Abdominal Muscle Separation During Pregnancy

Abdominal Muscle Separation During Pregnancy

What is abdominal muscle separation?

During pregnancy the abdominal muscle wall can separate in the middle. The fibrous band between the abdominal muscles softens, so that your abdominal muscles and this band can stretch to make more room for the growing baby. Sometimes the muscles will separate enough that you notice a bulge when you lift your head and shoulders as you go to get up off the floor or out of bed. You may also notice this when getting out of the bath, or out of a chair.

Hormones produced in pregnancy allow the elastic tissue and the muscles to relax and soften which often results in a gap like depression between the 2 muscle bellies referred to as a separation. Note that it is not a split as the muscles are intact but just set apart wider than usual.  It becomes more like well used elastic. In pregnancy the gap is often noticed as a central bulge or 'tenting' when sitting up from lying down, or when standing, the baby appears to be sitting very low.

To check whether you have a separation, or how large it is, refer to As Your Shape Changes, and use the charts in the booklet to record your measurements. You can then monitor that it goes away again after your baby has been born.

How to check for abdominal muscle separation

You can check for separation anytime during your pregnancy by following these instructions:

  • Lie on your back and bend your knees, feet flat on the floor.
  • Slowly put your chin to your chest. Raise your head and shoulders until your neck is 6 to 8 inches from the floor. Hold one arm out in front of you.
  • With the other hand, check for a gap (usually present in the first few months of pregnancy or postpartum) or a bulge (present in last 3 months of pregnancy) in the middle of your abdomen. There may be a soft region between the muscle, wider than two fingers' width.
  • If any separation is found, avoid further separation by:
  • Doing mild abdominal strengthening while crossing your hands over your abdominal area to support and bring the muscles together.
  • Exhale as you lift your head; this decreases pressure in your abdomen and allows your abdominal muscles to work more efficiently.
  • Avoid abdominal bulging by consciously contracting your abdominal muscle when lifting and avoid straining of any kind.

How to Avoid Abdominal Muscle Separation During Pregnancy

Your should try to reduce the strain on your abdominal muscles as much as possible during pregnancy and soon after you have had your baby, until this gap goes away. You should not "jack-knife" when you move from lying to sitting. This means that instead of sitting straight up, you should roll over onto your side and use your hands to push up into a sitting position. When getting up from a low chair, you should wiggle forward in the chair and then get up without putting strain on your abdominal muscles.

You should also avoid exercises which place strain on the lengthened abdominal muscles, including sit ups, abdominal curls and crunches during pregnancy (remembering that after 16 weeks you should not exercise lying on your back anyway). Even modified abdominal curls or crunches, for example while lying on your side, may still place strain on the abdominal muscle wall and increase the chance of developing an abdominal muscle separation.

Very few women are left with a wide permanent gap, which may reduce over time. Further intervention may then be required if the woman requests it. A surgical opinion may be sought.

Physiotherapy can assist you with assessment, advice and exercises to help retrain the strength and function of all the abdominal muscles and prevent exaggeration/acentuation of this gap and assist in preventing back and pelvic joint pain and dysfunction.

Subsequent pregnancies that are close together should not mean that you cannot prevent premature or an increased diastasis recti and just because you are carrying a multiple pregnancy doesn’t mean you will have increased separation. It is paramount that you close the separation after each pregnancy.

You should continue to follow this advice after your baby has been born, until the separation closes again.

Abdominal muscle separation after pregnancy

To help the muscle come back together, try the following exercises:

  • Lie on your back with knees bent and feet flat on the floor. Place your hands on your abdomen with your fingertips pointing down toward your pubic bone. Exhale as you slowly lift your head (and shoulders, if you can) while pressing down and in with your fingers - that will urge the rectus back together.
  • Take a long towel and wrap it around your torso with the ends in front. As you perform a crunch, pull the ends of the towel towards each other in front of your belly button, which will also urge the muscle back together.
  • Lie on your back with knees bent and feet flat on the floor. As you exhale, slowly extend one leg along the floor, feeling your abdomen contract below your belly button. Inhale as you return to the starting position. Repeat with the other leg.
  • Recheck the separation every week. If you don't notice any improvement after 4-6 weeks, consider speaking with your caregiver to get a referral to a physical therapist specializing in postpartum issues.