Abdominal separation after pregnancy

WHAT YOU NEED TO KNOW TO GET BACK TO FITNESS SAFELY.

Being a new (or even not so new) mum can feel like a challenge at times. Instinctively your baby comes first, but that can leave little time to take care of yourself.  For 9 months your body changed and adapted in amazing ways, it's not surprising so many mum's find their body now feels different or even unfamiliar; and just when it seems like the pressure is on to get back in shape quickly, some old exercise routines just don’t feel right postnatally, or don’t work the way they used to.  

This article focuses on just what goes on in the abdomen in the postnatal period and onward and how it can impact so much more than your waistline. In particular we will look at abdominal separation and aim to give you a practical understanding of the things you can do (and avoid) to make sure you are supporting your body and getting back to fitness safely!

Pregnant belly.jpg

What do you need to know about your postnatal abdomen?

Your postnatal body is amazing, fact!  You carried, cared for and gave birth to a growing baby, adjusting everything from your pelvis to your hormones and muscle support mechanisms along the way and whatever your birth experience, your body went through a huge process.

Bodies are fantastic at healing, but knowing a bit about the process can help things along.

What is an abdominal separation?

You may have heard of an abdominal separation, it is also known as a “Diastasis Rectus Abdominus” (DRA).  A separation happens when the tissue in between the “six-pack” muscles, known as the Linea Alba stretches during pregnancy to create space for the growing baby.  

DRA Graphic.png

The separation is extremely common, between 66% and 100% of women will have a DRA by their third trimester.  So in itself the separation is not a problem, neither is the size of the separation.  

In fact it appears that the problem occurs only when the gap begins to impact the way the muscles in the abdomen work together to support you.  

For many mum's there is spontaneous recovery of the abdominal muscles during the first 8 weeks after giving birth.  However for some women, the muscles and therefore the way they support you can stay altered past this point.  

Importantly, researchers tell us that if a gap has not resolved by 8 weeks, it is very likely to be the same in 12 months time unless mum has actively worked on it.  

But is this just a cosmetic issue?

Most definitely not!  An ongoing limitation in how the abdominal muscles support you can significantly increase the risk of back pain, urinary incontinence, pelvic organ prolapse and pelvic girdle pain either currently or in the future. 

But it is never too late to work on it!

How do the abs impact so much?

It all comes down to the way our abdominal muscles work together.  Our “abs” and “core” help us with so much more than sit ups and planking!  Let's go through the layers:

SUPERFICIAL MUSCLES

Most people are aware of the muscles on the surface of the abdomen such as your six pack muscles (Rectus Abdominis) and the Obliques (internal and external).  These muscles tend to be bigger and are essential for movement. 

But unless these movement muscles have a stable base underneath to move from they will struggle to do their job well, no matter how strong they are.

Imagine for a moment Usain Bolt trying to beat his 100m record on a bouncy castle.

DEEP CORE MUSCLES

This leads us to our super important deep core muscles.  Consisting of your diaphragm at the top, pelvic floor at the bottom and a corset of muscles around the middle (namely Transversus Abdominis and Multifidus).

Cylinder.png

Together these deep core muscles create a strong cylinder, much like the shape of a baked bean can (work with me here).  The similarities perhaps end with the shape, but consider how strong, stable and protective a can is?  This strong cylinder works to protect your spine, and support your organs throughout the movement created by your bigger muscles.  

This core support in turn reduces your risk of pelvic organ prolapse and incontinence as well as low back and pelvic aches and pains by supporting you in strenuous daily activities such as lifting the pram as well as returning to sports and classes.

What can I do about my separation?

This is the big question!  We are now learning is that the cause and resolution is often completely individual for each woman.  

If you are experiencing any discomfort, incontinence or having difficulty accessing your pelvic floor or abdominal muscles, it may well be the time to book yourself a 1:1 assessment with a women's health or abdominal specialist physiotherapist before increasing your exercise.

And even if you aren't noticing any of the above, there are still a few considerations to think of when getting back to activity.

IT IS NOT SO MUCH ABOUT STRENGTH AS IT IS ABOUT COORDINATION

The most common factor with mum's, is not that they don't have any strength in the abdominal muscles. Instead, it’s that after nine months of changes, the muscles are simply out of practice in working together.

When this happens, some muscles may work disproportionately hard or even continue placing stresses on the abdomen which could in turn maintain the separation.

In these cases, it may feel like the harder you work the worse it may become.

SO IT IS ESSENTIAL TO WORK ON THE CONNECTION TO YOUR DEEP CORE BEFORE TRYING TO PROGRESS STRENGTH OR IMPACT EXERCISES.

When all muscles of your cylinder work together you create the strong and protective can shape.  This acts as the stable base from which you can safely strengthen, work on shape and eventually progress back to your pre-pregnancy exercises.

How to connect to your deep core (cylinder)

The more we understand about abdominal separation, the more obvious it becomes that there is no one approach for everyone, but improving the connection to each part of your deep core appears to underpin recovery in most women.  A good programme will include progressive exercises and breathing strategies for the muscles and diaphragm.

 

PELVIC FLOOR

Sitting or lying comfortably with your knees slightly apart, imagine that you are trying to stop yourself passing wind by squeezing the muscles around the back passage. You should be able to feel the muscle lift gently but double check that your buttocks, stomach and legs are not moving at all.

Next imagine you are trying to stop yourself passing water.  (Do not try to stop the stream when you are actually passing water).

Lastly try to tighten the muscles around your back passage, vagina and front passage and lift up inside as if trying to stop passing wind and urine at the same time.  Once again double check you are not letting your buttocks, legs or tummy take over.  Focus on the lift from underneath.

Once you have this contraction easily, gradually try and increase the length of time you can hold it for without holding your breath.

Note it is also important to strengthen the quick firing of your pelvic floor ready for coughs, sneezes and impact by practicing the above contractions as short pulses on and off. 

Time yourself and count your pulses to get an idea of your progress.

 

DEEP CORE

Lying with knees bent and a neutral curve in your low back.  Imagine a line that connects the inside of your two pelvic bones (front of hips). Think about connecting, or drawing the muscle, along this line as if closing two book covers. or imagine gently drawing the naval towards the spine.

Check you are not holding your breath and that there is no movement of your hips, pelvis or spine.  

Other things to consider

HYDRATION

Drink plenty.  Your connective tissue has a high water content, this means that trying to get the muscles to reconnect when they are dehydrated or undernourished will be more difficult.  

POSTURE

Posture doesn't just mean how you stand, it is the way you hold and position yourself throughout the day.  Commonly for new mum's, it is sitting to feed for long periods of time that can impact the core activation.  Encouragingly, this is one of the easiest areas to see big gains as when you change simple every day habits you will be racking up the hours where you are practicing your new alignment

BOWEL HABITS

We have those hormones to thank again for constipation being more common pre and postnatally.  A backed up bowel however is another source of pressure and discomfort for the abdominal wall so it's well worth considering your fluids, diet, exercise and toilet positioning.

STRESS

Its no secret being a new mum can be a stressful time.  Sleep, hormones and a huge lifestyle change can take their toll even before you consider your new baby. However we also know that stress can have a huge impact on the speed of recovery.  Understanding how you respond to stress and knowing the things that work for you to reduce it can be a huge help.  Perhaps it's talking to a friend, trying meditation or even joining a postnatal class that includes some relaxation and breathing exercises. 

When to seek help

If you are experiencing any pelvic pain, abdominal discomfort or incontinence, it is definitely advisable to seek medical or physiotherapy input!  Every woman is different, so if you simply want some reassurance on how you are doing or are wondering if your exercise routine or daily activities are safe for you, contact a local women's health or abdominal physiotherapist.

summary

DRA Summary Remember.png
DRA Summary What to do.png

 

If you have any questions about this article or how to apply this information in your own body I would love to hear from you!  Or if you would like any information about booking a 1:1 postnatal assessment in your own home or about joining us for a mother and baby exercise and relaxation class, just click below.

Hayley is a Chartered Physiotherapist, Clinical Pilates and Yoga teacher in London and the South East.  With a Masters in Neuroscience, she specialises in combining mindfulness, movement and rehabilitation for all ages and conditions with a special interest in Pre and Postnatal Yoga and Pilates.  If you have any questions or thoughts about any of Hayley's work, she would love to hear from you - Hayley@LatitudeWellbeing.com.

HayleyProfile.jpg