What is Abdominal Separation?
What is Abdominal Separation?
Abdominal separation goes by many names, also being known as diastasis rectus abdominus muscles (DRAM, or DRA) or rectus abdominus diastasis, (or RAD).
DRAM is completely normal in pregnancy with studies showing 66-100% of women will have some degree of DRAM in their third trimester.
What causes DRAM?
A bit of an anatomy lesson to start, your ‘6 pack’ muscles are one big muscle that attaches at your ribs at the top and stretches all the way down to your pelvic. They are joined in the middle by connective tissue called the linea alba. DRAM is common through pregnancy due to the combination of weight gain, hormones and the stretch placed on the muscles by your growing baby.
As your baby grows, the connective tissue, called the linea alba, stretches and thins and the muscle bodies move to the side, this can create an area of weakness through the center of your tummy.
The degree of separation can be impacted by a number of factors including genetics, breathing patterns, movement patterns, your exercise habits and even your everyday activities.
While DRAM most often occurs during pregnancy, it can happen to anyone, at any age, if there is frequent pressure through the abdominal muscles.
Symptoms of DRAM
You may notice symptoms through your pregnancy or in the post natal period.
You may notice any of the following:
- A feeling of weakness through your abdominal muscles
- A soft ‘gap’ running vertically along the midline of your abs, especially when you are activating through your tummy
- A ‘doming’ or ‘bulging’ appearance in the middle of your abdomen
- Pelvic floor related dysfunction
Can abdominal separation be prevented?
While we may not be able to prevent it entirely through pregnancy, there are certainly some ways to reduce the severity.
Strengthen through abdominals before and during pregnancy. Just because you are pregnant does not mean you need to avoid any core exercises. Talk to your health care team to see what type of core exercise is right for you.
Work on your breathing. Our diaphragm links into our abdominals so dysfunction in diaphragm movement can impact abdominal movement and vice versa.
Reduce your load. When you are pregnant your body is already working hard with the extra load of your baby plus all the hormonal changes. Heavy lifting, either through exercise or work can place extra strain through your midline. Minimise heavy lifting if possible. Or chat with your health team about pregnancy safe exercise for you.
If you are concerned, check in with a Women’s Health Physio.
Treatment
Because every body and every pregnancy is different there is no one size fits all when it comes to managing abdominal separation.
At Rebound we undertake a detailed exam to assess the integrity and function of the abdominal wall. We use palpation and real time ultrasound to get a good understanding of the function of your abdominal muscles. We will also look at your breathing and diaphragm patterns, thorax and pelvic girdle function, as well as pelvic floor function. We take time to get to know your body and your goals.
Initially we will work on achieving correct activation patterns before moving on to more challenging exercises. For some women this will mean working on breathing patterns initially while others might start with an exercise plan. We recommend that you check in with a Women’s health physio before starting an exercise program if you are worried you may have abdominal separation.
How long does abdominal separation take to heal?
There is no conclusive evidence around timeframes for recovery with DRAM.
For many women they will recover quite quickly after the birth of their baby. Though for others it could take months to heal.
A study conducted in Norway found that around 30% of women will continue to experience DRAM at 12 months postpartum. Fortunately this same study found there was no direct link between ongoing DRAM at 12 months and likelihood of lower back pain.
As with many women’s health issues, abdominal separation is very under researched and so potentially under reported.
If you are at all worried about DRAM through pregnancy or post natally please check in with your local Women’s health physio.
References:
Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic painBritish Journal of Sports Medicine 2016;50:1092-1096.
Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in
postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019 Mar 1;19(1):62-68. PMID: 30839304; PMCID: PMC6454249.