Postpartum Abdominal Separation: What it is and What to Do About It
We all know that when a person is pregnant their belly stretches A LOT to accommodate the baby. Sometimes the muscles and skin just get stretched, but quite often a certain set of abdominal muscles actually separates. Let’s go through what actually happens and how to address it.
What Is it?
This abdominal separation is more formally called Diastasis Rectus Abdominis or DRA. The rectus abdominis muscles are the “six-pack” muscles that run down the middle of your belly, from the bottom of your breastbone down to your pubic bone. In between these muscles is a connective tissue call the linea alba. When the belly expands as much as it does in pregnancy, the linea alba can get stretched out, allowing the rectus abdominis muscles to separate. About 2/3 of pregnant people have some degree of this by the end of their pregnancy, but it doesn’t always persist postpartum. DRA is especially common after multiple pregnancies, because the muscles and tissues have been stretched multiple times.
Why Is It a Problem?
If this separation doesn’t come back together on its own, it can disrupt the stability of your back and increase potential for urinary leakage. Our abdominals are a big source of support for our spine. DRA can reduce the ability of our abdominals to brace our spine because there is an interruption in what should be a firm wall of abdominal muscles. This is especially important when you’re carrying a baby around much of the day or managing toddler tantrums. Back stress and pain is a common result of DRA.
This separation also impacts pressure management. Our abdomen is like a cylinder, with our pelvic floor on the bottom. If the front wall of that cylinder has a weak point, it disrupts our ability to manage pressure with things like coughing, sneezing, or lifting. This can put excessive pressure down on the pelvic floor and contribute to urinary leakage. If you gave birth vaginally and the pelvic floor muscles are recovering, this additional pressure can make leakage worse.
Aesthetically, DRA can also impact how your belly looks. It’s more likely that the belly protrudes with DRA because the stretched connective tissue doesn’t allow the belly to flatten as much and form a firmer wall. I have to note though, that there are many other factors impacting how a belly looks after pregnancy. Skin elasticity and fat distribution play a big role as well, and are often not under our control. I’ve seen many postpartum people with distress about how their belly looks, and I understand. I always stress that it can take a long time for things to settle after pregnancy, and we won’t have total control over where it ends up. Addressing DRA may help, but it it not a magic bullet for a flat stomach.
How Do I Know if I Have it?
A telltale sign of DRA is “coning” or “doming” down the middle of the belly with things like getting up out of bed, lifting, or performing abdominal exercises. This looks like a little hill only in the middle of the belly. A quick way to check is to perform a sit-up and look down at your belly. Because the connective tissue is too stretched out, when pressure is high at the belly it pushes out through the muscles. A healthcare practitioner like a pelvic health PT, midwife, or OB/GYN can formally check you for DRA.
What Can I Do About It?
If you are within the first 6 weeks postpartum, this may resolve on its own. If you are beyond 12 weeks postpartum and it has not gone away, you may need specific retraining to minimize it. The good news is that most separations can be resolved with the right exercises and movement training! A pelvic health PT can assess you and provide specific exercises to help train the muscles back together and allow the connective tissue to tighten again. I had DRA after my pregnancy and was able to completely resolve it. If the separation is extreme then surgery might be necessary, but this is very rare.
For day to day life, these tips can help:
Exhale whenever you lift, push, or pull to minimize pressure
Roll to your side and push yourself up to get out of bed instead of sitting straight up
Don’t perform sit-ups or abdominal twisting exercises until the DRA is resolved
Be cautious with abdominal exercises on your back with your legs in the air. If you see doming in your belly then it’s not helping the DRA.
If you think you have DRA or are not sure, seek out a pelvic health PT! You can email me at lindsay@lindsaybrunnerpt.com.