Anna Winstanley Physiotherapy York

Diastasis Recti aka Tummy Separation

Diagram of rectus abdominis and diastasis recti

Do any of these sound familiar?

  • Bulging along the midline of the abdominals
  • Mummy tummy appearance
  • Feeling weak during day to day activities like caring for your baby.
  • Negative body image
  • Reduced self-confidence.
You may be experiencing tummy separation or Diastasis Recti. Read on to find out more…

What do I need to know?

It is a normal, adaptive process.

Diastasis Recti is a thinning and widening of the connective tissue between the superficial abdominal muscle layer. This connective tissue is called the linea alba and runs from the pubic bone, up to the breast bone. During pregnancy the linea alba has to adapt to accommodate the growing baby. Without this normal adaptation, your baby would instead occupy the space where your internal organs are, making breathing and digestion even more difficult! 

Can it be prevented?

There are some suggested risk factors for developing diastasis recti:

  • Pregnancy – especially multiples
  • Genetics
  • Chronic straining (coughing, vomiting, constipation)
  • Excessive loading of the abdominals in exercise. 
There is no strong evidence to suggest any prevention strategies specific to Diastasis recti. However, the last two on this list suggest that we do have something to work with. Both of these involve managing the intra-abdominal pressure.

What’s pressure got to do with it?

Intra-abdominal pressure is the pressure generated within the abdomen. It can change depending on what’s inside your tummy (a full bowel, stomach or uterus – hello baby). If the abdomen itself changes shape (during certain movements, during breathing, coughing, sneezing, or when the muscles are stretched out (such as during pregnancy. 

When the pressure inside the abdomen increases, that pressure will push outwards, and if there is a softening of the linea alba, a ‘dome’ or ‘cone’ can appear. This can be disconcerting, but it’s not always pathological and some research has suggested it could even be a positive strategy that your body has to help move that pressure away from other organs or your pelvic floor. 

How can physiotherapy help? 

In a post-natal physiotherapy check up, I can assess the functional integrity of the abdominals in relation to the breath, your symptoms and the ‘core’. I can help you to understand how your body is behaving in real time, and explore different strategies to help you improve your confidence and the ability of your muscles to withstand pressure change. Again, its not a cookie cutter approach – I meet you where you are and look toward your individual goals. 

Common concerns

I’m worried my tummy is going to rip or split open. 

This isn’t going to happen. Although the linea alba has changed, it still retains a high degree of tensile strength. This is a common fear and one which can be a barrier to exercise, but with the right advice and considered gradual loading, it will get stronger. It will FEEL stronger.

I’m never going to be able to lift heavy / exercise / ever again. 

Over the course of your pregnancy your body has adapted gradually. Now, very suddenly, the load and the physiology has changed again! It’s important that you give yourself time to adapt again. Initially you may feel weak and your tummy might feel soft. There may be things you need to limit or modify in the short term, but you should gradually be able to resume activities. Evidence does not support a particular list of do’s or don’ts – each woman is unique. Listen to your body from day to day. 

I don’t like the way my stomach looks or feels post-partum.

It is important to acknowledge the aesthetic impact of carrying  a child upon your body, and it’s totally ok to want to look good. But before you dive straight into a challenging gym programme, please take time to build your foundations back up. This looks different for every woman, but may also incorporate non-physical work. Accepting your body for the amazing job it has done and continues to do, regardless of it’s shape it a really important step in becoming a Mum. If you have concerns about your mindset and emotional transition to motherhood, I offer a safe space to express those concerns too. 

In summary

  • Tummy separation is normal, but some women need help to recover post-natal.
  • There is no set  formula of exercises to “cure” diastasis recti – every body is unique.
  • There are holistic considerations that can also help such a nutrition and rest.
  • Physiotherapy can help you regain strength and achieve your goals. 

To discuss your needs or book a bespoke post-natal physiotherapy check BOOK HERE.

I look forward to spporting you in your post-natal journey 🙂

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Anna Winstanley

Hi I’m Anna, a Women's Health Physiotherapist and Pilates Instructor in York with a nerdy passion for all things women’s health and wellbeing. I’ve worked with countless women over the years, helping them to feel strong, overcome pain and improve their quality of life so they can be marvellous mums, excellent employees and super selves.

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