an option....BUT....the time to consider it is after the failure of more conservative measures (ie rehab!), and rarely is it ever the only option!
Surgery is never a quick fix, and usually involves a degree of rehab afterwards anyway to ensure a great outcome. Know that there ARE options prior to surgery for this condition. It will likely take the guidance of a professional, some hard work and some time, but nonetheless MOST ladies do not require surgery. Some do, but the vast majority do not.
MYTH - "There is nothing you can do about it, accept it"
Put simply - this is not true, incorrect and wrong. There is plenty that can be done. The first step, is to inform yourself, so you are aware of how you can help yourself along in your recovery. There are many positive things you can do to facilitate healing, and a few things you should think about avoiding too.
Look out for my next blog....7 key fundamental steps to healing abdominal separation. Follow my Facebook page to be sure you don’t miss it.
Mother Nurture Pilates | Physiotherapist led Postnatal Pilates classes | Leighton Buzzard, Bedfordshire