Around the second trimester, depending on the size of your bump, you will have experienced some degree of abdominal separation: diastasis recti. The rectus abdominis muscle is your “six-pack” muscle. It runs down your front, from your breastbone to your pubic bone: two segments running vertically parallel and intersected by a fibrous band, the linea alba.
In a brilliant design feature of the human body’s adaptability, as your bump grew, the linea alba stretches to allow your baby more space. The two bands of muscle stretch away from the centre. This is most likely to begin at the navel as that is where your baby usually requires most room.
This is a normal structural adaptation, you can’t necessarily prevent it, and neither would you want to – it is a design specially created for your baby’s comfort and growing power. Around 30% of women experience this abdominal separation in the 2ndtrimester, with a further 66% separating in the third trimester. Some research says that 100% of women have some level of diastasis of the rectus abdominis by the third trimester (Gilliard and Brown 1996, Diane Lee 2013). Look at those stats again: 100% of women have this happen at some point to some degree during pregnancy.
The extent of your abdominal separation depends on a number of factors:
Your abdominal tone pre-pregnancy
If you carried more than one baby
If you’ve had more than one baby
If you gain a lot of weight, or if carried a big baby for your height, your baby will have had less space and needed to “pop further out”
Age plays a part: it can be worse if you’re over 35
Lack of regular exercise
Postural load – are you stooping/lifting constantly without care for your technique and form?
Mind the gap
Until quite recently we’ve talked in fearful terms about THE GAP, and the need to “close the gap” postnatally. But actually we now know that it’s not the width of the gap that is the issue: it’s whether or not there is deep tone of the supporting muscles underneath that matters. You could have a 3-finger gap, but as long as your core muscles are firing properly and you can manage your intra-abdominal pressure – the pressure in the space between your respiratory system (your diaphragm) and your reproductive system, placing load out into your belly or down into your pelvic floor – this gap is considered to be “functional”, i.e. not a problem. You may never “close the gap” completely, but as long as you have tone supporting the linea alba, this is ok. So: a problematic diastasis recti is one where there is soft squishy tissue rather than tensile active tissue underneath the linea alba “gap”, therefore not truly supporting your core in movement and leaving you vulnerable to injury and pelvic floor issues.
Diastasis used to be considered a purely cosmetic issue, merely a cause of the “mum tum” or “postnatal pooch” – and dismissed roundly by GPs as a result “ah well you’ve had a baby what do you expect?”. But this is heartbreaking for me to hear of so many women fobbed off when they inquire about DR. There is a direct correlation between a diastasis lacking tone, and the impact and load placed on your pelvic floor and your spine. In essence: if you have a serious gap, you my also experience back pain and/or symptoms of pelvic floor dysfunction.
Diastasis has an effect on the strength and action of your oblique (waist) muscles, and mayhave an impact on the ability of your abdominals to control the pelvis and spine – this in turn could possibly be a cause of back and pelvic pain, if the integrity of your core support isn’t given some scaffolding with strength and conditioning exercises (such as Pilates).
You might have noticed when you were pregnant that when you got out of bed or even up from sitting, there was a strange doming in your stomach, a bit like an alien pushing out, or a Toblerone triangle. As a rule of thumb, you don’t want to see that doming any more. We don’t want to be in a position where you’re putting your muscles under pressure and encouraging it to happen. If you see it when you lift yourself out of bed or off the floor, try rolling over onto your side and pushing yourself up with your hands, rather than using your abdominals.
Continue to avoid ‘regular’ exercises – even if you get the “all clear to exercise” from the GP at your six week check up, unless they have actually palpated your abdominals to check for a DR, please don’t rush back into traditional ab exercises, oblique strengtheners (twisting curl ups and side planks), or any loaded rotation and definitely avoid getting back into running or any other high impact exercise just yet. Erring on the side of caution is always the best policy – despite what some celebrity trainers might suggest on their glossy Instagram feeds.
Excessive abdominal training when a diastasis is present, particularly with twisting movements such as oblique curl ups, can cause a downward pressure in the abdomen through the pelvic floor, which will pull the already weakened linea alba further out to the sides.
Diastasis recti doesn’t always resolve itself on its own, the first 8 weeks are where the main natural healing takes place, and if yours is still a problem gap after this point it needs conscious training and dedicated deep core healing work.
You can hear me chatting about diastasis recti on BBC Radio here. Any questions about postnatal healing – get in touch!
My new book Pilates for Pregnancy is available now