Post-natal Tummy muscle separation

Camilla Lawrence talks to Luke Salkeld from Peppy Health
30th Sept 2019

A common but poorly understood condition

A gradually growing bump is perhaps the least surprising and most visible sign of a pregnancy in progress. But what happens to that tummy after a baby has arrived can cause some women unexpected distress.

Whether it’s an ongoing distended or bloated abdomen, doming down the centre-line of the stomach with certain activities, or a surplus of fatty tissue that just won’t go away, the post-baby tummy may present itself as an unanticipated and unwanted physical aspect of motherhood.

Women’s health physiotherapist, Camilla Lawrence, says one of the things she looks for in patients who have given birth is whether they have what is known as “diastasis recti” – or tummy separation.

Without getting too technical, this is what happens when the two sides of the abdominal (Rectus) muscles stretch apart during pregnancy, to make room for the growing baby. That stretch or separation widens a strip of tissue which runs down the middle of the stomach, known as the linea alba.

It is a completely natural (and essential) process, and by the end of the third trimester, all women will have experienced some degree of separation to accommodate their increasing bump.

But after the birth, if a significant separation and widening of the linea alba remains, it can have an obvious effect on a woman’s appearance, core strength, and her morale.

Camilla explains: “After the tissue stretches and widens during pregnancy, whilst the tummy muscles are still sitting there on either side, further apart than they used to be, you obviously don’t have the same tensile strength across your core.”

The reasons why some women experience greater and longer lasting separation of their stomach muscles are still being debated. Age, hormone levels, size of your bump and baby, connective tissue adaptability and the number of previous pregnancies, may all have a part to play.

Tummy tightening

There are some women who have never heard of diastasis recti, who seek help from Camilla about back pain or pelvic floor problems, only to discover on assessment that they have a tummy separation and this may be contributing to their symptoms.

“We certainly have plenty of women who come to the clinic complaining of back or pelvic pain, and then we check their tummy and they’ve got a significant diastasis,” says Camilla.  “Luckily it’s very easy to test for, and we can then start to address this as part of their treatment”

“During pregnancy, the obvious sign of a diastasis is a doming, almost like a road hump, down the middle line of the stomach when you do a sit-up movement, like sitting up in bed or in the bath.

She continues: “Postnatally, women may also notice that their stomach feels weaker and is more distended than it was before they were pregnant – some describe that it still looks like they are pregnant months after they have given birth.”  This can be really upsetting, Camilla says, when many of her patients are concerned about their appearance as new mothers.

“There’s such pressure these days to get back into your jeans, and for everything to look perfect after you’ve given birth,” she says. “And it can be really distressing to have someone asking you when your baby’s due if you had it months ago.”

Bespoke exercise

Camilla strongly advises any mother concerned about her stomach to go and see a specialist women’s health physiotherapist who would be able to fully assess and confirm if they do have a diastasis, before providing advice and an individualised exercise program to safely retrain the muscles involved.

A physiotherapist would also be able to address any other contributing factors (such as posture, altered breathing patterns, possible c-section scar tethering and restrictions in associated joints through the back and pelvis).

She says: “A good number of patients come in saying, ‘I’ve been doing loads of planks and sit ups, and my stomach is still really big’.” But she explains: “These are high level abdominal exercises. After a whole pregnancy of those muscles and connective tissue lengthening whether you’ve got a diastasis or just general weakness in the core, we usually need to be starting with low level exercises, and then gradually build back up”.

Likewise, she sees other women who wonder why their tummy hasn’t just snapped back into perfect shape by itself – forgetting that their body has grown a baby and that their tummy muscles and connective tissue have had nine months of stretching and getting weaker.

She stresses: “It takes time, and bespoke exercises to make the abdominal wall and linea alba firmer again. It’s a gradual process, with constant progression.

“Our connective tissue and our muscular system do not get stronger unless we start to move, exercise, and load. But it’s about loading without straining, and if you work with a professional, they will know the points at which you’re doing too much, or too little, to get your tummy back to what it was.”

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