Lately ‘mummy tummy’ or as scientifically known ‘diastasis recti’ is being more widely recognized and there is improved awareness on how to manage it. In my practice as a physiotherapist, I still meet a lot of new mothers who are given misleading advice and get confused as to what they can do to fix the problem. Mummies tend to hear phrases like: “You’ve had a baby, what do you expect?” or “Start your sit-ups and your tummy will go down”. There is also the misconception that the only possible option to close the gap is through surgery.
So what is diastasis rectus abdominis and what causes it?
Diastasis recti is the separation of the tummy muscles (rectus abdominis). The muscles tend to separate during pregnancy as an adaptation to the growing abdomen. The problem occurs when the muscles fail to return to an acceptable distance in the first weeks postpartum.
The main problem with diastasis recti is that the abdominal muscles fail to function, which can lead to pain, increased risk of hernia, decreased strength and stability for everyday activities, and a risk of impairments of the pelvic floor such as pelvic organ prolapse.
The tummy looks flabby (mummy tummy) and sometimes the skin is wrinkled over the navel. Mums tend to notice the diastasis when they move and the tummy tends to bulge outwards. Mothers also tend to report losing weight and fitting into most of their pre-pregnancy clothes but find it difficult to close tight fitting jeans.
How do I check if I have diastasis recti?
- Lie on your back with knees bent and feet on the floor with hands by your side.
- Pass your fingers along the centre of the abdomen starting from the tip of the sternum down to the pelvis and pass your fingers from side to side of the abdominal muscles.
- Place your fingers over the navel and slowly raise your head off the ground, keeping the chin tucked in until you feel the tension under your fingers.
- Palpate along the entire mid-line and also move your fingers from side to side to check if your fingers dip between the ends of the abdomen.
You need to check the following:
- Bulging of the abdomen.
- Ends of abdominal muscles separate or come together to squeeze your fingers.
- How far apart your fingers are.
How does the gap gain function and tension?
- Stop doing activities that make the situation worse such as letting your tummy bulge with lifting and getting straight out of bed without turning.
- Pull your tummy in with everyday activities to build tension in the core. The way to build such tension and start you off on the way to recovery is something that a specialized physiotherapist will guide you on.
A physiotherapist will also guide you on:
- Need for splinting (abdominal binding) especially early on post-partum.
- Specialised exercises to gain more tension in your muscles.
- Advice on what exercises to avoid such as abdominal crunches, sit-ups, double leg lifts & planks etc.
- Advice on how to modify everyday activities so as not to make your diastasis worse.
- High activity sports tend to make the gap worse so care is needed.
Why is it important to visit a pelvic floor physiotherapist in the management of a diastasis?
- Assessment of abdominal system, core recruitment, breathing, extent of separation, ability to build tension in abdominal area.
- Assessment of pelvic floor muscles that play an essential role in restoring the gap.
- Exercise plan to restore the core.
Diastasis recti is common but not a normal occurrence after pregnancy. It should NOT be accepted as a natural consequence of having had a child. The training to restore function in the abdomin is very specific and certain exercises such as sit ups need to be avoided at all costs. The first few weeks postpartum are crucial and this is the time when the diastase can get worse, so it is important that mothers get the correct advice on how to support their core.
Rehab is more about regaining function and strength than closing the gap completely!
About the author
Carolyn Sultana works as a physiotherapist with the public sector and an APPI trained Pilates instructor. In 2013, she was awarded a Master in Women’s Health Physiotherapy from the University of Bradford. She is a strong advocate of women’s & men’s health care; conservative treatment and exercise, focusing mostly of pelvic floor rehabilitation for women and men who have problems of incontinence; pelvic floor dysfunction and anorectal dysfunction; and has an interest in the treatment of pelvic pain mostly related to sexual dysfunction.
Follow Carolyn on Women’s Health Physiotherapist or contact her on firstname.lastname@example.org, 79962109