Why Your Stomach is Still Bulging after having a baby: Diastasis Recti and how to fix it.

Guest post by Dr. Rachel Cutts

Ever felt pressure to bounce back and look like Beyonce after having a whole baby? 

Now that I have your attention—that’s irritating, right? Especially when you’re dealing with issues that make it feel almost impossible to get back your pre-pregnancy body. Especially when you don’t have a whole fleet of dedicated professionals helping you to do so. More power to her and anyone else with washboard abs after having kids, but this definitely is not the goal. You had an entire baby. You’re allowed to focus on healing and loving that baby. And if you’re here, you might need help healing your abdomen. I’d love to help with that.

You might have a particular postpartum-related abdominal issue that, unfortunately, puts a damper on your confidence. It’s an issue that might have strangers approaching you like, “Congrats, girl! When are you due?” months or longer after you’ve given birth. Unfortunately, there isn’t a cure for ignorant but well-meaning comments from strangers. So until we find one, feel free to give them a blank stare and carry on with your day. There is, however, a treatment for your abdominal symptoms.

This issue is most common after pregnancy and is more likely with second, third and subsequent pregnancies. People who experience rapid weight gain or poor technique with lifting weights are prone to get it as well. 

With two of my sisters having five kids in the last five years, I’ve become personally interested in treating women dealing with this common post-pregnancy side effect called Diastasis Recti.

Diastasis recti

What is it?

A condition where the midline fascia of the linea alba separates. OR in layman’s terms, there’s a significant gap separating your ab muscles right down the middle. It is defined as > 1 inch or more between the two sides of the rectus abdominis or 2-2.5 finger widths apart. 

Why did this happen to me?

Most likely due to the stress the uterus puts on your supporting abdominal structures when pregnant. Your body releases hormones that allow your tendons, ligaments and muscles to stretch more, so that it is easier to give birth. I’m sure your birth canal thanks you, but the stretched connective tissue in your abs, not so much. Most people do not realize that many of the common ailments and physical conditions we all struggle with could be related to a separated abdominal wall and a weakened corset muscle.

Some of these issues are: Lower back pain, bulging tummy and pelvic floor issues such as incontinence.

Imagine you had a cut. If it is wide enough the doctor will give you stitches to bring the divided tissue closer together. However, in this case, we want to do exercises that encourage your rectus abdominis to come closer together and strengthen your internal corset.

What makes it worse?

Doing anything that flexes your spine or contracts your six-pack muscles (rectus abdominis) can cause further separation and increase pressure on your abdominal wall.

Flexion exercise which includes any movements that make your abdominals stick out more (e.g-planks with your back arched)

Check out the illustration below for the offenders: Do not pass go, Do not collect $100 and just DON’T do any of these exercises while pregnant or for a few months after delivery. 

Can Diastasis Recti be fixed?

There is hope!!!

Especially if you address it right after surgery but even the most chronic cases can show improvement if you follow the steps below.

Can you show me the way Rachel? Well I thought you’d never ask. Haha 

Here’s how to fix it:
1. First stretch your lower back muscles and compress your abdominal muscles with the following exercise. 

When certain muscles become weak and overstretched (abdominals), other muscles (your back muscles) may become overactive and tight to maintain stability. 

Single Knee to chest (lower back stretch)

  1. Begin by lying down flat on your back, toes pointing towards the ceiling 
  2. Pull one of your knees in as close to your chest as possible to feel a stretch in your lower back and/or glutes
  3. Use your arms to push your bent knee close to your chest until a stretch is felt in your lower back
  4.  If you can, drag your abdominal muscles closer together by dragging your thigh muscles towards your belly button and hold there for 30 secs to 3 minutes, alternating and then repeat with the opposite leg
  5. If it does not aggravate your symptoms or pain, bring both legs toward your chest.

2. Next, Core stability training 

This is not the same as abdominal strengthening(rectus abdominis and obliques)

You can think of the core as a cylinder comprising of these parts below :

Diaphragm-the top

Pelvic muscles-bottom

Multifidus-posterior border  

Transverse abdominis-front and sides (your internal corset)

All these muscle groups work together as a cohesive whole to stabilize the spine and pelvis when doing dynamic movements such as running, twisting, and lifting.

Save yourself $50 bucks by training it to work again versus buying a back brace.

1st Exercise: Posterior pelvic tilt with transverse abdominis and pelvic floor activation.

  1.  Lay on your stomach with both knees bent
  2. Achieve a neutral spine(activating the glutes) and activate the transversus abdominis by breathing out slowly and drawing your belly button in (turns on when you breath out). 
  3. Doing these things first put your core in a better position to brace the core 
  4. Then we turn on the diaphragm by pretending as if someone was going to punch you in the stomach. It activates when you breath in and push the abdominal contents down. Repeat exercise for 3 minutes, quality repetition over quantity. You know you are doing the exercise right if your 6 pack muscles do not budge out and you feel a deeper muscle working.

2nd Exercise: Side Plank with Hips taps

  1. Start by performing all the instructions from the previous exercise in the side plank position.  There should be a straight line from your head to your feet.  
  2. Slowly drop hips down to the floor, barely tap hip to ground and then contract obliques to lift hips back up to starting position.
  3. Perform the exercise for 3 minutes with as many quality repetitions as possible. Maintain good form throughout the movement.

Repeat all exercises as many times as the day as you can. The more you practice the more it becomes like habit

Repeat all exercises as many times per day as you can. The more you practice the more it becomes like habit.

The progress to exercises like plank, deadbugs once you are able to maintain a posterior pelvic tilt with the exercises

If you need a little extra love:

Brace. An abdominal binder around the low back and abdominal region can provide soothing external support in the early phases of recovery to encourage the connective tissue to shorten. 

Taping-using Kinesiotape https://amzn.to/30uqhKn will be less constrictive and can be used to compress individual segments of your abdominal muscles while lifting weights in the gym. 

If you need further assistance, message me on IG.

@doc.rachelcutts_mvmt

Rachel Cutts, DPT, PT, RDN, OCS, CSOMPT

I am a Physical Therapist, Registered Dietitian, and Strength and Conditioning Coach that specializes in treating neuromuscular conditions using corrective exercise and manual therapy with a passion for empowering women.

@doc.rachelcutts_mvmt

#postpartumtaping #pregnancy taping #diastasisrecti #proudauntie #pelvicfloorhealth #pelvic floor

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