Congratulations, you're having a baby! You're elated, you've got all the hope in the world... and you've also got an endless list of questions and concerns. What changes are your body about to go through? What common issues might you experience? And what are these "split abs" that people keep talking about?
It makes sense: in order to accommodate your fully pregnant uterus (which will become 500 times its original capacity) and a full term baby (about 7.5 lbs), your abs will need to stretch. The abdominals are made up of four muscle groups, and the rectus abdominus (your "six pack") will experience something called a diastasis rectus abdominus ("DRA"): this is when the tendon that runs down the center of your abs will stretch wider, for an average of two finger widths. And by the way, your abs don't actually "split," they just stretch. This means the change doesn't have to be permangent, and can be corrected/improved.
100% of pregnant women will develop a DRA during their pregnancies. If the DRA distance is over 4.5 cm wide, manual treatment is strongly advised. However, research now shows that a DRA is considered "clinically significant" if the patient is unable to create tension between the edges of the rectus abdominus, and less so in the distance between the edges. Thus, even a small DRA is significant if you cannot use your abdominal muscles properly. There are no known determinants for the severity of DRA that will develop, and no link between lifting and DRA severity (as is often believed).
A DRA doesn't usually hurt as it develops, because it occurs slowly over the course of your pregnancy. But occasionally, a DRA happens suddenly, is associated with a muscle strain (and can be early in the pregnancy when you aren't "showing") and can be painful.
"How can I tell if I have a DRA that needs to be treated?"
You can have a clinical DRA while you're pregnant, or after giving birth. Here's how to test yourself:
- Lie flat on your back, exposing your belly.
- Lift your head.
- If doming occurs vertically down the center of your abs (see image on the right), you have a clinical DRA that needs to be treated.
“What are the implications of having a DRA?”
A DRA can affect every woman differently. Here are some possible issues:
- Pelvic floor dysfunction, which may include urinary incontinence (peeing by accident), urinary urgency (suddenly needing to pee), pain during intercourse, constipation, pain/straining during bowel movements, and more
- Pain in the lower back, pelvic region, genital area, or rectum
- Increased risk of injury during exercise/physical activity, especially to the lower back, abs, hips and groin
- Umbilical hernia
- Cosmetic issues, such as a "tummy pouch" that doesn't go away with exercise or nutrition.
“What does ‘getting treatment’ mean?”
When you see me for DRA treatment, you will receive three things:
- Manual work -- this is hands-on therapy, just like what you might expect from a physiotherapist, athletic therapist or massage therapist. During this part of the session I will use various therapy techniques to stretch and manipulate muscles, tissues and joints. I might also use some tools and lotions as well. For those of you who like the therapy jargon: techniques used can include fascial work (cupping, osteopathic techniques, Fascial Distortion Model), trigger point release, and massage.
- Exercise -- whether I prescribe one exercise or an entire workout program for you, strengthening is very important to ensure that the effects of the manual work performed will last as long as possible. These personalized exercises also decrease the number of treatments needed.
- Education -- in addition to treatment, I believe it's crucial for a new mom to learn how to treat herself and manage her own aches and pains. This way, she becomes less dependent on me (when she's ready), and understands her body's needs. I will help lay out expectations for your pregnancy and postpartum journey from a therapy and exercise point of view, and suggest inexpensive tools like lacrosse balls, foam rollers, golf balls and resistance bands to complement your self-care routine.
“How do I prevent a clinical DRA?”
Prevention is simple: start doing the right strengthening exercises before you get pregnant, and while you're pregnant! This includes choosing the right exercises to treat your transverse abdominus (TVA) muscle and your pelvic floor muscles (Kegels), and learning to breathe properly. The stronger and smarter these muscle groups are, the faster postpartum recovery will be. Also, studies show that a proper general strength training routine unloads the rectus abdominus group, preventing clinical DRA. So add that into your routine as well. This is how 40% of DRA's will resolve spontaneously by six weeks postpartum, and 70% will have resolved by a year postpartum.
The second prevention tip is up for discussion in the therapy world. That is: if you keep your superficial abdominal muscles and fascia "loose" or with good "resting tone," a clinical DRA may not develop. This is where receiving regular manual therapy and a safe exercise program throughout your pregnancy is helpful.
“I think I have a clinical DRA. What do I do now?”
Whether or not you have a clinical DRA, proper care begins with working one-on-one with a professional. Contact me for more information -- let's inform, prepare and protect the body that makes the baby.