Probably the most important thing you can read about abdominal separation

Let’s take a deep dive into what’s what when it comes to diastasis recti (aka abdominal separation, also abbreviated to DR). So much is written, so much is talked about, but my impression is that the discussion is going in the wrong direction. Mothers want to fix the separation at all costs – but that isn’t what it is all about. This article is probably the most important thing you can read about abdominal separation.

Diastasis recti: what do we currently know?

We have 4 layers of abdominal muscles:

1. The transverse abdominis – often referred to as the corset muscle – goes around the entire torso and its function is to stabilise the back and pull the belly button in towards the spine.
2. The internal obliques
3. The external obliques
4. The rectus abdominis – we often call these muscles the six-pack.

Unfortunately, we overuse these muscles in our everyday life and in our workouts, when what we really need to focus on is coordinating our core muscles, our inner core.

Our core is made up of:

• The diaphragm
• The pelvic floor
• The transverse abdominis
• The deep back muscles

Most muscles in our body attach to a bone to create movement. Around the stomach we have no bones that do that, so instead we have several layers of abdominal muscles held together by fascia and connective tissue called the linea alba. The linea alba connects your ribcage to the pubic bone in your pelvis, but also holds the right and left parts of the rectus abdominis (aka the six-pack) together.

The linea alba is a band of thick elastic tissue made up of collagen fibres, with a structure similar to netting. The linea alba softens and stretches during pregnancy to allow the uterus to grow and take up more and more space. Although 100% of all pregnant women have a separation at week 37, it’s when the separation continues after childbirth that it can cause a problem.

Problems associated with abdominal separation include urine leakage, pelvic organ prolapse, lower back pain, pelvic pain, umbilical hernia, and belly pooch.

Some more facts about diastasis recti:

• 27% of women have DR in the 2nd trimester
• 66% of women have DR in the 3rd trimester
• 53% of women have DR immediately after giving birth
• 36% of women still have DR eight weeks after giving birth

One study found the following: Spontaneous healing of the separation only occurs during the first eight weeks after birth, after that it plateaus. So unless you do something about it, the same separation will still be there a year after the birth.

The growing uterus is not the only thing that affects the separation – there are also various forces that pull the separation apart. These forces stretch the linea alba further, pushing out the abdomen due to the increased internal abdominal pressure.

The following activities contribute to worsening the separation:

• Change in internal abdominal pressure due to pregnancy
• Exercises involving trunk flexion (e.g. sit-ups)
• The expulsion phase during childbirth
• The pushing process (it takes varying amounts of time for each woman – some have the right technique and some don’t).
• Posture

Other influences include overuse of the external abdominal muscles, poor breathing patterns (breathing with your chest or holding your breath), pulling your stomach in all the time, and pushing your bottom underneath you when you stand or sit (this makes your pelvic floor become too tight, which is a weakness in itself). However, I would like to point out that there is no one factor that exacerbates DR – it’s a combination of factors.

I also want you to take a look at the picture below, where I mention all the factors that affect the healing of diastasis recti. It even includes sleep and constipation. Your whole lifestyle needs to change, step by step, and it’s not just about stomach exercises – that would be too easy! I tend to argue that what you do for 30 minutes doesn’t matter in comparison to what you do for the remaining 23 hours and 30 minutes of the day.

What I know about diastasis recti based on my own experience and after coaching hundreds and hundreds of mothers:

• The width of your DR matters less than how deep and how long it is. It’s all about how good you are at activating your inner abdominal muscles in your everyday life and when you exercise. If you have a 3 cm separation but none of the other symptoms I described above, don’t worry. However, you can have a 2 cm separation and have multiple symptoms and not be able to activate the right muscles.
• You can live a perfectly normal life with a 2–3 cm separation as long as it doesn’t bother you or interfere with your daily life. If the separation never closes but you can generate tension in the linea alba and can activate all the core muscles when needed, i.e. they are in sync, then you don’t have to worry about the separation.
• Some people with diastasis recti may have a flat stomach – so don’t be fooled by the stomach’s appearance! A flat stomach can just as easily mean that someone is pulling their stomach in around the clock, a habit that they have had since their teenage years when they started becoming aware of having to have a flat stomach …
• Belly pouch is usually related to poor posture where the shoulders are hunched forward and the upper body sags. This means they overuse the external abdominal muscles and usually have tight hip flexors. The internal organs and intestines are pushed outwards and constantly press against the linea alba so it has no chance of becoming strong and tight again.

What does all this mean for you?

Unfortunately, there are no set ‘rules’ as to what you should do. Everyone needs to work on different things to fix the problem. But there are three main areas that every woman who has been pregnant needs to work on:

1. Learn correct body alignment by learning to stack your upper and lower body and by not swaying or pushing your bottom underneath you/pushing your hips forward.
2. Learn to breathe correctly. It is in fact through the right breathing technique that we can start to activate the internal abdominal muscles correctly.
3. Add stabilising exercises linked to your breathing so you begin to coordinate the internal abdominal muscles with one another.

By finding this kind of alignment and breathing optimally, your core muscles will work better, your stomach will be stronger, and this means you will be able to remove the pressure from the linea alba. The linea alba needs to regain its density, and this is achieved with correct alignment and the ability to activate the internal abdominal muscles – including the pelvic floor (which is done by changing your breathing pattern. It’s all connected!) If you start doing crunches, sit-ups, advanced planks, jumps and running too early, while your core is weak and the linea alba is too stretched out, this may lead to injuries – including pelvic organ prolapse.

But most importantly, be aware of diastasis recti in your everyday life. And especially during the first eight weeks after giving birth.

Sources/references (Boxer et al 1997; Boissonault & Blaschak 1988; Toranto 1990, Oneal et al 2011), pelvic pain (Lo et al 1999, Whittaker 2013), incontinence (Spitznagle 2007), prolapse (Spitznagle 2007), increased risk of abdominal injury (D. Lee course notes 2011) and a bulging abdominal wall [a.k.a. Mummy Tummy] (Braumann, 2008).

Photo Andreas Lundberg

Illustrations Trainimal Woman