Every mom experiences some level of widening abdominal muscles during pregnancy due to a growing baby. This is also known as diastasis recti. But not every mom regains muscle tone and strength. Find out what you need to know to love your body, strengthen your core and regain function. This is self-care in real life…
Pregnancy is beautiful and amazing. The ability to create, nourish and carry a baby is an unforgettable experience. But, it is not easy. And often prenatal care is given more attention than postnatal care, a time when a lot of moms struggle along with little sleep, hormones in flux, and the unexpected side effects of carrying and delivering a baby. (You can read about my personal challenges with varicose veins in my 2-part series- here and here.)
Let’s be real, pregnancy changes the body in many ways that affects mom’s body confidence and her long-term health. ‘Belly pooch’ is one common change that mom notices after pregnancy but not only can this affect her confidence but it may be a sign of an underlying condition that needs to be addressed- diastasis recti.
Whether you are expecting, have recently had a baby or gave birth many years ago, there are things you can be doing right now to support your core muscles, the ones that get stretched from a growing baby. Dr. Ashlee De Nooy is a Women’s Health Physical Therapist who works with moms before and after pregnancy so that each woman can enjoy the active lifestyle and body confidence she desires.
If you have been curious about diastasis recti or simply don’t know if your activity and wellness routine is beneficial for restoring core function or body confidence, my interview with Dr. Ashlee will not only answer your questions but give you some practical actions you can take today to support your body.
What is diastasis rectus abdominis?
DRA is a widening of the distance between the rectus abdominis muscles, or your “six pack abs”, caused by stretching of the linea alba, or the tissue that connects those muscles together.
Do ALL moms have diastasis recti? How do you find out?
All moms have this during pregnancy as it allows for your belly to grow. Some signs to look out for are if you’re seeing any doming at, above, or below your belly button when you sit up or roll out of bed, or if you still look like you’re pregnant long after having a baby.
What if mom gave birth many years ago? Can she still address this issue?
Absolutely. Training your breathwork, as well as learning how to engage the core/pelvic floor muscles will make a significant difference.
What is the connection between diastasis recti and still looking like you’re pregnant?
- The issue with DRA is that the linea alba is that not able to generate enough tension due to weak core and pelvic floor muscles, therefore allowing the rectus abdominis muscles to remain separated giving mom her “belly pooch”.
- Sitting or standing with poor posture is a significant factor as well.
Are there any myths about diastasis recti and healing your core?
Many moms don’t know that they have a DRA or that it is even a thing. I think that’s because they either don’t have it because their abdomens have healed, or they they just aren’t aware of it. It’s true that all moms have some sort of separation, however your body is still healing up to one year after birth.
This doesn’t mean that you should just wait and see if it will go away. If your core and pelvic floor are weak it can lead to other issues such as incontinence (loss of bladder control), pelvic organ prolapse (when pelvic organs have dropped out of place), and back pain.
Are there any differences healing and core restoration among moms who have had a cesarean and moms who have delivered vaginally?
Yes. There are several factors with the caesarean – was mom in labor or pushing prior to? Was it scheduled? What type of incision did she have? For the vaginal delivery – how long was labor and second stage of labor? Was there any tearing? An episiotomy? These will all be taken into account during an initial assessment and creating a specific plan of care for my patients.
What are the potential consequences of not addressing diastasis recti? Are there any long-term complications or challenges that can arise?
Weak core and pelvic floor muscles can lead to low back or pelvic girdle pain, pelvic organ prolapse, and incontinence. Another one is mom looking like she is still pregnant even though she is several months or even years postpartum. Some moms may already be experiencing some of these symptoms and not even realize it’s because they have a DRA.
We know that exercise has a wealth of benefits- mentally, hormonally, and physically. Are there any exercises that are harmful or not helpful for moms with diastasis recti?
Definitely. If moms are noticing any bulging or doming above, at, or below the abdomen, this is an exercise they should not be doing or need to modify. Typically a curl up, plank, getting in/out of bed causes this intra-abdominal pressure.
Learning how to breath and engage those muscles will prevent you from having this pressure. It’s difficult to say not to do a certain exercise because there are moms that have a DRA and know how to create tension along their linea alba and can do a plank without any issues.
What are some safe and effective exercises for moms wanting to feel great and help their bodies heal after childbirth?
- Diaphragmatic Breathing – Laying on your back or side with your knees bent, inhale through your nose to expand your abdomen. Do not allow your chest to move much. Exhale through your mouth and allow your abdomen to lower.
- Pelvic Floor Contractions – Perform a gentle contraction (as if you’re preventing yourself from passing gas and stopping the flow of urine) while you exhale.
- Clamshells – Lay on your side with your knees bent. Keeping your heels together, lift your knee up to the ceiling and back down. Do not rotate your back while performing this activity.
What expectations can mom have to ‘close the gap’? How long does this usually take and can the gap ever be fully closed?
- This is really determined on an individual basis. The rectus abdominis is connected by the linea alba, so essentially the gap won’t be completely closed. So it really depends what that distance was to begin with and to what extent it was stretched out during pregnancy, and how the body regenerates the tension of the linea alba.
- Another factor depends on is if mom is breastfeeding. This can make a difference in the laxity of the fascia.
- Lastly it depends how diligent mom is with her exercises. If you have a mom working on her exercises diligently she could notice significant changes in 6-8 weeks. It really depends on how much time puts into it in between sessions and how her body responds.
What if mom wants to get pregnant again? What should she know going into her next pregnancy? Is there anything she can do to minimize the widening of the gap during pregnancy?
One thing mom can do is tape her belly or wear a belly band to support her growing belly. There are several well made products out there. There are a few different ways to tape the belly depending on what she’s having issues with. One way is a crisscross pattern. Seeing a women’s health physical therapist will be beneficial in knowing which way will be most appropriate.
Learning how to stand and sit with good posture, so mom isn’t putting too much stress on her abdominal muscles, is also important.
Avoid sitting straight up from a lying down position. This will help to minimize the stress placed on the abdominal muscles. Instead, do a log roll keeping your whole body as a unit to get out of bed.
How does posture sitting and standing affect diastasis recti?
When you’re standing with poor posture – bum tucked under, head and shoulders forward – this allows your rectus abdominal muscles to widen. Think of your abdominal muscles as a zipper. If you are standing with your muscles open (zipper open), it makes things look pooched. When you stand with upright posture, untucking your bottom, shoulder blades pulled back and down, and rib cage over your pelvis, this “closes the zipper”.
What are 3 things mom begin doing right now to take action?
- Avoid activities that are causing your belly to dome along your midline.
- Ex: Roll out of bed vs sitting straight up
- Wear a belly band for support when pregnant or for 6-8 weeks postpartum. If you choose to bind or wear a belly band after pregnancy, this should be for comfort/support only.
- Working on diaphragmatic breathing (See above)
How would you encourage a mom who has just had a baby and is frustrated with her body shape?
I want moms to love and accept their bodies. This can be difficult for moms postpartum, or even during pregnancy, because your body has gone through several changes, not just physically. One thing that I tell moms is that their baby/babies were in their body for several months, so it will take several months for their body to heal. Nourishing their body by eating well, hydrating, exercising, and grace along the way, will make all the difference.
When should a mom reach out for support and therapy to heal her core? Where should she look to find someone who specializes in this? What about online programs vs physical therapist?
Pregnancy: If mom is experiencing any pain, having difficulty with any activities, or leaking, she should make an appointment with a women’s health PT. Addressing this issue during pregnancy will improve her postpartum healing.
Postpartum: New moms should have physical therapy following delivery to address posture, movement, activities such as using the toilet, getting in/out of bed, lifting/carrying their child, pelvic floor and core, to help them return to their optimal function. There are other countries that provide their moms with this care because they know they will be helping moms get better quicker and prevent other issues such as DRA, incontinence, low back pain, and pelvic organ prolapse.
You may look online, and even use social media for a recommended Women’s Health PT.
Dr. Ashlee is a Doctor of Physical Therapy and owner of Body Works Physical Therapy, LLC. She is happily married with three children and has been practicing for almost 8 years as a physical therapist. Her passion for women’s health began after having her first son and realizing there was a huge need for physical therapy in pregnancy and postpartum in terms of education and treatment. Dr. Ashlee is located in Greenville, SC. Her passion is helping active moms move and feel their best while doing the activities they love!