Recently, there's been a lot of media focus on ab separation (also known as Diastasis of Rectus Abdominus/DRAMs), following the announcement last year that surgery for ab separation would become Medicare subsidised. So what is ab separation, and should you be worried if you have one?
What is ab separation?
During pregnancy the tendon that holds the 2 columns of our “six-pack” together stretches and thins, resulting in a ridge or bulge down the middle of the tummy. The separation is the result of both the stretch and the hormonal affects to the muscles and tendons that accommodate the size of the growing baby. During pregnancy this is a good thing, as it protects your muscles from tearing as your tummy grows. Recent studies have shown that in the third trimester 98-100% of mums have a seaparation!
Following birth, the separation can still be felt/seen in about 60% of mums, and for many it can stay for several months. It can be made more pronounced due to:
larger baby bump during pregnancy
hypermobility (high flexibility of joints/tendons/muscles)
weakness of the abs and pelvic floor
overloading your abs after during and after pregnancy
Your physiotherapist will measure the width and depth of your separation, and if it is wider than 2 finger widths and quite deep, it can affect how your abdominal and pelvic floor muscles function to support your pelvis and spine. Many mums we see with a separation say they feel like their abs are weaker. Occasionally, a large separation may also be linked with an abdominal hernia, but a separation on its own is not a hernia. Sometimes this resolves on its own after delivery (given time) and sometimes this remains. Over the years, seaparation has been blamed for incontinence, prolapse and back pain, although recent research has shown that you are not more likely to experience lower back pain if you have one.
What can I do about it?
Support your tummy from the outside:
Support and compression garments (such as SRC, 2XU or Solidea recovery shorts, or firm “shapewear”) can provide support to your lower back, pelvis, pelvic floor and tummy
For smaller DRAM, Tubigrip can provide good support
You should start wearing your support garment as soon as it is comfortable to after the birth
Wear your support garment during the day, especially when you are most active, and take it off to sleep
Minimise excessive strain to your tummy muscles:
Avoid situps, planks and “bicycle crunches” – unless prescribed and taught by your physiotherapist
Practice good lifting technique and keep weights low
Keep good bladder and bowel habits, such as minimising straining to poo
Seek treatment for constipation if this is an issue for you - straining with constipation can put more stress on your tummy muscles and your pelvic floor!
Get out of bed from your side
Strengthen your tummy muscles and pelvic floor gently and gradually:
Activate your pelvic floor and deep tummy muscles before you lift/cough/sneeze
Your physiotherapist will assess, and teach you how to activate your pelvic floor and deep tummy muscles
Participating in regular low or moderate intensity exercise for these muscles is essential for their recovery - this can include clinical pilates, gentle bodyweight training, physio home exercise programs or yoga-based exercise
Deep breathing:
When the abdominal muscles are stretched or weak after pregnancy, a lot of women hold their breath during lifting, sit to stand and getting out of bed, which can increase the load on our tummy muscles
Diaphragmatic breathing (“belly breathing”) exercises can help to encourage correct muscle use
Learning to maintain normal breathing during exercises can reduce the load on the tummy muscles
The take-home:
Ab separation is very common after pregnancy. Your physiotherapist can advise you on support wear, teach you how to correctly strengthen your muscles and show you different day-to-day strategies which can assist with recorvering with your seaparation. Even if the seapration does not completely reduce, rehabilitation can help you to lower your risk of problems from it.
In rare cases, some women do go on to have surgery for their separation, especially if they continue to have difficulties after doing rehabilitation. All of the exercises and strategies will still help to prepare for and recovery from surgery, and your physio can help you to return to exercise and activity again post surgery.
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