Women's Health

Abdominal separation: The ins and outs of treating this common condition

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Diastasis recti — commonly known as abdominal separation — affects most women during pregnancy.

However, despite affecting up to 100 per cent of women during their third trimester, abdominal muscles separation can cause more issues for some than others for differing periods of time.

Here, we break down the details of this condition to help aid your understanding and assist in your postpartum recovery.

What is abdominal separation?

Abdominal separation — officially termed diastasis recti or diastasis rectus abdominis (DRA) — can affect anyone but is particularly common among pregnant women.

To start with a brief anatomy lesson, the rectus abdominis — or abs — are technically one muscle with two sides, joined by a connective tissue at the midline. This connective midpoint is called the linea alba.

Abdominal separation occurs when stress is placed on this connective tissue (as it is during pregnancy), and a significant weakening of the linea alba can cause ongoing problems for an individual if untreated.

While there remains no consistent definition of diastasis recti, most medical literature defines it as a gap of at least two centimetres or two finger-widths between the two sides of the abs at any point along the linea alba.

Causes of abdominal separation

Abdominal separation can occur in all types of people, including infants and men, but pregnant women are the most affected group.

Pregnancy is a key cause due to the stretching of the abdominal wall to accommodate a growing foetus, but there are no hard-and-fast rules as to who exactly will be affected and to what degree.

Having said that, one may be more likely affected if they:

  • Have had more than one baby
  • Are expecting multiple births (twins, triplets etc.)
  • Are carrying a larger-than-average baby
  • Already have weakened abdominals
  • Experience polyhydramnios (excess amniotic fluid).

It should also be noted that the stretching and separation of the rectus abdominis during pregnancy is completely normal. It's your body's natural response — a protective measure to avoid tearing.

However, this can also weaken the tissue and problems may arise if your abs remain significantly separated after the birth.

Abdominal separation in pregnancy

During pregnancy, the growing uterus places increased pressure on the abdominal wall, causing it to stretch and expand.

Abdominal separation normally begins during the second trimester of pregnancy and affects as many as 66 to 100 per cent of women during their third trimester.

It can also affect up to 53 per cent of women postpartum due to the stress of delivery.

The Australian Society of Plastic Surgeons estimates 3500 Australian women suffer moderate to severe diastasis recti and back pain each year.

Symptoms of abdominal separation

Abdominal muscle separation has various symptoms and side effects. However, it's most easily identified through visual appearance.

Visual clues of diastasis recti can include a depression or indent between the two ab muscle panels. You may also see a protrusion or 'doming' of the area.

Another symptom has been described as a belly "pooch" — a bulge of excess skin or fat gathered around your lower abdomen.

The main role of your abs is to aid in the stability and movement of your body. It is a key part of your 'core' mechanism.

Therefore, any area of your physical function that requires a strong core (hint: There are a lot of them) can be affected. Common symptoms include:

  • Lower back pain
  • Hip pain
  • Pelvic pain
  • Weak-feeling abdominals or core muscles
  • Weak pelvic floor
  • Incontinence or constipation, and/or
  • Poor posture.

Is abdominal separation painful?

The separation of abdominal muscles is unlikely to be painful in itself but it can lead to pain in other areas of the body (particularly the back, hips or pelvis) and can also be related to other issues that cause pain.

A lot of women report pain, typically in their lumbopelvic region. However, this can be true of many people postpartum, regardless of whether or not they experience DRA.

How is abdominal separation diagnosed?

If you believe you are experiencing difficulties related to rectus abdominis diastasis, visit your doctor who can typically confirm through a basic physical assessment.

They may be able to tell just by looking at the area or they may ask you to do a simple ab crunch exercise.

In some cases, they may order an ultrasound or CT scan.

Abdominal separation after a C-section

During a caesarean or C-section surgery, doctors may separate your stomach muscles to gain access to your uterus. Some reports have linked caesareans with a greater risk of DRA after birth.

C-sections may require a bit more patience when it comes to healing time. Extra care should be taken before diving back into exercise, for instance.

Many folks who have had C-sections — whether or not they also have DRA — have found using a belly band to be a valuable aid in the process.

The Belly Band by Kin is incredibly helpful in the postpartum period and can help you regain strength in the core and improve your posture.

The Belly Band is a second pair of hands holding you in to support loose tummy muscles while you regain strength in your core.

How to prevent abdominal separation

One way to prevent the separation of the abdominal muscles is through exercise and strengthening before and during pregnancy.

A strong core and pelvic floor muscles are thought to help prevent the severity of abdominal muscle separation.

One study found that exercise during the antenatal period reduced the presence of diastasis of the rectus abdominis by 35 per cent. It also found the width of the separation may be reduced by exercise during both pre-and postnatal periods.

Abdominal separation exercises

Both prevention and treatment of diastasis recti are focused on core strengthening.

Whether you're pregnant or not, learning to engage your core — not only during exercise but during everyday life — is an invaluable habit.

This can mean monitoring your posture when sitting and standing and engaging your abdominal muscles to practice correct, supportive posture. This is most easily done by lifting and sucking in your stomach, drawing your belly button towards your spine.

During pregnancy, it is always best to seek out professional guidance, assistance and advice to ensure any exercise taken is done safely and correctly.

Following pregnancy, pelvic floor contractions are considered highly effective for a speedy return to normal, and can typically be done even during the first six weeks after birth.

Other gentle core exercises can also be beneficial. Examples of this include:

  • Pelvic/glute bridges
  • Pelvic floor contractions
  • Side-lying clam exercises
  • Sitting on an exercise ball to engage your core and assist with good posture
  • Four-point kneel arm and leg extensions
  • Breathing exercises (practice breathing into your diaphragm)

If you're looking for further ideas for postpartum exercise, consult our comprehensive exercise guide.

Before undertaking any exercise during or after pregnancy, we always recommend consulting a GP, physiotherapist or pre-and postnatal exercise specialist to ensure you've got the right exercises in your bank and — more importantly — that you're doing them correctly.

Exercises to avoid

It's best to avoid exercises that shorten and put undue stress on the abdominal wall, such as sit-ups and crunches when experiencing DRA.

These exercises can actually make abdominal separation worse and set back postnatal treatment, especially if done incorrectly.

Remember that pregnancy shifts your centre of gravity and coupled with hormonal changes, like a rise in relaxin, can loosen ligaments. Pregnancy also affects your blood pressure and heart rate.

Therefore, it's important to accept that not all exercises are recommended during and after pregnancy and it's wise to consult professionals at various points in your pre-and postnatal journey.

How to repair abdominal separation

Exercise for abdominal separation

Exercise has been proven to reduce the width of DRA, can help to tighten your abdominal muscles and improve side effects of diastasis, such as improved pelvic floor function and posture.

Consult a physiotherapist for a personalised plan.

Binding for abdominal separation

The binding of the abdomen can help relieve pain, alleviate symptoms and improve your quality of life when experiencing abdominal separation, especially after caesarean surgery.

Kin's Belly Band is one such tool to assist those who have recently given birth, whether or not they suffer from abdominal separation.

Binding helps support your posture, draw your abs back together and help you feel more stable. The Belly Band can also go some way to reduce the width of your abdominal separation!

A combination of binding while doing safe exercise was found to be quite beneficial for treating abdominal separation.

The Belly Band is a must-have for mums to get around comfortably after giving birth.

Surgery for abdominal separation

Diastasis rectus surgery is also an option for more serious cases. Abdominoplasty — the repair of the abdominal muscles — surgeries are typically completed by plastic surgeons.

Those who elect for an abdominoplasty can also elect for a tummy tuck to remove any excess skin and assist with any cosmetic concerns an individual has following DRA.

Abdominoplasty is known to improve symptoms like lower back pain and urinary incontinence.

Can abdominal separation disappear by itself?

The good news is that, depending on the severity, abdominal separation can heal itself with time.

While for some, the abs will 'bounce back' fairly quickly, others can take years, and some may never fully return to prenatal levels.

Having said that, many people who have recently given birth could be feeling back to normal within eight weeks.

How long does it take to fix abdominal separation?

There is no conclusive research on how long it takes to fix abdominal separation. Healing times will vary depending on severity, treatment plans, individual physiology and lifestyle choices.

While some recover within eight weeks, other studies and personal anecdotes suggest the issue can persist for years postpartum.

One British study of first-time pregnant women found 45.4 per cent still experienced DRA at six months postpartum, and 32.6 per cent at 12 months postpartum.

Unfortunately, like many women's health issues, abdominal separation remains relatively under-researched and potentially under-reported.

Fortunately, there are many options to easily and affordably treat DRA, alleviate symptoms, re-strengthen your core, and improve your quality of life.

References

Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial, Journal of Musculoskeletal and Neuronal Interactions

Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain, British Journal of Sports Medicine

The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study, BMC Women's Health

Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review, Physiotherapy Journal

Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial, Physical Therapy - Journal of the American Physical Therapy Association

Abdominoplasty Improves Low Back Pain and Urinary Incontinence, Plastic and Reconstructive Surgery - Journal of the American Society of Plastic Surgeons

Randomized controlled trial of abdominal binders for postoperative pain, distress, and blood loss after cesarean delivery, International Journal of Gynaecology & Obstetrics

Abdominal Muscles Separation Factsheet, The Royal Women's Hospital Victoria