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"Having a baby is a beautiful, life-changing event. After childbirth, women often struggle to heal from the physical effects of pregnancy and delivery. Many women worry about that post-baby belly because they don’t like how they look. In reality, that bulge might be signaling a bigger issue—diastasis recti—a condition that requires help from a pelvic health physical therapist.
Diastasis recti (DR) is when the left and right sides of the rectus abdominis, an abdominal muscle that stretches vertically from the base of the ribs along the midline of the abdomen to the pubic bone (a.k.a. the “six-pack” muscle,) pull apart from stretching and thinning of the linea alba, the fascial connective tissue between them. This allows the contents of the abdomen to protrude through the opening, creating that post-baby bulge or “mummy tummy.”
Many women are concerned about the aesthetics of having a DR, but what they don’t realize is that its presence indicates dysfunction in the coordination of the stabilizing muscles of the trunk, consisting of deep lower abdominals, the pelvic floor muscles, deep back muscles and the respiratory diaphragm. These muscles work in a synergistic fashion to control intraabdominal pressure and provide stability to the spine and pelvis in the transfer of loads between the right and left sides during movement such as walking, reaching or carrying. Poor coordination of these stabilizing core muscles puts women at increased risk for having back pain or pelvic floor dysfunctions, such as bladder or bowel leakage, pelvic organ prolapse (dropping of the bowel or bladder), pelvic pain (vaginal or rectal pain), or sexual dysfunction (decreased sensation or increased discomfort with intercourse).
There is a common misconception that because childbearing is a “natural process,” that the muscles of the abdomen and pelvic floor will return to their pre-pregnancy state on their own. Research shows that over 66% of women have a DR in the third trimester of pregnancy, 53% continue to have a DR immediately postpartum, and 33% have a DR at 12 months postpartum. Many women see closure of the diastasis in the first weeks after childbirth but those who continue to have a DR at 2 months postpartum have no further improvement without intervention of exercises or physical therapy.
A pelvic health physical therapist has specialty training in assessment and treatment of a wide variety of pelvic floor and abdominal muscle dysfunctions. These specialists can accurately assess a DR by measuring the distance between the left and right rectus abdominis at the navel, above it, and below it while the patient is lying down and while doing a crunch. A DR is present if the separation is greater than 2 cm. There are specialized exercises of the abdominal and core muscles that help improve diastasis recti, however it’s important for women to seek a specialist, as doing these exercises incorrectly can worsen symptoms.
The goal of physical therapy is to retrain women to activate the correct deep core muscles of the trunk at the appropriate time during movement and function allowing for increased trunk stability and decreased pressure throughout the abdomen and pelvis. Fortunately, pelvic health physical therapists are experts in treating the core and pelvic floor and helping women to heal this region of their bodies."
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