Thursday, August 28, 2014

Diastisis Recti (aka Abdominal Separation)

Yes, it is normal to go HUH when a scientific name gets thrown in the heading :P.

I have been wondering alot on this situation and concluded myself that all women who goes through a pregnancy phase cannot run away from their abs widening. Why we can't feel it of course is the 'relaxin' hormones that preps up for women to bear a new being in them.

That's why you get alot of people fussing 'take care ok, be careful ok' etc.

Even doing anything that works our rectus abdominis aka our abs we see physically, will encourage diastisis! I thought plank and push ups are ok but nooooooooo, there is more to that.

avoid crunches
 
Yikes...
 

So what are the exercises that us bearing little ones can do to aid ourselves from the nagging pains and gear ourselves for labour?? Check out the last two questions. It does get rather frustrating. That shall be covered in the next post or if you're sharp enough the author below will let you know :)

The author below explains the best along with the links she provide. Super uber useful. Enjoy!

Courtesy of fit2be mom who has got 7 kids! And befitmom who gives a good explanation about what it is =) plus lion mom rawr

What is Diastasis Recti?

First, an anatomy overview. The rectus abdominis muscles are the abdominal muscles running down the center of our bellies. The left and right side of these muscles are joined together by connective tissue, called the linea alba.
Diastasis recti, or abdominal muscle separation, is the separation of the left and right sides of the abdominal muscles. Many women call this condition “mummy tummy.”

Who’s at Risk for Diastasis Recti?

It’s common for babies to be born with diastasis recti, especially premature babies. Usually no intervention is required and the gap will close gradually as the baby grows. Later in life the risk of developing diastasis recti increases for adults who:
1. are overweight in the abdominal area;
2. lift heavy weights incorrectly;
3. perform excessive and inappropriate abdominal muscle exercises;
4. are pregnant.

How Common is Diastasis Recti in Pregnancy?

Every woman’s abdominal muscles widen and stretch during pregnancy. This is what the muscles were designed to do. The condition diastasis recti occurs when the abdominal muscles separate or do not close after pregnancy. Health professionals may use different methods of diagnosing diastasis recti. Some consider any gap width diastasis recti and others may look for a gap wider than 1 – 3 cm. Studies have shown that between 35 – 62% of women have diastasis recti postpartum.
There are many websites reporting that 90% of women are experiencing diastasis recti during pregnancy. This is simply not the case and there is no research to support this. As stated, the stretching of the abdominal muscles during pregnancy is a perfectly natural occurrence. The gap will usually close naturally 6-8 weeks postpartum. If it does not, this is when you need to consider treatment.

Now here’s the kicker: It’s often the pushing phase that makes DR way worse! You can go all pregnancy with little to no DR and then have a traumatic birth with a long, arduous pushing phase where you’re bearing down all wrong, or you might have a surgical birth where your abs get sliced apart, doing major nerve damage, and that’s where the DR happens. More on that below…

What Increases the Risk of Developing Diastasis Recti in Pregnancy?

Diastasis recti usually develops in the second or third trimester of pregnancy. This is a pressure related condition, from the force of your uterus pushing up against the back of your abdominal wall. Factors that increase a pregnant woman’s risk of abdominal muscle separation are:
1. excessive weight gain during pregnancy,
2. older maternal age (over 35),
3. multiple pregnancies,
4. close successive pregnancies (within one year),
5. pregnancies with multiples,
6. anterior pelvic tilt.

What are the Health Implications of Having Diastasis Recti?

A diastasis recti of more than 2.5 cm can cause health implications. This may include lower back pain, hernia, and incontinence issues (because of the relationship between the abdominal wall and pelvic floor). A mild diastasis is mostly a cosmetic issue for postpartum women – hence the “mummy tummy” term, which is a bulging of a woman’s abdomen that diet and exercise cannot fix.

How do I Check for Diastasis Recti?

This is a great video for learning how to check for diastasis recti, as well as a corrective exercise, the pelvic tilt. Warning: there are many videos on YouTube about this subject, but not all can be trusted!! The one below was recommended to me by a women’s health physiotherapist.

How is Diastasis Recti Related to Pelvic Floor Muscles?

Your abdominal muscles and pelvic floor muscles work together. What goes up must come down, what goes in must go out – so to speak. Diastasis recti affects the pelvic floor and vice-versa. In a U.S. study of women with diastasis recti, 66% also presented pelvic floor dysfunction symptoms. This includes urinary incontinence, faecal incontinence or pelvic organ prolapse symptoms. Learn more about how your delivery method may affect your risk of developing pelvic floor dysfunction.

Can I heal my DR while pregnant?

I’ve witnessed and heard countless stories of many women closing their gaps while pregnant! Kelly Dean, licensed physical therapist and owner of The Tummy Team, presented a couple case studies at her workshop “The Importance of Core Strength in the Prenatal & Postnatal client” regarding women who finished prior pregnancies with 4-6 finger gaps, closed them with physical therapy on their core, then went on to finish subsequent pregnancies with 2 finger gaps that closed within 6 weeks. She’s also had clients close their gaps during pregnancy and I’ve had members report the same, usually during the 1st or 2nd trimester. They find out they have diastasis at the same time they learn they’re pregnant. They start the work of aligning and targeting their transverse, and it closes a bit or all the way. Then baby grows, and belly expands, and maybe it opens up a bit, but then the DR closes right back up again shortly after delivery! Kelly’s research has led her to state that 98% of women who have been pregnant will have diastasis, but about 2% of women don’t have diastasis after pregnancy. But those are studies on women who’ve never had rehab or TummySafe Fitness ;)
“Remember how I said I was starting to feel separation above and below my navel? Well after being very faithful with my alignment, tummy safe workouts and not letting my “guts spill on the floor” everytime I bend over, I am happy to report that I no longer feel any separation! Which is amazing because my baby belly has grown quite a bit in the meantime!” Fit2B in Nebraska, Bethann W. 28 weeks" 
 

Should I splint during pregnancy?

No one would deny a cast to a person with a broken leg and tell him, “Oh just stand right, and keep your leg muscles tight, and it will get better all by itself!” Um, no. your belly is truly broken, and it needs that extra support. When the two sides of your abdominal wall have separated to 3 finger-widths or more, your belly will have a really hard time “getting a grip” again. It’s an injury, and it needs support! Kelly Dean of The Tummy Team recommends splinting when a diastasis is 3 finger-widths or wider, and she also made a strong case that splinting can help fight post-partum depression regardless of presence of diastasis recti. It is usually not necessary to splint during the first trimester of pregnancy, but it is often recommended for later stages. Click HERE to read our Splinting info page and recommendations
 

Should I splint after delivery, even c-section?

YES! You should. Kelly Dean of The Tummy Team and I are working hard to get the word out that no woman should leave the hospital or birth center without a splint and a prescription for abdominal rehab. They’ll give you these things if you merely ask nicely. It’s common practice in many hospitals in my area to provide splints after multiples birth or ceasarean section, but not for vaginal birth; meanwhile some hospitals don’t offer any splinting. There’s no consistency in America, but postnatal belly binding seems more common in other countries.

What moves should I avoid while pregnant?

The fast answer is that you should avoid crunches, sit ups and planks. But the more detailed, personalized answer is that you should avoid any exercise that increases pressure within your belly, any move where you cannot tighten your transverse abdominis against gravity’s pull on your belly, and any move where you cannot maintain good balance and alignment and proper breathing technique… Oh and anything where you lie flat on your stomach once the uterus rises out of the pelvis. But doesn’t that feel a bit like I’m telling you that you can’t do anything at all? Because sometimes you don’t know until you’ve tried, and by then it’s too late and you’ve just made your diastasis worse and maybe even mal-positioned your baby. Believe it or not, there is QUITE a bit you can do on your back well into the 3rd trimester that HELP position your baby! So here’s some articles about why crunches stink, and for fun I’ve also included proof that the fitness industry is still selling sit ups to pregnant women!!! Gah!
 
 
This article by Katy Bowman makes a strong case for avoiding treadmills and high heels, too! Click HERE to read “4 fast fixes for pelvic floor disorder.”
Want proof that the fitness industry is still teaching that crunches/situps are okay for pregnancy women? Well, the American College of Sports Medicine says situps okay for pregnant women in THIS ISSUE of Certified News. And there is ZERO mention of diastasis recti in that article. Sigh.
 

What motions should I focus on while pregnant?

I’m starting to like the word “motion” over the word “exercise” because most people might object to “exercising all day” but they can’t object to being “in motion” all day. We move to live. We live to move. And certain movements are WONDERFANTABULOUSO when you’re preggers. Below this amazing picture there are more articles for you to read. Basically it boils down to aligning, walking and squatting, though.
 
Here’s my article on the 3 best exercises for pregnancy and birth… yeah I said exercise because I do LOVE exercise motions
 
Here’s a guest article written by Kim Vopni of pelvicfloorwellness.com for Fit2B Studio that details her professional opinions about the best exercises for pregnancy and post-partum. It’s wonderful advice!
 
Here’s one of my fave epic squatting blogs by Katy Bowman called “What to Expect when You’re Squatting.” Okay, I admit it: I’m a Katy Stalker!

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