Elaine’s Pre & Postnatal Classes

Abdominal separation and why you need to know about it during & after pregnancy …

A common occurrence during & after Pregnancy, is ‘ Diastasis Recti’ or separation of the abdominals. See my post below for more information on this condition, and how best to manage it.

Diastasis Recti During Pregnancy – AKA Abdominal Separation

Diastasis Recti (D.R.) is a fairly common condition of pregnancy and postpartum in which the right and left halves of Rectus Abdominis muscle spread apart at the body’s mid line fascia, the linea alba.

Widening and thinning of the linea alba occurs in response to

A. The increased levels of Relaxin & Progesterone Hormones in the body (which increase the laxity of joints)

B. The force of the growing uterus, pushing against the abdominal wall.

A small amount of widening of the mid line happens in all pregnancies (and is normal!), but when that opening measures more than 2cm or 2.5 finger-widths, it is becoming a compromised D.R.

D.R. usually occurs in the latter half of pregnancy, but can occur sooner in women who

  • are over 35;
  • have a sway back posture (where the pelvis & belly thrust forward);
  • have twin or multiples pregnancy;
  • have pregnancies which occur quite close together.

It is estimated that D.R. occurs in 30% of 1st pregnancies. D.R. separation in a previous pregnancy significantly increases the probability, and severity, of the condition in subsequent pregnancies with 50% – 60% pregnant women on their 2nd / subsequent pregnancies experiencing a D.R. of more than 2cms during pregnancy.

You may not notice you have D.R. while pregnant (unless you test for it), it is more commonly noticed post-pregnancy, when the abdominal wall is lax. Some postpartum women’s mid lines close to less than 2 finger-widths spontaneously, but for many, the tissue remains too wide, causing problems. Returning too soon to inappropriate or intense exercise plans, can not only delay the healing of the D.R., but can make it worse – so if you are already planning your post-baby exercise routine, seek advice on the correct approach to take.

  

Problems / Symptoms associated with Diastasis Recti.

D.R. reduces the integrity and dynamic  of the trunk, that the abdominal muscles normally provide.  This can compromise trunk stability & mobility, aggravate lower back pain, affect posture, create pelvic floor dysfunction, hernia, cosmetic defects, and can also affect vaginal delivery. 

Testing for Diastasis Recti/Abdominal Separation during Pregnancy.

This simple self-test will help you determine if you have diastasis recti. Please note it is a self-test, and not a medical diagnosis! If you are especially concerned about the opening or width or the Diastasis, you are advised to ask your midwife, attending consultant or consult with a physiotherapist specialising in Womens’ Health.

The following test is safe to do during pregnancy (especially in relation to lying on the back – where here it is just for 1 minute at most). It is also useful to ask someone else to assist you.

  • Lie on your back with your knees bent, and the soles of your feet on the floor.
  • Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline-parallel with your waistline– at the level of your belly button.1-2 finger width= Normal 2.5 finger width D.R._resized
  • With your abdominal wall relaxed, gently press your fingertips into your abdomen.
  • Supporting the head with the hand, Roll your upper body off the floor into a “crunch,” making sure that your ribcage moves closer to your pelvis.Diastasis Recti Test above navel
  • Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle. Test for separation at, above, and below your belly button.Diastasis Recti test below navel
  • You may visibly notice a ‘cone-shape’ protrusion occur as you lift up – that is your uterus temporarily rising through the opening. If it appears wider than 2cm apart. D.R. has occurred and modifications need to be taken when exercising your abdominals.

Exercises to Avoid during Pregnancy if Diastasis Recti is present

(especially relevant once we come into 2nd trimester onwards!)

  • Any exercise that causes your abdominal wall to bulge outward;
  • ‘Back-bend’ movements or  ‘4 pt Kneeling’ positions that do not recruit sufficient abdominal support;
  • Exercises that require you to raise the head & neck up & flex the spine;
  • Exercises requiring you to hold the legs up unsupported and in a long lever position, while resting a supine / semi-supine position;
  • Full Plank Positions & their variations; Modifications onto the elbows and or knees may be more suitable alternatives
  • Dynamic Upper Body Twisting (i.e. under spring-load)

Simple Things to Do to Help minimise D.R.

  • Do exercises that help the Posture during Pregnancy (especially if you naturally deviate toward a Sway Back Posture).
  • Practice sitting erect, ears above shoulders- shoulders above hips.
  • Regularly mobilise or stretch the lower back, hips, hamstrings
  • Avoid lifting heavy weights including young children (this one I know can be very hard not to do!!)
  • Practice Breathing Techniques, especially Lateral Costal Breathing, to encourage the expansion of the sides of the ribs, the sides of the body, the mid back areas.

Attend one of our Antenatal Classes @ Platinum Pilates

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