Diastasis Recti - Avoiding the Gap!

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So many Moms come to my yoga classes with abdominal separation. They have all experienced different pregnancies and different births, but the one thing they have in common is that none of them had any idea they were ever at risk of developing a condition that could potentially affect them physically and emotionally for many months - sometimes even years after birth. As with most things in life, prevention is better that cure. In part one of this two part blog I’m hoping to raise awareness of diastasis recti and share some ways of avoiding or minimising abdominal separation with good self care during pregnancy.

What is Diastasis Recti?

Diastasis recti is a separation of the rectus abdominis muscles, leaving a gap that allows your belly to protrude. As your belly expands during pregnancy, the connective tissue between the long flat rectus abdominis muscles (the linea alba) gets stretched out, allowing the rectus abdominis to pull apart and separate vertically down the middle. Pregnancy hormone relaxin also plays a role in the process by relaxing the connective tissue throughout the body to accommodate your growing baby. 

 Although not physically dangerous, many women are uncomfortable with the bulge that is left and it may seriously affect a mothers confidence in her appearance. In more severe cases the condition can cause significant back pain and make it hard to lift heavy objects because the integrity of the core is compromised. Occasionally, a portion of the intestines can bulge through the space between the muscles, which is called a hernia. 

Sometimes the tissue heals, and the muscles spontaneously come back together after delivery when hormones return to pre-pregnancy levels - But if this doesn't happen in three to six months, you can end up with a gap that won't close without treatment. Studies show that about 40 percent of women have a diastasis at six months postpartum. If left untreated this condition can go on to cause much discomfort for many years.

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Who is at Risk?

With any pregnancy you are at risk of developing a separation, however you present a higher risk of developing diastasis recti if …

  • You are carrying multiple babies.

  • You are over 35.

  • You perform abdominal exercises or physical activity with poor form whilst pregnant.

  • You put on more than the ‘recommended’ amount of weight during your pregnancy.

  • You are on child number two - and upwards. 

  • Your diet is generally poor and you are often dehydrated.

An example of a diastasis recti

* If you are currently pregnant and feel like you are developing a separation, then please do go and speak to your health care provider! They may be able to help or refer you to an expert*

Can I prevent it?

There is no guaranteed way of avoiding abdominal separation - In fact some degree of stretching of the linea alba is necessary and inevitable during your pregnancy. The good news is that ‘‘pregnancy per se cannot be a causative factor of permanent diastasis recti.’’ and there are things you can do to reduce your chances of the separation becoming too large and the connective tissue becoming too weak to heal efficiently and spontaneously postpartum.

First  STOP doing traditional crunches, sit ups, planks etc. These can make your condition worse and tend to make the rectus abdominis muscles tighter, pushing them further apart and stretching the connective tissue even more so that it grows thinner and weaker. Also it is very easy to perform these exercises with poor form -  In fact it’s virtually impossible to perform them with good form when you are pregnant, you are more likely to  push the belly out and create a coning effect, rather than pulling the navel in towards the spine. 

Then..Learn to find and stay in touch with your deep core muscles. I Know - sounds crazy right, you’re carrying around a bowling ball in your belly and here I am telling you to think about your deep core muscles - Well just hear me out.! Falling ‘out of touch’ with our core is a big factor in developing an abdominal separation, everything is so stretched out that we forget how to switch on the muscles we need to support everyday movement- or perhaps we never really knew in the first place. 

So where are these ‘deep core muscles’ ? Well, let's start at the very deepest level - The pelvic floor muscles are a collective group of muscles and connective tissue that sit in our pelvis. They are a powerhouse little group of muscles that often receive little attention, perhaps because of their intimate and (embarrassing for some) location and connotations. The truth is that without these little muscles we couldn’t go to the bathroom, enjoy sex, have babies or support our internal organs - so they are pretty darn critical! The pelvic floor muscles also form the root of what we like to call our ‘core’ - a weak pelvic floor will affect how the whole core functions. If we fail to engage our pelvic floor during exercises that involve our core - which is just about every exercise, then we are only creating more weakness in already weakened areas. To give you a visual analogy….

Think of a full toothpaste tube without the lid on - this represents our core with no pelvic floor engagement. When we move or exercise we create pressure change in our core  - if we squeeze the toothpaste tube - things start to get a bit messy!!!

But the issue doesn’t stop there - The transverse abdominals  (along with the multifidus that run up the length of the spine) are prime stabilisers of the core.  The transverse abdominals are the deepest layer of abdominals and provide great support for the core when activated correctly. When your trans abs are activated it feels like wearing a corset, they should fire just an instant before limb movement.  Failure to activate the transverse abdominals efficiently will result in poor body alignment and core function. It is precisely this poor alignment and function that can increase the chances of abdominal separation for pregnant women who are active.  Daily movement causes pressure change in the core but the pressure is not evenly contained or distributed if the trans abs are not being consciously activated.

Another visual analogy for you - Imagine a tyre with weak spots, you fill the tyre with air, the pressure increases, weak spots become weaker. If you drive on that tyre and subject it to more pressure change then you are likely to get a flat!

So how do I stay in touch with my core while I’m pregnant?

First, learn to identify and tone your pelvic floor. If you have never attempted to identify this muscle group before, then a little help goes a very long way. You could ask for help from a physiotherapist, a knowledgeable yoga or pilates teacher, your midwife or gynecologist. You could also use these excellent videos with Pelvic Floor Physical Therapist and author Michelle Kenway below. She explains how to identify the pelvic floor muscles and how to strengthen them in a series of 5 short videos.


It’s worth noting that a strong pelvic floor will aid you in the delivery of your baby and even speed the healing process postpartum, as healthy strong tissue will receive greater blood supply - BUT you must also learn fully relax and release these muscles for the final pushing phase. Visualisation techniques can help (thinking of the soft petals of a rose gently opening is one hypno birthing technique). When you practice your pelvic floor exercises concentrate just as much on the relaxing as the lifting!! 


Then, learn some abdominal breathing to keep the trans abs toned and strong…..The following method of abdominal breathing is known as ‘baby pumping’. It can be done daily for a few mins a time. This video explains that ‘baby pumping’ is a safe and effective way of working the abdominals during pregnancy.

My favourite way to practice..

  • Come to hands and knees (wrists directly under shoulders and knees directly under hips)

  • Inhale and relax and expand the diaphragm and abdominal muscles. Think of letting baby be really heavy and hanging down, loosen and relaxing all abdominal muscles but don’t arch the spine.

  • Exhale and contract the abdominal muscles squeezing them in and think of giving the baby a ‘hug’. The exhalation should be long and smoothe, continue to engage the abdominals and the pelvic floor throughout. Exhale through slightly open lips and visualize blowing out a candle with a steady breath.

  • This video shows me performing baby pumping at 39 weeks.

  • You can also do this exercise postnatal to begin to restore muscle tone and increase blood flow to the area.

So is there anything else I can do?

Yes, there is still lots more you can do!!

Stay Mindfully Active. Women who exercise regularly during pregnancy are statistically less likely to end up with a diastasis recti. In a systematic review ‘‘Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods’’ 2014
Three studies reported that antenatal exercise reduced the presence of diastasis of the rectus abdominis muscle by 35% compared with non-exercising control groups and two studies showed that antenatal exercise reduced the width of diastasis during the antenatal and postnatal periods. The improved blood flow to the area being part of the reason that the abdominal muscle tissue stays healthier.

Partaking in exercises like yoga done mindfully and slowly, can be especially helpful as it encourages you to draw attention to your body and really focus on which muscles you activate. A good teacher will be able to help you identify your pelvic floor and transverse abdominals. However many physically active women have still been known to end up with a separation - due to bad form when exercising and other contributing factors.

Pregnant lady wearing a belly support.

Pregnant lady wearing a belly support.

Wear a belly support. This helps to promote good posture and can prevent you from getting back aches. Wear it especially when doing anything physical as a gentle reminder to activate those trans abs, it also lifts your belly off of your bladder for instant relief. Be sure to buy a product specifically designed for pregnancy and allow it to train you to actively ‘hug’ baby in just a little when going about your daily routine. You could also speak to your physio about supporting your pregnant belly with kinesio tape. For more on this subject, click here for a great blog by Sia Cooper, a nurse and personal trainer made famous for having a 6 pack during pregnancy!



Improve your diet. A study published in 2018 found that ‘‘Low collagen type I and type III levels in the midline of the abdominal wall may play a key role in the development of diastasis recti.” It compared two groups of eighteen women, one group with diastasis recti and one group without - all the women had previously given birth. The results from analysis of tissue from their linea alba concluded that collagen was less abundant in women with diastasis recti than in those without the condition, and the difference was statistically significant. Collagen is a protein that forms connective tissue throughout your body, from your bones to your skin. It's the the glue that holds you together - it keeps our tissues and joints elastic and healthy. When your body makes collagen, it uses amino acids — nutrients you get from eating protein-rich foods, like beef, chicken, fish and eggs . The process also requires vitamin C, zinc and copper. You can get vitamin C by eating citrus fruits, red and green peppers, tomatoes, broccoli and greens. You can get the minerals by eating meats, shellfish, nuts, whole grains and beans.

Besides eating a varied and healthy diet to help boost you collagen levels, you could also add a super collagen boosting food like bone broth to your diet and/or speak to your healthcare provider about taking a collagen supplement.

* If you are currently pregnant and feel like you are developing a separation, then please do go and speak to your health care provider! They may be able to help or refer you to an expert*

In the next part of this blog we will look at ways of healing a diastasis recti postpartum. Remember, prevention begins with awareness - Pass on the knowledge, share with your pregnant friends and lets raise awareness of this condition.

Good luck on your journey Mommies!

References

Collagen I and III in women with diastasis recti (Pub Med 2018)

Rosa Maria Blotta,I,* Sirlei dos Santos Costa,I Eduardo Neubarth Trindade,I Luise Meurer,II andManoel Roberto Maciel-TrindadeIII

Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review (2014)

DR Benjamin, AT van de Water, and CL Peiris.

Blog by Sia Cooper

https://diaryofafitmommy.com/kinesio-taping-during-pregnancy-techniques-for-the-pregnant-belly/

‘The Best Way You Can Get More Collagen’ Cleveland Clinic