Early Abdominal Separation Management

A Rectus Diastasis (abdominal separation) has not had a lot of attention in the past and as such there is not a lot of scientific evidence out there. Over the years however, we have realised (thankfully!) that an abdominal separation can have a significant impact on how well a women’s core muscles work, and of course poor core stability can leave you prone to injury in many different parts of the body, especially the lower back and pelvis.

What is a Rectus Diastasis?

It is a problem with a piece of connective tissue called the linea alba. This linea alba runs from where your ribs meet just below your sternum, all the way to your pubic bone.  There are 4 layers of abdominal wall muscles, 4 on the right and 4 on the left. All 4 muscles on each side converge in to attach to the linea alba in the center.

Muscles only work well if what they connect to is solid.  If you have an abdominal separation, then this linea alba has been stretched.  As something is stretched it thins out.  This is why a separation feels like a ‘gap’ between your abdominal muscles in the center. The problem is, this thin, stretched bit of connective tissue is not solid like it used to be.  It moves now like a rubber band.  Now this is a major problem for the abdominal muscles since as suggested above they need a solid anchor for their attachment site.  If they do not have this then they do not do their job well, which is to stabilise the lower back and pelvis in order to prevent injuries and pain.

When should your abdominal wall be assessed?

Sooner than you think!  Although the answer to this question is not backed by scientific evidence, we feel we have enough anecdotal experience to suggest that the best outcomes are obtained if we assess women throughout their pregnancy.  If we do this and put measures in place to manage a diastasis, then we can often (although not always) ensure the problem is resolved early in the post-natal period.

How do I avoid a Rectus Diastasis?

There are a few easy steps to take to try and avoid a rectus diastasis. Learn to move with minimal abdominal wall involvement. For example, when on your back roll on to your side, the push yourself up with your arms, rather than sitting up through a normal “sit up” movement pattern.

Learn to let your abdominal wall go. Your uterus is going to expand anyway, so the last thing you need is an abdominal wall that is tight and high in tone.  If the muscles don’t allow space for your uterus to expand, the linea alba will stretch and in some cases tear.

Do not do high intense abdominal exercises in pregnancy, we cannot stress this point enough. It makes no sense to try and “work” and therefore shorten a muscle that needs to be lengthened.  There is plenty of time to rehabilitate the abdominal wall post baby. Plus, abdominal exercises also create a lot of intra-abdominal pressure and this places undue strain on your pelvic floor and pelvic organs.

Get your core muscles assessed by a Physiotherapist under real time ultrasound and ensure they are working optimally. If not, there are lots of great exercises you can do in your pregnancy.

What do I do if I have an Abdominal Separation?

See your Physiotherapists ASAP. Again, research is scarce, but we think based on tissue healing theories and what we see clinically, that we have a 12-week window post Nataly, whereby if we treat the rectus diastasis well we can improve the integrity of the lines alba (i.e. help fix the rectus diastasis. You may be given a tubigrip, this is a compression stocking big enough to go around your abdominal wall. You will be prescribed very specific rehabilitation exercises. In addition, you will be shown which movements and exercises to avoid.

If you are reading this beyond 12 weeks post natal, and you have a rectus diastasis, don’t worry we can still do our best to help, the sooner you address the issue the better!