Separation of the abdominal muscles in pregnancy and beyond

(also known as split rectus sheath or separation of the abdominal muscles)

What is diastasis of the rectus abdominal muscles?

During pregnancy, your tummy muscles stretch to allow room for the baby to grow. The linea alba, the connective tissue which connects the two sides of the rectus abdominus muscle, thins and lengthens to allow room for baby to grow. For some women this can lead to doming of their tummy eg when they try to get up out of bed. It affects all women in pregnancy but the degree of lengthening that occurs may be different for each individual.

This is due to the growth of the baby in the uterus pushing against the abdominal wall, and pregnancy hormones that soften the connective tissue. It is usually a painless condition and after pregnancy it is often common to have a gap of about one to two fingerbreadths between the tummy muscles. This is not a problem and will usually heal within 6-8 weeks following the delivery of your baby. Following the exercise advice in the Fit for the Future leaflet will help you strengthen your tummy muscles.

However, if the gap is wider than 2 fingerbreadths and you have a visible “doming” of your tummy when you sit up we recommend following the advice and exercises below. You will also be invited for a physiotherapy follow up appointment at six weeks to check your tummy and progress your exercises appropriately.

1) In the early days try to avoid activities that cause your tummy or abdomen to bulge outwards. This could include…

• sit ups/abdominal crunches
• holding your baby on one hip
• rising from a lying position by pulling up and twisting at the same time
• intense coughing while your muscles are unsupported
• constipation causing you to strain

2) When getting out of bed, bend your knees up, roll onto your side, drop your legs off together and push up into a sitting position with your arms. Do the reverse to get back into bed.

3) Take care when lifting; remember to bend your knees and avoid twisting. Be intentional with your movements and not rushed. Try to draw in your tummy muscles (see below) and don’t hold your breath. Avoid unnecessary heavy lifting.

4) When you are upright, try to stand and walk tall but relaxed, gently drawing your tummy in and bottom under.

5) Try not to strain when you are opening your bowels. You may feel more comfortable by supporting your tummy in this position and avoid holding your breath.

1/ Connecting with your core muscles.

Your deep tummy muscles form part of the muscular corset of the abdominal wall. Lying on your back with both knees bent, let your tummy relax. Gently breathe in and as you breathe out, gently draw in the lower part of your abdomen (tummy) towards your spine. If you can engage your pelvic floor at the same time. Do not move your back or pelvis as you do this.

Build up gradually, aiming to hold the contraction for 5 – 10 seconds, while breathing normally. Repeat exercise 5 – 10 times with a few seconds of rest in between each one. Once you can do this lying try in sitting and then in standing.

2/ Pelvic tilting with deep abdominal tightening.

Lie on your back with both knees bent up and tighten your deep tummy muscles as above. Without holding your breath, tilt your pelvis to flatten the arch of your lower back onto the floor or bed. Hold for 5 – 10 seconds, then gently release. Repeat exercise 5 – 10 times.

3/ Knee Rolling.

Lying on your back with your knees bent up. Gently rock your knees slowly from side to side as far as you feel comfortable.

Try these exercises up to three times a day.