Tuesday, September 13, 2011

Diastasis Recti (Abdominal Separation)

Diastasis Recti (DR), often called abdominal separation, occurs in up to 50% of pregnancies in the 3rd trimester.  It is when there is stretching of the fascia (Linea Alba) that runs vertically between your right and left rectus abdominis muscles. DR usually occurs in the third trimester when your growing uterus puts the most strain on your abdominal muscles. 

DR does not usually cause pain locally, but it may lead to back pain, pelvis pain, and pelvic floor dysfunction. The good news is that it can usually be rehabilitated postpartum.

How do I know if I have it?
We recommend asking your healthcare provider to check for you.  She will ask you to lie on your back with your knees bent and feet flat on the floor.  You will raise your shoulders off the ground like you are doing an abdominal curl.  She’ll then use her fingers to feel for both sides of your rectus abdominis and measure the gap in between. A gap of 3cm+ at the umbilicus or 1cm+ above or below the umbilicus, is considered Diastasis Recti.

What causes it?
DR in pregnancy is caused by increasing pressure on the abdominal wall.  Why do some women have DR and others do not?  Postulated reasons include: genetics, pregnancy hormones and rapid/excessive abdominal growth.  It is important to note that having a strong core does not cause DR.  Some practitioners believe that a strong core may actually prevent DR.

If you are pregnant, and you DO NOT have DR
Continue doing exercises for all your core muscles: pelvic floor, transverses abdominals, erector spinae, rectus abdominals and obliques.  There are many benefits to a strong cure during pregnancy.

Please note: If you are 16+ weeks pregnant, supine (lying on your back) exercises should be done on an incline (head higher than your lower body).  This is to avoid putting too much pressure on the vena cava which may cause dizziness.

If you are pregnant and you have DR 
1. Avoid abdominal exercises that put strain on the rectus abdominis.  Ex. Abdominal curls, v-sits, boats and front planks.
2. Focus on pelvic floor and transverses abdominal exercises to prevent discomforts and prepare for post partum recovery. Pelvic floor lifts (Kegels) and baby hugs are good choices.
3. Choose mindful movement strategies.  Ex. When laying down, roll over onto your side and use your chest and arm muscles to bring yourself to sitting.
4. Prioritize your mind-core connection during pregnancy so that you will not be starting from scratch post partum.

If you think you have DR post partum
Ask your healthcare provider to assess your separation at your postpartum visit(s).   If you have DR, ask your healthcare provider or certified pre and postnatal fitness specialist for guidance in healing your separation. 

If your abdominal separation persists, ask your healthcare provider to refer you to a physiotherapist who is specializes in postpartum health.  Your local Fit 4 Two instructor can also give you a list of suitable physiotherapists.

It is important to note that doing exercises which engage your rectus abdominal muscles (e.g. abdominal curls), may worsen DR and lead to other problems.  Take the time to get strong from the inside out. 

All Fit 4 Two prenatal fitness classes are safe for women with abdominal separation.  The best choices for rehabilitating abdominal separation postpartum are the Fit 4 Two Tummies 4 Mommies Workshop or Tummies 4 Mommies Series.  All Fit 4 Two postnatal fitness classes are safe for women with abdominal separation except our boot camp series.

Finding it difficult to stay disciplined with your pelvic floor exercises on your own? Feeling like you need more instruction and cues? You're in luck...there's an app for that! Download the Fit 4 Two-approved Pelvic Floor Trainer App and enjoy both visual and audio routines at your fingertips.

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