Post-Pregnancy Abdominal Muscle Separation / Diastasis of Rectus Abdominis Muscle (DRAM)
What is Diastasis Recti?
Diastasis Recti is the separation of the abdominal muscles (rectus abdominis), resulting in a gap of more than 2.8cm in the middle of the tummy. Although this impairment can happen in both men and women, it occurs more commonly in women due to the physical changes during pregnancy. The rates of incidence range from 67% to 100% in post-partum women.
Why does it matter?
Diastasis Recti can lead to:
- Post-delivery lower back and pelvic pains
- Faulty and poor postures due to poor core muscular stabilization of the spine and pelvis
- Urinary incontinence, or uncontrolled leakage of urine
- Gastrointestinal problems such as constipation and bloating
- Abdominal hernias, the abnormal protrusion of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides.
Who does it affect?
- As mentioned, a diastasis can occur in both men & women.
- For men, DRAM can be caused by improper exercise technique such as weightlifting without proper form, thus placing too much pressure on the abdominal wall.
- Newborns can also be born with abdominal diastasis. Such diastasis usually resolves as the baby grows.
- For pregnant women, diastasis in the third trimester is inevitable as the uterus naturally stretches to allow for the rapid growth of the baby. This in turn initiates a separation of the rectus abdominis and linea alba (connective tissue between 6 packs) to accommodate the growing baby. This separation usually heals by itself in 8-12 weeks. For many new mums, however, the gap can persist. This is because the connective tissues are no longer providing tension and stability, resulting in compromised abdominal/tummy muscles. This lack of protection and stability affects the whole body both aesthetically and functionally. Most mummies complain of frustrating post-baby tummy protrusions that would not reduce even when their baby weight is long gone.
What to look out for?
Most often, diastasis recti (DRAM) or abdominal separation can be seen with a protruding dome down the length of the tummy, particularly around the belly button. You may notice this in every day movement, such as when getting up or lying down in bed.
You can assess your tummy if you are at least 8 weeks post-delivery. A diastasis occurs when there is a gap of more than 2.8cm (around 3 fingers spacing) between the abdominal muscles.
Here are some simple steps to help you identify DRAM:
- Lie on your back, with your knees bent and feet flat on the floor.
- Place your fingers on your belly button.
- Lift your head and neck slightly off the floor as if to do a sit-up or crunch, while tightening your abdominal muscles. Press your hand down gently between your abdominals, horizontal to your spine. If there is a gap larger than 2 to 3 finger spaces, you could have DRAM
- Perform these tests above and below your belly button, and measure for gaps in these areas
How can a Physiotherapist help?
A proper assessment is required to determine the management plan. The aim of treatment will be to restore the function of the rectus abdominis and the surrounding core muscles, in order to stabilize the pelvis during activity and under load. As your body recovers and with better core muscles activation, symptoms such as lower back strains or pelvic pains will reduce. Musculoskeletal physiotherapists trained in the treatment of DRAM or physiotherapists specialized in pelvic floor dysfunctions can help assess and tailor a programme suited for your condition.
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