During pregnancy you may have noticed an abdominal bulging when you sat up from lying down. Sometimes in mid to late pregnancy, the layers of abdominal muscles and connective tissues separate as the uterus expands. It is more common in women with more than one baby, multi-births or in caesarean and non-exercising mothers.

The gap usually occurs around the umbilicus but can spread upwards to the sternum or lower to the pubic bone. The bad news is that a gap over 2.7 cms is associated with back pain, incontinence and even prolapse later in life. The good news is that the separation improves in the majority of women with the right treatment.

To measure an abdominal muscle diastasis

  • Lie on your back with both knees bent.
  • Place the middle fingers of one hand over the belly button with fingers pointing down towards your toes.
  • Lift your head forwards and feel the firm ridges of the rectus muscle either side of your fingers. As you feel the sides of the muscle coming together, note the number of fingers that fit into the gap.
  • Wait 6 to 8 weeks after a caesarean before doing this test.

Tips to reduce the abdominal separation

  • Immediately post partum, wear a cross over diastasis splint with velcro closure or the long line recovery shorts.
  • Wearing the shorts is not enough - forward trunk curling movements and exercises must be avoided.
  • Always roll onto your side to get out of bed.
  • Protect your tummy with coughing by: crossing both arms over abdomen with one hand on either side of the separated muscle. Pull the hands and muscles towards the navel with coughing or sneezing.
  • Consistent strengthening of the pelvic floor and deep abdominal initially, then later, in coordination with the trunk curling and rotating abdominal muscles ensures the best possible reduction of the gap.

The wider the gap, the longer the rehabilitation of your abdominal wall will take. When the rectus muscles and underlying layers of connective tissue do not regain sufficient closure by 12 months post partum, repair by a plastic surgeon may be necessary to improve function.

Before surgery, ultrasound is used to determine the extent of connective tissue damage before deciding to proceed with the repair.

For step-by-step instruction in pelvic floor and deep abdominal strengthening and suitable exercise progressions, refer to Hold It Mama.