If you’ve had your baby and still look pregnant, the problem could be Diastasis Recti. Teixeira Murray finds out what you need to know about this condition from Jeremy Kern, private physiotherapist at Kern and Co, Flora Mayo Clinic, and biokineticist Che Bresler, owner of Pienaar and Bresler Biokineticist.

It’s been months since you gave birth. You’ve started eating healthily and even resolved to do some exercise. But you still have this weird pot belly that simply won’t go away. Your confidence has taken a serious dive, you still look pregnant and your middle feels like jelly.

Don’t despair – you may have a condition known as diastasis recti abdominis (DRA), and though it sounds very foreign, it’s actually more common than you think.

Simply put, DRA is a condition in which there is a separation between the abdominal muscles, specifically the vertical muscles that run down your middle.

Johannesburg physiotherapist Jeremy Kern explains that in most patients he has worked with, DRA presents as an abdominal protrusion, “So for many women, it may look like they are still pregnant, because there is this small wobbly pouch in their lower tummy area.”

What causes DRA?

There are varying degrees of DRA because the abdominal muscles stretch at varying degrees during pregnancy. Theoretically, the muscles that stretched during pregnancy should heal by themselves after delivery, but this is not always the case, and the result is a gap and/or protrusion on the abdomen that might be accompanied by back pain.

“In most cases, women resign themselves to the fact that it’s a by-product of being a child-bearer, and so never even realise they have this condition. Only when they experience severe pain, do they seek medical attention,” says Kern.

DRA is not limited to women and can affect men as well. However, it’s more common in pregnant women as the stretching of the abdominal muscles is required for the growth of the baby, so precautions in both exercise and daily movement must be taken during pregnancy, particularly in the third trimester.

Almost every pregnant woman will have some degree of DRA, as the muscles in the abdomen stretch, but if the muscles have been over-stretched they become weakened, and the result is an abdominal separation. You are more at risk of DRA if you have had multiple pregnancies in a short space of time, or have been pregnant with multiple babies.

Exercising safely

Exercise and healthy eating are essential during pregnancy, but it’s imperative that exercise during pregnancy is adapted to the many changes in the body, as incorrect exercises and bad posture can increase the risk of DRA.

Johannesburg biokineticist Che Bresler says she’s seen far too many women trying to maintain their pre-pregnancy bodies by doing exercises that put too much strain on their abdominal muscles. “If you are pregnant, make sure your pregnancy exercise routine focuses on overall strength and well-being and not trying to keep strong tummy muscles,” she says. “A good habit to practise is getting on to your side before getting out of the bed and avoid trying to rock yourself up using your abs.”

How do I know if I have DRA?

If you suspect that you might have DRA, you can test for it at home, but you must seek help from a professional to improve the condition.

Simply lie on your back, with both your knees bent. Then place your fingers above your belly button (horizontally) and do a small crunch by tilting your head forward only, and press down using your fingers. Feel how many fingers fit in between the abdominals. Normally the severity of DRA is gauged by how many fingers’ worth of separation there is. A gap of two or more fingers is usually a cause for concern. However these muscles can be strengthened through exercise and treatment by either a biokineticist or physiotherapist.

Bresler emphasises that women should take special precautions when starting any exercise routine during and after pregnancy. “Unfortunately many women believe that the condition can be healed by vigorous exercise and diet, but the wrong exercise could make the condition worse.

“We do not recommend any form of exercise that puts stress on your abdominal muscles, including conventional crunches and planks. A physiotherapist or biokineticist can teach you exercises that are safe.”

Treatment for DRA

Kern says DRA doesn’t usually hurt, but it can lead to painful issues, so most of the work he does is around the re-alignment of the patient’s lower back and or pelvis. “Most of the patients I treat have complained of lower back pain and pelvic instability related to the weakened abdominal muscles,” he says. “In some cases patients have developed a hernia that causes great pain and then medical attention is highly recommended. No two cases are the same, and there are many factors that determine how treatment will proceed. ”

If the separation or gap in the abdomen is very large and causes significant pain, or extends beyond the rectus abdominus muscle, through the obliques and transverse abdominus, you could require surgical intervention as you could also have an umbilical or ventral hernia, with associated risks that can only be corrected surgically. In that case a plastic surgeon will sew the abdominals closer together. But surgery is only recommended if you are not planning any more pregnancies.

“If you do choose surgery, or it is necessary, it doesn’t mean your abdominals will be strong immediately after that. You still need to learn how to activate those muscles again and how to work them in function. You will still need rehabilitation for these muscles,” says Kern.

DRA is a serious condition, but can be effectively treated once diagnosed. The key is to seek medical advice and work with a physiotherapist or biokineticist to ensure safe and effective healing.

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