Diastasis Recti During Pregnancy

Why do women in their second pregnancy show earlier? Why do the belly buttons of pregnant women turn from "innies" to "outies?" Why do pregnant bellies make that cone shape when the abdominals contract?

The answer: a condition called diastasis recti.

Diastasis recti is the separation along the midline of the rectus abdominis, which is our outermost abdominal muscle, or our "6-pack" muscle.

The recti muscle comes in two parts and these two parts are joined together by a strip of connective tissue called the linea alba. This linea alba is that thin line that you may or may not see running from your sternum to your pubic bone. During pregnancy, the growing uterus creates a force against the abdominal wall at the weak spot of the connective tissue – the belly button. The hormone relaxin helps this process along by making the connective tissue more flexible and, combined with the force from the growing belly, enables the muscles to spread apart.

As the muscle separates, the connective tissue stretches sideways becoming thinner and weaker. Where there were formerly muscles, there is now thin and stretched out connective tissue. The growing uterus along with the other internal organs is now pressing against that connective tissue and basically making the belly button "pop." The protruding organs are what is behind that belly cone that pregnant women often see when they contract their abs. Diastasis recti, if not treated, gets larger with each subsequent pregnancy and this is why women show earlier the second time around.

But this is not the whole story. The recti is not only there to hold your organs and belly button in place – it also acts as a support system for your lower back. Thin and stretched out connective tissue is not a great support system for your back and can be a cause of lower back pain. Pregnancy places a big strain on the spine and is responsible for significant postural changes. A weak core caused by a separated recti muscle cannot offer adequate support.

Further, diastasis recti makes "pushing" in labour much more difficult. Your uterus is tilted forward because the connective tissue does not hold it in place as well as a closed recti muscle would. As the uterus tilts forward, the cervix goes out of alignment with the vaginal canal creating a detour in the baby's passage through the birth canal, thus making pushing harder and placing additional strain on the already weakened abdominal wall and pelvic floor.

Unfortunately, after birth the muscles don't just snap together again – despite what you might have been told – and the beautiful "baby belly" turns into a "mummy tummy." This, as you now understand, is not only a cosmetic issue, diastasis recti is connected to lower back pain, weak pelvic floor issues, gastro-intestinal problems, increased risk for hernias with abdominal trauma and overall injuries as a result of a weak core.

The good news is that diastasis recti can be improved, and sometimes fully rehabilitated – even during pregnancy! One of the better researched methods for this is The Tupler Technique® - a program that was conceived by Julie Tupler, RN in New York over the last 20 years. A study that was done at Columbia University* showed that women who did the Tupler Technique® exercises during pregnancy had a smaller diastasis than the women who did not do these exercises. Evidence research by Tupler shows that having a smaller diastasis during pregnancy from doing the Tupler Technique® resulted in decreased back pain, faster and more effective pushing in labour and a faster recovery of abdominal muscles after both a vaginal and c-section birth.

Pregnant women who do the Tupler Technique® follow a daily program of seated, and then later, back-lying exercises to strengthen their deepest abdominal muscles (the transversus abdominis) and keep the diastasis from becoming larger or even on occasion helping to make it smaller. They prepare for labour and birth by learning the skill of pushing with their strengthened and splinted abdominal muscles while relaxing the pelvic floor muscles which they have stretched and strengthened during the program.

Most women, health care and fitness professionals address the issue of diastasis recti in the postpartum months. But it is so important to start working on it during pregnancy. The benefits of a strengthened core along with a closed diastasis during pregnancy are plenty: reduced or no more back pain, better posture, improved functional strength, reduced risk for urinary incontinence or prolapse, an ability to push more effectively in labour, a faster recovery from vaginal birth or C-section and a much reduced likelihood of developing a diastasis in the future.

Here are some hints for preparing for a healthy abdominal wall in pregnancy:

Do this:

Put your hands on your belly and feel your belly expand as you take air in through your nose. Now, exhale and bring your belly button all the way to your inner spine. Hold it there for 30 counts – counting out loud as this forces you to breathe. Now, squeeze even deeper imagining your belly button going from your inner to the outer spine. Hold it at the inner spine and squeeze again to the outer spine. Do 10 of those squeezes while counting out loud. Let your belly expand again. Do 10 sets throughout the day.

Don't do this:

Crunches, Pilates 100s, Backbends, Twists, coming straight or jack-knifing from back-lying position into sitting (log roll to the side instead when getting up)

Practice pushing at home...

... when you have a bowel movement. Sit on the toilet with your feet slightly elevated so that you are in more of a squatting position. Pull the belly button to the spine and hold it there as you push out your bowels.

* Read the abstract of the research that was published in the Journal of Women's Health Physical Therapy. 29(1):11-16, Spring 2005. http://bit.ly/nWhllK

******Footnote:

Susanne trained personally with Julie Tupler, and teaches the Tupler Technique® in Ottawa offering Tupler Technique® Perfect Pushing™ workshops for women during pregnancy as well as workshops for men and women who want to see their diastasis healed and achieve a stronger core and flatter bellies.