What is it?
Abdominal Separation occurs naturally in many pregnant and post natal women. The two parts of the rectus abdominis (“six pack”) muscle are attached down the centre of the abdomen by a fibrous band called the “linea alba”. During pregnancy, the linea alba stretches to allow the muscles to spread apart and make room for the growing uterus. We call it “Abdominal Separation” when the muscle bellies spread more than 2 finger widths (approximately 3cm) apart. One study reports that 33% of women have a separation by the time they are 21 weeks pregnant, 60% at 6 weeks after the birth, 45% 6 months after the birth and 33% at one year after the birth.We don’t fully understand why some women develop larger abdominal separation than others. It does not seem to be related to a woman’s age, height, weight, abdominal circumference or the size of her baby.
Is it a problem?
Most women are eager to decrease their abdominal separation so that they can return to their pre-baby abdomen and be strong and healthy to cope with the physical demands of motherhood. It is important to know that some women will always have a small abdominal separation after birth and can still function well and regain a flat and strong abdomen. Some women are concerned that they are more likely to develop back pain with abdominal separation. In fact, women with mild or moderate abdominal separation are no more likely to develop back pain within the first 12 months after birth than those without it.
What can I do about it?
For most women, their abdominal separation decreases from straight after the birth until 2 months after the birth.After 2 months, the separation doesn’t seem to get much smaller by itself so it seems important to treat abdominal separation early after birth. If an abdominal separation is wider than 4 finger widths (5cm), we give an abdominal support stocking (called tubigrip) to wear during the day or recommend pregnancy recovery shorts.
General exercise and especially abdominal exercises can decrease the abdominal separation though we are still waiting for more research to make clear exactly what exercise works best.There is some evidence that supported abdominal crunches decrease the abdominal separation.It is certainly important to strengthen the 4 layers of abdominal muscles along with the pelvic floor muscles after birth, especially if there is an ongoing abdominal separation. A women’s health physiotherapist will be able to assess your separation and set a specific exercise program to help you improve your abdominal strength and co-ordination. It is best to book an appointment for 6 weeks after the birth so that you can have a comprehensive post-natal assessment of your abdominals and your pelvic floor.
Pelvis Floor Muscle Exercise
The pelvic floor muscles are a group of muscles that sit at the base of the pelvis and function to help you stay continent. They also have an important role in supporting your pelvic organs (bladder, uterus, bowel) and supporting your back by increasing pressure in the abdomen.
To exercise them first try lying on your back with your feet bent up.
Take a deep breath in and imagine you are in a busy lift and need to pass wind.
As you breath out, try and squeeze and lift your pelvic floor muscles up inside you to stop from passing wind.
You should not see your legs or buttocks move with a pelvic floor muscle contraction. It is very important that you are not holding your breath or straining or pushing downwards. It should feel like a small lifting, sucking in movement.
Once you can contract this muscle you can practice this exercise in any position. It is important to squeeze and lift the pelvic floor muscles before lifting, sneezing or any activity that increases pressure in your abdomen.
There are many other exercises that you physiotherapist can provide you once they asses you. If you have any concerns our would like to make an appointment for Women’s Health please call Penrith Physiotherapy Sports Centre on 4721 5567 or you can book online.