What is abdominal muscle separation or Diastasis of the Rectus Abdominus Muscle (DRAM)?
Abdominal muscle separation is when the two long muscles called the rectus abdominus muscles separate from each other during pregnancy. This is the body’s common and NORMAL safety mechanism which occurs most often in the second and third trimester of pregnancy as the body changes to make room for the growing baby.
What this means for you postnatally?
This separation will usually resolve in the first 6-8 weeks postnatally and is usually only considered to be a concern if you are still feeling the muscle weakness/separation after this period of time. Up to 1 in 3 women will still experience some separation a year after the birth. The depth/width of the muscle separation are the most important components in assessing this potential concern and needs to be done by a physiotherapist or doctor.
Why is this important?
If the muscles remain separated with a significant depth it means the deeper stability muscles aren’t providing your back with the full support it requires. The other structures in your back (vertebrae, disc, ligaments) then have to compensate for this weakness and this may also increase in the incidence of lower back pain.
What can be done to help?
• Exercises to strengthen the deep abdominal muscles.
• Wear an abdominal support, such as Tubigrip or high wasted compression underwear/tights
· Avoid sit-ups or abdominal crunches until you have seen your physiotherapist
• Getting in and out of bed with the log roll- Sit on the edge on your bed and then lean onto your elbow and at the same time lift both legs onto the bed. From this position, you can roll onto your back. For getting out of bed it is the opposite.
• Minimise lifting anything heavier than your baby or anything that causes your tummy to bulge with strain.
How do you monitor the recovery of your Abdominal Muscle Separation?
• Lie on your back with your knees bent and place your fingertips across your belly at the level of your belly button.
• Lift your head and shoulders away from the floor (a small sit up) and feel for the sides of your abdominal muscles coming together.
• If you can feel a gap wider than one finger then you may still have a separation
Exercises to start before your Six Week Postnatal Physiotherapist Assessment:
• Pelvic floor exercises (see blog “The Physiotherapist wants to see me at six weeks post-natal, what can I do before this to help my recovery?” for more information)
• Deep abdominal strengthening exercises:
o Lie on your back with your knees bent and your feet flat on the floor.
o Place your hands on your lower tummy just inside your hip bones.
o Gently tighten your tummy muscles, pulling your belly button in towards your spine.
o You should feel your back flatted on to the floor.
o Do not hold your breath.
o Hold this contraction for 10s. Relax and repeat 10 times.
o Repeat this up to three times a day
What else will the physiotherapist assess at your six week postnatal review?
• Will check any scarring (caesarean or vaginal)
• Will check and correct your posture breastfeeding/baby holding or carrying
• Address any continence concerns
• Mobility assessments
• Musculoskeletal assessment
• Rectus abdominal assessment for any separation
• An optional pelvic floor check (either internal or external, whatever if preferred if safe to complete).
• Give you advice on resuming sexual intercourse safely
• Give you advice on good bladder and bowel habits
• Return to exercise advice and individually tailored exercise program to work towards your goals
Contact Proactive Physiotherapy today and organise your six-week postnatal appointment with one of our Pelvic Physiotherapists on 07 4084 0602.
References:
Department of Health and Aged Care, Australian Government. (2022). Abdominal separation (diastasis recti) https://www.pregnancybirthbaby.org.au/abdominal-separation
The Royal Women’s Hospital, Victoria Australia. (2018). https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Abdominal-muscle-seperation-270719.pdf