It’s becoming more and more common for women to seek treatment from a Women’s Health Physiotherapist for Abdominal Separation. Some women find their stomach muscles weaken and separate during and after pregnancy. The stretching and thinning of the abdominal muscles is a natural occurrence during pregnancy (30-70%) to accommodate the growing baby and up to 66% of women have a significant separation by the end of their third trimester.
The good news is that for the majority of women this condition resolves during the early postpartum period. Unfortunately for some however, a weakened abdominal wall persists well into the postpartum period, impairing activities of daily living. Learn how to recognise, prevent and treat abdominal separation.
Image Source: BabyCentre
What is Abdominal Separation?
The clinical name for the separation of the abdominal or stomach muscles is Diastasis Recti Abdominis (DRA). This refers to the separation and thinning of the recti abdominis muscles and stretching of the Linea alba, a fibrous connective tissue structure. (see above image) This fascial structure plays an important role in maintaining the integrity of the anterior abdominal wall to maintain stability with load transfer activities such as standing, walking, lifting, bending and squatting.
Can only pregnant people get Abdominal Separation?
Whilst pregnancy is the most frequent cause of a separation there are other causes that affect a variety of people including men. These include: improper weightlifting or abdominal strength training, obesity, or conditions that increase intra-abdominal pressure such as chronic obstructive pulmonary disease. Advanced maternal age (>34), history of midline or caesarian surgery, multiple pregnancies, having twins or triplets can increase the chance of having a separation.
A separation is considered an issue when the distance measurement exceeds 2.5 to 2.7cm width and severity ranges from mild (2.5-3.4cm) to severe (5-20cm or greater)
How is it measured?
The most common measurement of separation used by Physiotherapists is finger width measurement, where the measurement is considered significant if more than 2 fingers can horizontally be placed in the interrecti space (with each finger approximating 1.5cm).
What if I do nothing about it?
For some lucky women with great collagen elasticity, within 6 to 12 weeks after giving birth, their separation may be minimal and not symptomatic. For others, the process is a little slower or never seems to completely resolve. Unresolved abdominal separation can sometimes lead to problems later in life. A correlation has been found between separation and pelvic floor dysfunctions such as; stress urinary incontinence (SUI), fecal incontinence and pelvic organ prolapse (POP). A large separation with impaired muscle strength and poor recruitment of the abdominal muscles can sometimes result in posture dysfunction, impaired bio-mechanics, decreased stability during load transfer activities, and poor tolerance and/or pain for activities of daily living.
What can I do about it?
If you are unsure if you have abdominal separation or would like to discuss about your options; it’s best to talk to a specialists in this area and get assessed by a Women’s Health Physiotherapist.
Wearing tubi-grip bandage in the initial post-natal period which binds tightly around the abdomen, supporting the recti muscles may help. It’s important to wear when you are walking around, lifting prams, toddlers or your baby. You can take this off at night. Some women may choose to buy SRC recovery shorts which is another support garment. It’s important to note that you should not become reliant on the garment and will need to wean off, whilst retraining your deep abdominal muscles to help support the anterior abdominal wall.
What can I do to prevent further separation?
· It is important to avoid abdominal exercises that may further separate these muscles such as sit-ups and crunches. Also avoid aggressive stretching of the abdominals.
· Bracing your pelvic floor muscles and deep abdominal muscles during functional transfers such as rolling over, lying to sitting, sitting to standing.
· Bracing with your pelvic floor and deep abdominal muscles during lifting, sneezing, coughing
· Sleep with a thin pillow under the belly when on side to minimize drag on the separation.
With guidance from a Women’s Health Physiotherapist you can learn correct exercises and progressions and be on the road to recovery!