​​Is your post-baby belly just ‘mummy tummy’? Or something deeper?

Diastasis Recti i.e AB ( abdominal ) Separation

While a lot of women are concerned about abdominal separation during pregnancy and post natal period, it is important to understand that this is a normal change in tissue to accommodate for a growing little one. 

Let’s see what is the Anatomy:

The Rectus abdominus muscle i.e your AB or 6 pack muscles form a part of your outer core muscles . These are joined together in midline by a connective tissue called Linea Alba.

Underneath these muscles are the side pockets such as your internal and external oblique muscles, and underneath these muscles are  your deep core muscles - Transversus abdominis. 

DRAM (Diastasis Recti Abdominis Muscle) in pregnancy: 

During pregnancy in order to accommodate the baby the abdominal wall stretches, which can cause a "separation" in the midline. This is a normal and necessary process during pregnancy. As pregnancy progresses the linea alba continues to stretch and thin. When the pressure in the abdomen exceeds what the linea alba can control, abdominal doming or coning can occur (upper tummy having a triangle shape). 

While we can't stop from this occurring completely, we can reduce or limit activities that cause intra-abdominal pressure. 

Tips during pregnancy: 

• Avoid getting up from the bed from a full sit up motion- always roll on to the side and use your hands to push yourself up. 

• Wearing compression garments

• Strengthen Pelvic floor muscle and deep core muscle activation

• Avoid sit-ups

• Focusing and retraining on Diaphragmatic breathing 

• Engage core /squeeze belly button to spine while doing activities like- pull/push or lifting weights. 

DRAM in Post-natal period:

While there is a lot of hype around 'abdominal separation' and 'how many finger widths' know that this is one of the less important factors when it comes to abdominal wall rehab. A small degree of 'separation' is within normal, <3cm is not significant. The most important factor to consider is the tissue tone, ligament integrity and watching for DOMING when sitting up/getting out of the bed, inner and outer core strength, pain or discomfort. 

Tips for self-check: 

• Lie on your back

• Bend knees

• Lift head & feel your midline

• More than 2 fingers = check in with a physio!

Signs You Might Have It

• Bulging/doming when you sit up

• Weak core

• Consistent lower back pain

• Tummy that won’t go away

• Feeling unsupported

Tips during postpartum period: 

• Roll on to side to get in and out of the bed if you have excessive doming

• Strengthen core muscles - depending on the degree of the DRAM

• Work with your breath during exercise, exhale during the exertion phase or the hard phase of the movement to reduce intra-abdominal pressure. 

• Engage core /squeeze belly button to spine while doing activities like- pull/push or lifting weights. 

• Wear supported compression garments. 

Normal tissue healing helps this 'separation' reduce significantly in the first 6 weeks postpartum. It is common to have a large DRAM in the first few days postnatal and for this to reduce significantly in the first month or so. However it is very important to consult a WOMEN’S HEALTH PHYSIOTHERAPIST  after 6 weeks of post-partum for DRAM check and pelvic floor check up.