How to heal my ab separation post partum

How to heal my ab separation post partum

100% of women by 38 weeks will have abdominal separation – it is a completely normal part of pregnancy and signifies that your body is changing to accommodate the growth of your baby (amazing!). Following the birth of your bub your ab’s unfortunately do not ‘bounce back’ or ‘snap back’ to the way they were. Sometimes you have great spontaneous improvement in your abdominal section, but a lot of women do not. The way your stomach looks, feels and functions can be very different, and this is terrifying when you do not know how to help it. In this blog you will learn what abdominal separation is, what muscles are involved and finally how to heal and rehab your abs.

What is ab separation, and why does it matter?

To rehab your abdominal separation, ‘Diastasis Recti’, it’s important to know what this separation is.

Your abdominal muscles connect from the bottom of your chest bone all the way down and connect onto your pubic bone – the hard bone at the front of your pelvis. If you picture yourself having a 6-pack (I wish), in between your six-pack muscle, also called your rectus abdominis, you have a connective tissue in the middle which join them together. This connective tissue is called the linea alba

Throughout your pregnancy your posture, pelvic bones and abdominal muscles are changing to make space for the baby. Abdominal separation is a thinning and separation of this linea alba tissue down the centre to accommodate for this space needed.

Our abdominal muscles have many layers which include:

  1. Rectus abdominis muscle – the top layer, our 6-pack muscle
  2. External and internal obliques – the next layer which are our side ab muscles
  3. Transverse abdominis muscle – the deepest layer

The transverse abdominis muscle (TA) is part of our deep core. Everyone talks about having a strong core however that’s a topic for another time!

Our transverse abdominis muscle has lots of functions it provides for the body – but the most important functions for pregnant and postnatal women are:

  • It helps stabilise our linea alba (the ‘gap’ between our tummy muscles) and our pelvis.
  • It helps with defecation (pooing)
  • It controls expiration (breathing out)
  • It works with our pelvic floor to prevent leaking and prolapse
  • Its strength is needed for everyday activities

This is the muscle that gets the MOST stretched during pregnancy, and again it doesn’t just stretch, it gets THINNER.  

This is super important because a stretched and thin muscle is a weak muscle that doesn’t know how to work very well. We just learnt how important its function is, and now you are holding a baby all day long so we need to be strong.

Therefore, specific rehab is very important for it. Some women will have spontaneous improvements in their abdominal region within the first 8-10 weeks postnatal, however other women won’t. Every woman’s body is different; therefore, we cannot rely on generic exercises to increase your strength, change your tissue type, and improve the ‘gap’.

How do I know if I have ab separation?

 You may notice your tummy looks a bit different with certain movements like getting out of a chair, getting out of bed, getting out of the car, with coughing/sneezing or at the gym. You could see a coning, doming or bulging through the middle section of your abdominals, or you could see a complete sinking in through the midline of your abs. Ab separation varies a lot between all women and during the postpartum period it can be very disheartening when your stomach looks different, and you may still feel like you ‘look pregnant’. If you have this appearance, we can help.

This could begin to happen during your pregnancy, towards the later stages of pregnancy, or during the postpartum period. You could not notice it for years after birth but that doesn’t mean you cannot help it; abdominal separation can always be rehabbed.

You can do a self-assessment for diastasis recti; here’s how:

  1. We can measure at different points on the abdominals to better direct our exercises. Start by laying on your back
  2. LOWER: Find your belly button and imagine 2cm below this. Lift your head up slightly and press your fingers down in the middle section. Do your fingers find a gap here, how many fingers wide is it? How far do your fingers go down inside this gap? Is it hard when your press into the gap? Or squishy?
  3. UMBILICAL: Find your belly button again and press down exactly here lifting your head up at the same time. Ask yourself all the same questions as step 2.
  4. MIDDLE: Find your belly button again and now go 2cm above this. Lift your head and ask yourself all the same questions as step 2.
  5. UPPER: Find the bottom of your rib cage and measure along this to the midline. Lift your head and measure the same things again = width, depth and tissue quality.

Can you prevent ab separation?

As research now shows, everyone in pregnancy will develop an amount of diastasis recti by week 38. Therefore, our aim during the pregnancy journey is to focus on minimising separation as this assists in postpartum recovery. The more we focus on your abdominals during pregnancy, the easier the rehab process after birth and the more control you have over your abs.

A few things help in minimising diastasis:

  • Noticing whether you are developing doming, coning, tent-like appearance on your stomach
  • Noting what is causing this
  • Limit bearing down, straining on the toilet/during exercise
  • Keeping ribs ‘stacked’ over pelvis and limiting standing too much in the pregnancy posture
  • Learn to activate your lower transverse abdominis muscle which stops doming from happening
  • Optimising breath and pelvic floor function

How to rehab my ab separation

Every postnatal woman needs a 4-6 week women’s health physiotherapy assessment and in this assessment we would identify what your abdominals are functioning like. OR if you have just self-checked, you had your baby 5 years ago and feel you aren’t happy with your abdominals – get them looked at! Unfortunately, ab separation rehab is very specific and requires a very individualised exercise program, but it is achievable!

The way that we heal it = we USE it, we EXERCISE it.

That’s right, we do crunches, we do planks, we do all the feared exercises, BUT we do them in a specific way. This specific way teaches you how to engage your deep core FIRST, then you do your crunch. When we do it this way, we are controlling the pressure inside our stomach which normally would bulge out.

I want you to try to activate your lower abdominal muscle (transverse abdominis):

  • Laying on your side completely relax your abs
  • Put your hand on your lower tummy (under the belly button)
  • Try to draw in your lower abdominal section, then the middle tummy, then the upper stomach.
  • This is not the same as a ‘sucking in’ of your abs or a ‘drawing your belly button to your spine’. We want the lower section to be switching on first.
  • If you cannot feel it or if nothing happens, that’s okay, its very difficult to do however we this is the first step in healing your diastasis recti
  • Practice doing 20 of these, rest and complete another 20.

No matter how far along in your pregnancy or postpartum journey, ab separation can always be helped. We understand changes in how your abs look and feel like can be hard, which is where we can help. Our physiotherapists have done advanced training in Diastasis Recti rehab and have helped so many women achieve their goals. If your unsure what to do or whether yours can be healed, reach out and we will give you the advice and reassurance you need.

If you want to heal your ab separation à we will see you soon!