Post-Baby Body Blog Part 1 (Diastasis Recti)

Diastasis Recti (aka mommy tummy, aka post-preggo pooch, aka what the heck happened to my stomach?)

Getting asked if you’re having a boy or a girl by the grocery store cashier months after giving birth isn’t fun. As if the pregnancy, delivery, and sleepless fourth trimester wasn’t hard enough! Many first, second, or (God-forbid) tenth-time mommies want to know how they can return their stomach to pre-pregnancy status.

The obnoxiously termed “mommy tummy” has been getting attention on NPR lately. Sadly, the coverage on this issue is often reduced to overly simplified explanations and solutions to a hugely complex and highly individual issue. If you are looking for more in-depth answers, you’ve come to the right place. When a postpartum mommy comes to see me, the very first thing I check for is abdominal separation, otherwise called Diastasis Recti (or DR).

So… tell me more about DR

A pregnant woman’s body makes awe-inspiring transformations to accommodate a growing fetus, including the stretching of abdominal muscles. This is a completely NORMAL and NATURAL process. 100% of women have a slight separation in their Rectus Abdominis muscle (the six pack muscle) during their third trimester. Another way of saying this is that 100% of women have slight DR by the time they go into labor.  

The challenge arises when the abdominal muscles do not return to their pre-pregnancy position after giving birth, which increases the risk for low back pain, hernias, prolapses, pelvic floor dysfunctions, as well as aesthetic issues like a pooching of the belly. That is not to say that every woman with DR will have these issues but they may be prone to them later in life if they participate in unsafe movements or activities.

To understand how to improve postpartum abdominal separation, you first have to understand how the abdominal cavity works. It’s helpful to think of the abdominal “core” as a box: the top is the diaphragm that helps you breathe, the sides are the butt muscles, the front is the abdominals, the back is the lower spinal muscles, and the floor is the pelvic floor muscles. Inside the “box” are organs, blood, intestines, sometimes babies…etc. When you lift something heavy, for example, these muscles contract in order to contain the gut contents, to stabilize the joints, and to assist in the motion of the movement. When there is abdominal separation from DR, there is weakness in the front of the box.

When you go to lift an item or make a quick movement, that pressure is uncontained right down the middle of your stomach where the separation exists. Ever wonder why your abdomen resembles the chestburst scene from Alien when you roll over in bed? That is uncontained pressure “tenting” your abdomen and pushing out gut contents (yikes!) If you want to know how to make your physical therapist twinge, just perform this maneuver. Trust me – works like a charm.

The tricky part is that our bodies are not one and the same. You may not need to strengthen every part of the “box”- in fact, it could be counter-productive. For example, runners tend to have tight Oblique muscles (which are located laterally in the abdomen) so these women would benefit from having manual work done to decrease the pulling tension on their sides. Despite it being very counter-intuitive, many women have tight pelvic floor muscles after giving birth. Pelvic floor strengthening (kegels) would be inappropriate for this population of women. Hopefully, you’re beginning to see why there is no simple, fix-all solution.

So, how do you know if you have DR?  

Luckily, there is a super easy test that you can do at home right now! Simply lie down on your back with your knees bent and feet on the floor.  With your head resting comfortably on the floor, put your fingers about an inch or two above and below the belly button along the long axis of the body. Bring your head toward the ceiling like you are doing a crunch. If you feel a separation of 2 or more fingertips then congratulations! You are officially part of the DR club! Next pour yourself a glass of wine and gaze at your beautiful child.  It was worth it.

This brings me to my next point.  DO NOT DO CRUNCHES.  THEY ARE BAD FOR YOUR SPINE AND WILL MAKE YOUR DR WORSE.  Watch any celebrity trainer on YouTube. Crunches have fallen out of style anyway, and should be especially avoided by members of the DR club.

Second question I get often: Can’t I just wear a splint or an abdominal binder?  Won’t it just heal on it’s own?

Unfortunately, no– splints do not work. Wearing a binder will neither keep your abdominals together nor will it allow it to heal on it’s own.  

The goal is not always to “close” the separation. It is not always possible. In those cases we correct the movement to stop the progression of a worse separation.  

In an ideal world, every pregnant woman would learn safe body mechanics to decrease the risk of DR and every post-partum woman would get assessed for DR. If you’ve recently had a baby, get your cute post-partum butt into a clinic. Physical therapists who have additional training for DR are experts at this stuff. A physical therapist will build an individualized plan that is effective and safe for your distinct (and extraordinary) body.

A helpful hint!

Maintaining good habits during pregnancy and thereafter can help prevent DR from worsening. The simplest concept you can integrate into your daily routine is proper breathing.

Learning how to breathe correctly when you lift your little one (or any heavy object)

Still lying on the floor from testing for DR? Great. Stay there. I’d like you to put one hand on your chest and one hand on your belly. Breathe into your belly- the hand on your chest should only move slightly and the hand on your belly should rise as you inhale and fall as you exhale. Your rib cage should be moving laterally. Now try this in both a seated position and in a standing position. Once you get used to this type of breathing in standing, as you go to lift your child from the crib, for example, inhale as your hands contact their body and exhale as you bring them to your chest. The same goes for putting them back down. Inhale to begin and exhale as you lower your child to the ground.  

YOUR BODY IS INCREDIBLE

The concepts you will learn from a physical therapist are useful throughout your lifespan. Becoming a mother is a completely over-whelming process. But there is light at the end of the tunnel. Doing this type of work is enlightening and induces confidence in your body. When else can you justify focusing an entire hour on your “box?” Your body is remarkable – it’s time you gave it the attention (and gratitude) it deserves!

 

Written by Jessica Hawley-Gamer, PT, DPT ~ heart-led mother, runner/yogi, Pilates instructor, prenatal/postpartum/pelvic physical therapist living in Encino, CA. She can be found on FB at: https://www.facebook.com/ptformoms, on Instagram as: mama_PT, or emailed at: mamaphysicaltherapy@gmail.com. Jessica works for Rehab Specialists Inc. at their Encino clinic.