I have an abdominal separation, now what?

Abdominal separation, or DRAM (diastasis of the rectus abdominus muscle), is very common during, and after pregnancy. Your left and right rectus abdominus muscle (your 6 pack muscles) attach in the centre to a ligament, called your linea alba. During pregnancy your linea alba stretches as your belly expands, causing your abdominal muscles to separate and move away from the midline. Some people are more likely to get a separation. Risk factors for abdominal separation include:

  • Twins/triplets
  • Large baby (>4kg at birth)
  • Genetic predisposition to ligament laxity (stretchy ligaments)
  • Excessive fluid, fluid retention or excessive weight gain during pregnancy
  • A short period of time between pregnancies
  • Repetitive movements that cause strain to the abdominals (heavy lifting, coughing, constipation or sit ups)

You might notice a bulging or peaking of your abdominal muscles when you do movements such as doing a sit up/getting out of bed. You should be assessed in hospital by a physiotherapist, who will check whether you have had an abdominal separation. It is considered a separation if the muscles are more than 2 finger-widths apart. If you have an abdominal separation it’s important to have this monitored by a physiotherapist to ensure it is improving and not getting worse. 

How to manage an abdominal separation:

  1. Compression – you can compress your abdominal area with either post-natal recovery shorts or leggings (for example the SRC brand) or with a Tubigrip bandage. This helps to support the abdominal muscles and should be worn during the day, for 3-6 weeks after the birth, and especially if you are doing any activities which require bending or lifting. 
  2. Minimise lifting – try to avoid lifting anything heavier than your baby in the first 6 weeks. This is because lifting can strain your abdominal muscles and slow the healing of these muscles. Repetitive heavy lifting post-pregnancy can also increase your risk of a back injury because your abdominal muscles are not working as well as usual to support your spine. 
  3. Strengthen your deep abdominal muscles – your deepest abdominal muscle is your transversus abdominus, which is very important in supporting your spine. To strengthen this muscle, kneel on your hands and knees. Relax your tummy, then draw your lower abdomen gently up towards your spine and hold for 3 seconds. Repeat 10 times. Progress to 10 x 10 holds. You can also do this in other positions, such as lying on your back with your knees bent, or sitting up tall in a chair. There is also likely to be great benefit in completing some Pilates-based exercises to also facilitate improvement in these deep abdominal muscles.
  4. Contract your pelvic floor and deep abdominal muscles when bending and lifting – see our blog on “How to strengthen your pelvic floor muscles” if you are not sure how to do this already. Every time you lift something (such as your baby, the shopping, the pram) contract these muscles to support your abdominals and your spine. 
  5. Avoid sit ups (roll onto your side first to get out of bed), heavy lifting and straining on the toilet. 

Once your abdominal separation has become smaller (less than 2 finger-widths) you can gradually build back into doing some more challenging abdominal exercises, but it is best to be guided by one of our physiotherapists her at Instinct Health to ensure you don’t do these too quickly and risk worsening of your abdominal separation.

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