For many postnatal women the presence of a Diastasis Recti Abdominis (DRA) aka Abdominal Separation (AS) is a common concern. However, DRA can be easily managed with a little help and guidance from the team at The Fertile Project and some dedication on your behalf.
We mostly hear about a DRA in relation to pregnant and postnatal mamas, as pregnancy is considered a major factor resulting in natural separation, but is not limited to this population (for more information please check out our blog on DRA myths). During pregnancy the growing and developing baby puts added stress and strain onto the muscles and fascia of the anterior abdominal wall (our stomach region). It is natural for the connective tissue along the linea alba and rectus sheath (the tissue that connects and contains the two sides of our abdominal muscles) to stretch. This stretch allows the abdomen to expand with the growing baby. If this connective tissue stretches so that there is a two finger gap between the sides of the rectus abdominis (aka the six pack), it is defined as a Diastasis Recti Abdominis or DRA.
At The Fertile Project, we are not concerned with the size of your gap, we believe a two finger gap is exactly that, a two finger gap. Rather we are interested in whether or not your body is able to generate tension within your linea alba. Is the DRA functioning well? A well functioning DRA involves the body being able to contain intra-abdominal pressure. How do I do this? By engaging your deep core muscles and ensuring that they are coordinated; this requires whole body alignment and the ability to move well. A functioning DRA creates an optimal environment for healing and recovery.
Some of the factors contributing to a poorly functioning and/or non healing DRA, is poor breathing mechanics, poor posture, poor movement strategies, poor gastrointestinal health and the inability to control and contain intra-abdominal pressure (IAP), for this reason; men, women (pre & post children) athletes (in particular, those lifting heavy weights) and children are all susceptible to DRA.
What is Intra-Abdominal Pressure (IAP)?
The pelvic floor muscles, deep abdominal muscles, back muscles and the diaphragm (breathing muscle), make up one’s core. Together, amongst other things they support the spine and control the pressure inside the abdomen.
The internal pressure within the abdomen varies during different activities. Some activities give rise to an increased internal abdominal pressure, such as lifting a weight, coughing, sneezing or simply getting out of bed. However, when the weight is put down or we finish coughing or sneezing – the internal pressure returns to normal.
Ideally, the regulation of pressure within the abdomen happens automatically. If any of the muscles of the ‘core’ are weakened or damaged, either by biomechanical restrictions through the pelvis or spine and ribs, an imbalance in the whole body alignment or a neurological/nervous system issue, this coordinated automatic action may be delayed or absent.
If your intra abdominal pressure is not properly contained, the pressure can travel down to strain your pelvic floor or head north and impact reflux. If the pressure is moving out, it will add to the stress and strain on the connective tissue of the linea alba, aiding in the original development of a dysfunctional DRA. This extra load may also prevent your already present DRA from healing. The mummy belly or little pouch that mamas might get, can be a sign that the body lacks the ability to contain this pressure.
What’s next? What can I expect when I see one of the pelvic health osteopaths at The Fertile project?
At The Fertile Project, helping those with a non functioning DRA is about working out the why and the what. Why is the regulation of the IAP dysfunctional? What is putting extra load on the linea alba? Does it involve a poor movement pattern and/or a poorly engaging core? Is it diet related?
We will look at your whole body, assess your functional movement patterns and potential breathing dysfunctions, as well as looking at your alignment and the muscles, joints and fascia that are potentially responsible for silencing your deep core, and in turn, impacting your ability to control IAP.
We will use real time ultrasound to assess your deep abdominals and to see if co-contraction exists between the deep abdominals and pelvic floor muscles. If required there is the option for an internal assessment of the pelvic floor muscles. Together we will develop an individualized treatment plan, including treatment to any musculoskeletal factors contributing to the DRA along with specific movement practices and advice on lifestyle modifications to assist with the healing process.
The essential parts of your treatment include; knowing when your movement practices are non-optimal and by that I mean adding inappropropriate stress to your DRA, education about how to monitor this and recognising the signs to look out for that may suggest you have poor regulation of IAP. Knowing how to adapt your movement so that you can continue to strengthen and move your body in a safe manner, without reinforcing the dysfunction is essential.
Things to look out for that indicate you are not containing the IAP during movement and or exercise;
- Presence of a visible doming (tenting) of the abdominals either when exercising or even when you are moving around e.g. rolling over in bed or getting out of a chair.
- The sensation of pelvic pressure, a bulge or dragging in the vagina or pelvic area when exercising.
- Low back, pelvic and/or deep hip pain during exercise.
- The presence of accidental urinary or fecal leakage during exercise.
If you are experiencing any of the above symptoms when exercising it is essential that you cease that specific activity immediately and see an Osteopath trained in pelvic health (or physio). If you’re a practitioner and one of your patients is experiencing any of these symptoms, you’ll need a pelvic health practitioner in your referral network.