ASK A PHYSIO April….Abdominal Separation after childbirth

 Do you mind if I ask you a quick question (for my sister) for your next newsletter…


She has a muscle separation in her stomach from her last pregnancy and wants to know if she has to completely close it before she can do any sit ups etc? She still has a one finger gap. I think she is getting quite depressed about her stomach not going away even though its been 4 months. Michelle, 29.
 
Separation of the tummy muscles ( also know as diastasis recti abdominus) has been shown to occur in 66% of women during their third trimester and can persist in up to 60% of women post partum. It occurs when there is a separation between the right and left side of the rectus abdominis muscle which covers the front of the tummy.
During pregnancy there is decreased strength of the connective tissue and this allows the baby to grow and push into the abdominal wall without restriction.  The linea alba fascia thins and the rectus abdominis can split to allow more room for the baby.
 
Risk factors include:
 

 Do you mind if I ask you a quick question (for my sister) for your next newsletter…


She has a muscle separation in her stomach from her last pregnancy and wants to know if she has to completely close it before she can do any sit ups etc? She still has a one finger gap. I think she is getting quite depressed about her stomach not going away even though its been 4 months. Michelle, 29.
 
Separation of the tummy muscles ( also know as diastasis recti abdominus) has been shown to occur in 66% of women during their third trimester and can persist in up to 60% of women post partum. It occurs when there is a separation between the right and left side of the rectus abdominis muscle which covers the front of the tummy.
During pregnancy there is decreased strength of the connective tissue and this allows the baby to grow and push into the abdominal wall without restriction.  The linea alba fascia thins and the rectus abdominis can split to allow more room for the baby.
 
Risk factors include:
Increased age of mother
Large pregnancy weight gain
Larger baby size
Multiple gestations (twins!)
Multiple children
 
The degree of separation is important when thinking of returning to exercise. As a general rule 1-2 fingers is quite normal post partum. Research has shown that our transverse abdominis  (inner core) has a crucial role in lumbopelvic stability and disruption to the fascia which occurs with diastesis can disrupt this mechanism. Therefore strengthening our inner core muscles is usually a good idea before starting heavier abdominal work.  All exercises should work on closing the separation and not increasing it.
 
Regarding your sister, it is advisable she see a Physiotherapist to palpate her separation while she is doing a sit up or a plank, test her core strength and assess what exercises would best help her. Most people can achieve closure but some people never fully close the gap. It is common for some ladies to take up to a year or so until they improve further. To help she needs to be doing some exercises or Pilates to aid recovery. Having a Physio use a Real-time ultrasound to teach her how to recruit her deeper core muscles and assess he pelvic floor is often really helpful and provides her with objective measures to improve on. 
 
If you or someone you know is unsure about restarting exercise post delivery then book a Women’s Health Assessment with Sally our Women’s Health expert to discuss further.