The Tummy Muscle Challenge

(Rectus Abdominus Diastasis)

 

During pregnancy the abdominal muscles stretch and lengthen.  By the end of pregnancy the two Recti (vertical) abdominal muscles can stretch apart and the fascia between can become thin. This may be anything from 2-3 cms wide and 12-15 cms long to a space measuring 12-20 cms in width and extending nearly the whole length of the muscles.(see picture) The technical term is “diastasis”

 

The risk of developing a severe diastasis increases for women who have had twins or triplets, those who carried large babies and women who have had previous pregnancies quite close together. Another risk factor is if you have very flexible joints.

 

A severe diastasis can weaken the entire abdominal “corset”.  This lack of support, (added to the softening of ligaments from pregnancy hormones) further increases the risk of back/pelvic problems before/after birth and may cause problems in subsequent pregnancies. There is also a risk of an abdominal hernia if the diastasis remains over long period of time and the fascia tears.

 

Advice during pregnancy:

 

NO HEAVY LIFTING OR STRAINING DURING PREGNANCY AND UNTIL THE GAP HAS REDUCED TO 2cm AFTER BIRTH.

 

It is very important to take extra care of your back when your abdominal support is reduced in this way. Try to work at a ‘stand-straight’ height and ensure that your low back is well supported when sitting (try using a rolled towel in the small of your back).

 

Always bend your knees and roll when getting into or out of bed.

 

You will need to wear an abdominal binder or tubigrip for support during the day. This will help to protect your back, support your uterus and keep baby in a good position. It will also prevent further strain to your abdominal muscles as the pregnancy progresses.  

There are some great support underwear garments available at reasonable cost:

Try "Hold Me Tight" available at The Warehouse or www.holdmetight.com.au

or "Seamless longline shaper" at K mart

or the sports wear "Skins" are really great (but the cost is a bit more)

 

 

Advice for postnatal care:

You will need to wear firm underwear or similar garment that covers the length of your tummy from under ribs to top of thighs until the diastasis has zipped up to 2 centimetres or less. This can take four to six weeks. Tubigrip can help but it often rolls up around your waist so I suggest you look at the options below. Buy a size larger than you usually wear.

Some ideas: bike shorts, “skins” or compression shorts for sports, control panel undies, firm leggings, even a wrap-around lava lava or scarf. Wear something like these suggestions for support during the day In the early days after birth you may find it helps to sleep in the support garment until your abdominal tone improves.

 

Checking for diastasis (it is quite difficult to check this on yourself when you are pregnant, ask your midwife or physiotherapist to check for you. If your diastasis is not reducing by six weeks, you will need to see a physiotherapist to ensure that you have exercise specific to recovery)

 

Rest the finger tips of one hand across the centre of your abdominal muscles just above or below your belly button.  Position your legs as below.  Tilt your pelvis back, and then as you breathe out lift your head and shoulders towards your knees.  Keep breathing out as you lift up.

 
   

You will feel the firm edges of the muscles on each side and a soft gap in the middle.  (Rest back after 10 secs). 

Exercise Advice:

 

You will need to modify any exercise programme until the diastasis has resolved to less than 2 centimetres in width.

 

DO NOT do sit-ups/truck curls until this time

 

Lower Tummy Muscles or TABS: (transverse abdominus muscles or “core”)

these are vital for support during pregnancy and after birth)

TO FEEL FOR YOUR TABs:

Place your fingers on the bony point of your pelvis, where you would put your hands on your hips. Now move your fingers down about 2 cm and in about 2 cm, which is below your tummy button.

Take a normal breath in and as you breath out try to gently tighten the muscle by pulling in your lower tummy towards your spine, from your tummy button down. You should feel the muscles harden under your fingertips.

 

Sometimes it can be difficult to activate these muscles for the first few weeks after birth.

 

  1. Start with trying on hands and knees: place your hand below your tummy button.  Gently draw your lower tummy in towards your spine and away from your hand. Hold 2 seconds                                         Do this 5 times twice a day

 

  1. After two or three weeks, see if you can do this gentle tummy control in standing; when you are at the kitchen bench or laundry (where you will be quite a lot!) This gentle activation will help to shorten the muscle fibres and encourage them to remember their role in support and control.

 

 

Pelvic Floor Muscles:

 

Remember to begin relocating these muscles during the days after birth: do not expect too much, even a flicker is a good start. If you need help or advice on what and when to do pelvic floor exercises then click here : pelvic floor muscles You will find some guidance to get you started.

 

 

Linley Edmeades

August 2013