Why do I still look pregnant? All you need to know about abdominal separation

by | May 21, 2020

If it’s been months since you gave birth, yet you still have a bit of a pooch and it’s not going away with a good diet and decent core exercises. Teixeira Murray discusses the common affliction of diastasis recti abdominis and provides some pointers on what to do about it.

Motherhood is one interesting journey and if weird pregnancy cravings and weight gain, perineal tearing and dealing with engorged breasts aren’t enough, there is also a very naughty condition known as diastasis recti abdominis that can prove to be another proverbial thorn in the side.

What is diastasis recti?
During pregnancy our bodies are constantly changing and, as you know, hormones govern most of these changes. Hormones are also responsible for the growth of the uterus and the relaxing of the connective tissue between our abdominal muscles. Two large parallel bands of muscle – known as the rectus abdominis muscle – that meet in the middle of the abdomen are slowly separated by the growing uterus. If this separation is too wide and the muscles too weak to retract after birth, you may be left with a very wide gap and this is when you have diastasis recti.

When you first notice diastasis recti?
Most of the time you may not notice the ‘bulge’ until only after having given birth and you have lost most of the baby weight. It is then that you may question the wobbly protruding belly that remains in spite of tummy binding, exercises and even a good healthy diet. You may also find that you have lower back pain and pelvic discomfort months after having given birth naturally or via caesarean.

According to the Mayo Clinic, about 98% of mothers have had a form of diastasis recti after delivery, as the uterus has grown and the abdominal muscles have stretched. It becomes a problem when the separation is greater than 2.7cm between the two sides of the rectus abdominis muscle.

Who gets diastasis recti?
Women most prone to diastasis recti are those who have a small frame; are older than 35; those who carry multiple babies at a time; who have had multiple pregnancies; have weak muscle tone and pelvic discomfort.

It must be noted that diastasis is certainly more common in post-pregnancy, but it is not only caused by pregnancy in itself. Diastasis recti is directly due to internal abdominal pressure, which is only increased by pregnancy. As such it can occur in children and men as well, especially after surgery or injuries.

First test yourself
If you think you may have diastasis recti, you don’t have to see the doctor immediately, but can confirm your suspicions with a home test. Lie down on your back on the floor, bend your knees and ensure your feet are flat on the floor. Place one hand on your belly with your fingers just above your navel. Gently press your fingers down towards your spine, raise your head and neck, but keep your shoulders on the floor. As you press down, you should feel where the parallel abdominis muscles are and how far apart they are separated. The gap between the two bands is commonly measured by the number of finger widths – two, three or even four fingers. Anything wider than two fingers is a significant gap, which will then require a professional consultation with a biokineticist or a physiotherapist.

Trying to improve diastasis recti
As more and more women are becoming more conscious of healthy living and exercise even during pregnancy, it’s unfortunate that most women and their trainers can mistakenly make a diastasis worse by the exercises that they do while pregnant. Any form of exercise that puts stress on your abdominal muscles is off the cards.

The top five exercises to avoid are:

  1. All kinds of planks, irrespective of the variations, as they put increased pressure on your core.
  2. Crunches can actually make your diastasis recti larger, so they should be avoided.
  3. Push-ups also put great stress on the abdomen.
  4. All kinds of twists in all trimesters.
  5. Avoid all quadruped positions: being on your hands and knees pulls all your weight down onto the already thinned connective tissue.

Alternatively you should consult a personal trainer who understands your concerns of diastasis recti and how to prevent it.

What exercises should you do?
Once you have given birth and you are ready to work on healing diastasis recti, you should allow for 10 – 30 minutes of daily exercises that won’t stress the abdominal muscles, but will slowly strengthen them over time. These include exercises from the Mutu System (mutusystem.au) developed by mom and trainer Wendy Powell. These exercises include:

  1. Abdominal drawing, where you pull your stomach in as if you are trying to fit into tight jeans. Hold it and breathe normally for 10 seconds and repeat.
  2. Belly breathing is when you lie flat on your back and you take deep inhalations allowing your belly and chest to fully inflate. Then, slowly and forcefully exhale, drawing your abdominal wall in as if you had a corset on.
  3. Heel slides with alternating arms. Lie flat on your back on a mat with your knees bent and feet flat on the floor. Straighten your arms and raise them directly over your shoulders. Exhale and slowly extend one leg out in front of you, letting it hover a few inches above the floor. Simultaneously extend the opposite arm back above the head, just off of the floor. Inhale and slowly return to start. Repeat on the opposite side. Work to keep your hips and core stable through these movements.
  4. Quadruped abdominal allows you to strengthen your core post-delivery. Get on all your hands and knees[WU2] and pull your shoulders wide and away from your ears to a form a flat back. Take a slow, deep inhalation and allow your abdominal wall to relax and expand toward the floor. Then exhale and drawing the core muscles upwards.

Always practise caution and ensure that you seek medical attention should you experience pain or unusual core weakness. In severe cases a diastasis may have to be corrected through surgery, but this will only be recommended once a woman no longer wishes to have more children.

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