09 Sep Diastasis Recti and The Pelvic Floor Connection
There is a lot of talk about ‘mummy tummy’ lately. What to do about diastasis recti, why it happens, and why healing it matters. For many it doesn’t matter to them why it happens, or even why it needs to be healed – they just want it gone! Well girls – it is important to know why it happens and why healing it matters and knowing this information will actually help you get rid of it too!
Mummy Tummy is a name used to describe a medical condition known as diastasis rectus abdominus (DRA) which means separation of the rectus muscles from the midline. In layman’s terms, it means that there is a gap between your two 6-pack muscles and the connective tissue has weakened.
Why diastasis recti happens?
Diastasis recti happens for many reasons, one of them being pregnancy and birth. The forward pressure on the abdomen contributes to increased and continuous stretch and pressure on the connective tissue that can cause the rectus muscles to lose their ‘alignment’. There are also postural and hormonal changes that occur in pregnancy that may contribute to the gap as well.
Why healing diastasis recti matters?
Women don’t like the gap or the ‘pooch’ that remains after pregnancy and they will try all sorts of diets, exercise programs and products in an attempt to get rid of it. These tactics are used to address the cosmetic side which is the main motivator but it is important to know that diastasis recti is about MORE than aesthetics.
The two 6-pack muscles (the recti) attach from the sternum to the pubic symphysis (pubic bone). Because of their attachment points on the pelvis, a gap in between them and weakness in the connective tissue, directly affects the pelvis and pelvic floor. In fact 52% of women with pelvic floor dysfunction have diastasis recti.
Research tell us that 100% of pregnant women will get DRA in their third trimester as measured by an enlarged inter recti distance (Mota et al 2014). Research also shows that some women also stretch through the abdominal muscles (Brauman 2008) and we know that muscles that are lengthened beyond optimal loose contractile strength as seen on the length tension curve as their maximum force generated decreases (Gordon 1966). So it stands to reason that many women trying to get rid of their mummy tummy need to pay attention to their pelvis as well.
In the pelvis, the shape of the bones provides what is called ‘form closure’ while the surrounding muscles, ligaments and connective tissue contribute to what is called ‘force closure’.
During pregnancy biomechanical changes occur which can reduce the effectiveness of both form and force closure such as;
- Altered alignment and load bearing
- Altered muscle length in the pelvic floor and abdomen (both longer and shorter) which results in reduced ability for muscle force production
- Diastasis recti – a distortion in the abdominal wall that impairs function of the muscles including their role in pelvic stability
- The abdominal muscles are stretched to allow space for the enlarging uterus which can lead to loss of muscle tone and strength in the abdominal region and a compromised ability to produce tension in the thoracolumbar fascia, resulting in reduced force closure in the pelvis
- Changes to muscular co-ordination (reduced)
- Hormones – The role of relaxin and progesterone is to increase the extensibility of the ligaments and smooth muscle to allow the pelvis to expand more readily for the delivery of the baby – when the ligaments are lax it affects the force closure
Healing a diastasis recti is important because if left untreated it can contribute to back pain, constipation and as we have said, pelvic floor dysfunction. The good news is that it is never too late to work on healing your DRA or improving the function but the sooner you address it, the better the outcome.
After giving birth body with diastasis recti. Photography by Jade Beall http://www.abeautifulbodyproject.org/
How to heal diastasis recti?
Spontaneus healing of diastasis recti only occurs in the first 8 weeks post partum, beyond that intervention is needed (Coldron et al 2008). Intervention in the form of posture and alignment work, breath work and exercises such as those found in the Bwom app are what is needed to heal a DRA and the corresponding pelvic floor dysfunction.
Using an abdominal wrap in the first 8 weeks postpartum is a great way to support the abdomen and pelvis and it helps provide temporary form closure while restorative exercise helps rebuild the ability of the muscles and tissues to provide force closure.
For those who are past the 8 weeks postpartum timeframe, wrapping may still be helpful for some but not all. It is best to have your abdomen and pelvic floor assessed by a women’s health physiotherapist who specializes in the pelvis and pelvic floor.
While they are often considered independently, the abdomen and pelvic floor are intimately connected and they deserve more attention than they get. Book an appointment with a pelvic health physiotherapist today.
About Kim Vopni
The Fitness Doula. Author of Prepare To Push™ – What Your Pelvic Floor and Abdomen Want You To Know About Pregnancy And Birth, Owner of Pelvienne Wellness Inc, and Co-Founder of Bellies Inc.
Kim is a mom of 2 boys and is a Certified fitness professional who also trained as a doula. She combines the support aspect of a doula with the principles of fitness to help her pregnant clients ‘Prepare To Push’ while postpartum she helps her clients optimize healing and regain their core confidence for motherhood. In 2009 she created a women’s health event called Kegels and Cocktails designed to empower and educate women on the importance of pelvic health.