Mummy Tummy and what you can do about it.
By Renee Simons, RMT
Having a baby is one of the most exciting times in a woman’s life. Filled with the awesomeness of giving birth to a teeny tiny creation, unconditional love and profound joy. Women are made to create life and bring it into the world and yet it can also be one of the most daunting adventures in life. Fraught with unknowns and difficulties we weren’t prepared for.
Mummy Tummy or Diastasis Recti is one such challenge. This is where the “six-pack abs” or Rectus Abdominus muscles begin to separate down the midline of the trunk as a baby grows to term. While this is a normal adaptation during pregnancy, the separation should normally begin to draw together in the first 8 weeks of postpartum, however, in some instances, this is not the case.
Fun fact: Abdominal separation is not limited to pregnancy and postpartum women. Men, women and babies can also experience diastasis recti. Common causes can range from performing excessive abdominal exercises incorrectly to lifting heavy weights with poor biomechanics or postures. Premature babies can also present with this because the abdominal muscles have yet to fully develop. This usually corrects itself over time.
Pregnancy and delivery can all contribute to developing diastasis recti or DRA. As a women’s uterus grows it creates tension and pulls the abdominal fascia (connective tissue), between the right and the left rectus abdominus muscle apart. Coupled with hormones such as estrogen and relaxin the tissues stretch or expand beyond their normal limits. The delivery position has also been shown to be a factor when pushing. Working in positions against gravity can increase pressure and strain on the abdominal muscles, surrounding fascia, and internal organ attachments.
It is normal to have some space between the abdominal muscle right after delivering a baby. If you have ever experienced the joy of giving birth then you know first hand the strange transition from a taught, ready to burst belly to the soft, squishy and almost empty feeling space left after bringing your baby into the world. What you may have also noticed over the next few weeks and months is the sense that not all your internal parts were in a comfortable position.
Part of the delivery process is to 1. Delivery the baby 2. Expel the placenta from the uterus and perhaps the least well known or thought about 3. Reposition the internal organs that were displaced by the ever-expanding uterus and new life was growing.
Things like delivery position, length of labour and pushing, interventions (vacuum, forceps, c-sections) can all impact this final process of giving birth, not to mention our tendency towards pushing ourselves as new moms to get back into our pre-pregnancy skinny jeans, running 10K and doing it all on our own. Without ever giving a thought to the major reorganization needed for our bodies. We would never expect someone who has just had a joint replacement surgery to be up and at ’em doing their full pre-op routine right out of the gate, but somehow this expectation has been normalized in our new mommy culture. We don’t always value the need for rest and slow progression as our bodies heal and adapt to fluctuating hormones, nutrient depletion (you just built a human by BTW), and lack of sleep!
How do I know if I have DRA you might ask?
Here’s how you can do a quick self-check:
Lie on your back, legs bent, feet flat on the floor.
Raise your shoulders up off the floor slightly, supporting your head with one hand, and look down at your belly.
Move your other hand above and below your belly button, and all along your midline ab muscles. See if you can fit any fingers in the gaps between your muscles across the midline.
If you feel a gap, or separation of one to two finger lengths, you likely have a moderate case of diastasis recti. After a few weeks postpartum, the gap will start to narrow as your muscles regain strength.
You can also have your healthcare provider (Physician, Physical Therapist, Midwife) assess this for you if you have a concern or notice a gap larger than 2 finger-widths apart. In some cases, callipers or ultrasound will be used to evaluate for DRA.
Having a baseline evaluation of your abdomen and pelvic floor is a great place to start BEFORE you get pregnant, however, it’s never too late to start. If you notice you have some symptoms of the following symptoms it might be worthwhile to be assessed. I personally recommend my clients see a trained Pelvic Health Physical Therapist.
Lower back, hip, SI joint or pelvic pain
Constipation
Bloating or pooching of the abdomen
Poor posture or abdominal weakness
Doming or peaking (V-shape) when performing an abdominal type sit up motion
Incontinence- bladder or bowel
What can you do about it you ask? There are many options available. While the internet is a glorious source of information I would seek professional advice on this one in particular if you have a serious separation. There are a variety of binders or wraps that can be worn postpartum, exercises, and physiotherapy treatments. Another less known option is Visceral Manipulation (VM). Visceral whaaaaaat?? Organ massage sounds a bit crazy, I know, but it can be a great option for improving function and the look of your abdomen. Visceral Manipulation is a gentle manual therapy from the osteopathy world. Using assessment to evaluate the tissue’s ability to activate and the physical positioning in the abdomen, therapists gently work with the body to encourage neural adaptations between the brain signalling, the organs, and supporting connective tissues. In turn, the body moves towards restoring better positioning of internal structures and therefore function. In the case of DRA, the connective tissue can be tensioned by the attachments of the small and large intestines and pulled laterally or away from the midline. This then pulls on the two rectus abdominal muscles making it harder for them to return to their original midline position. VM can work to decrease the tension on the intestines to allow for better internal positioning (less bloating or constipation Yay!) as well as allowing for better line of pull and therefore muscle activation of the abdominal muscles or core engagement. When our internal structures or in an optimal position the contour of our tummy also looks and feels better.
When left untreated DRA can lead to chronic constipation, incontinence issues, pain, pelvic floor dysfunction, poor posture, lack of mobility or strength, and in some cases hernias.
If you have been struggling with mummy tummy or can’t seem to get rid of that pesky little pooch consider being evaluated or try some visceral manipulation. Many registered massage therapists and osteopaths offer VM treatments.
Renee Simons, RMT has been practicing since 2004. She has a focus on women's health, and working with those dealing with digestive issues.
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