Abdominal Separation (Diastasis Recti Abdominus)
This topic seems to be at the forefront of the postnatal conversations now. Every exercise on Instagram claiming it can fix it or prevent it, but can we really do that? One of our Pelvic Health and Continence Physiotherapist Taryn helps answer some questions around Abdominal separation.
Abdominal separation is a stretching of the linea abla (LA). Simply put, the LA is the connective tissue that connects all our abdominal muscles through our midline, helps maintain abdominal pressure and transfer forces from the right side of your body to the left and vice versa. It’s easy to see in pregnancy because it lies directly below our linea negra (the darker line down the centre of our tummies).
The separation of the LA happens in 100% of woman who carry their baby/babies past 35 weeks pregnant. This is an essential adaption our bodies have made to accommodate our growing babies. The degree of separation and the speed at which it comes together after pregnancy is mainly dependent on our genetics (how your connective tissue behaves). Things that can affect the amount of separation include multiple pregnancies, hydramnious and potentially the exercises you do (though there is no research yet to back this up).
How much separation is normal?
The normal amount of abdominal separation even before you fall pregnant can be up to 1.5-2cm. A separation of >3cm post-partum is classified as a DRA.
How quickly will the gap close?
You will get most of your natural reduction in size in the first 8 weeks postpartum. This is because your uterus will return to pre-pregnancy size and your abdominal organs will shift back into place. But there is no time limit on the progress you can make strengthening the LA and abdominal muscles.
Do I need to worry about how big the gap is?
What is happening within the gap is more important than the size itself (in most cases). If you can maintain the pressure in your abdomen and transfer forces effectively there is no need to worry about the size functionally. If cosmetically you are not happy with it there are surgeries that can help.
Have my tummy muscles ripped or torn?
It can sometimes feel that way. We get lots of strange sensations in our abdomen when pregnant. But no, there is no ripping or tearing. There is only a stretching of connective tissue. The beauty of this is, that if we progressively overload the tissue, we can get it stronger again in most cases.
What is the difference between abdominal separation and an umbilical hernia?
As babies our umbilical cord passes through our LA, to do so it needs to pass through a small hole. Later in life we fall pregnant and our LA stretches and so does the small hole around our umbilicus. In some woman this hole will stretch large enough for it to be classified as a hernia. It is only a concern if it is large enough that our organs (intestines) may pass through it.
What can I do to prevent abdominal separation?
So much is out of our control, as I said above our genetics play the biggest role. If you are concerned an individual assessment from a Pelvic Health Physiotherapist during pregnancy is the way to go! Your pressure management strategies can be assessed and modified if need be and core strengthening exercises can be perfected.
What can I do after my baby is born?
Your abdominal separation can be assessed as soon as your baby is born (by a physiotherapist on the hospital ward). An individual program is essential, and this can start from day one. Your program may look like pelvic floor and core exercises, abdominal supports or even crunches.
How do abdominal supports or supportive tights work?
After pregnancy your abdominal muscles are left in a lengthened or longer position. Supportive garments help by placing the abdominal muscles in a shortened position, therefore making them easier to activate. The way to strengthen the LA is to progressively overload it through strengthening your abdominal muscles.
Taryn Anderson, Pelvic Health and Continence Physiotherapist, is part of our Pelvic Health Team providing you with expert abdominal separation management. Our Pelvic Health team are trained to assess and manage abdominal separation during pregnancy and postpartum. You will need to book a “Women’s Health Initial Assessment”, to book