Closing the Gap on Mummy Tummy
Your post-pregnancy bulge may actually be Diastasis Recti Abdominis
By Monique Molino
Photo credits: Sharon Giordano
As a triathlon athlete and Pilates aficionado, it wasn’t as if Paige was out of shape. But when she performed certain core exercises, her postnatal tummy produced a frustrating little mound that looked like a hot dog under her skin. In Pilates mat class, she periodically experienced back pain and saw that same mysterious bulge pushing through the gap between her six-pack abs. When she finally saw her doctor, Paige learned she had a disorder called Diastasis Rectus Abdominis, also known as “abdominal separation” and more commonly referred to simply as “mummy-tummy.”
Normally, the rectus abdominis muscles are joined at the linea alba, a fibrous structure that runs down the midline of the abdomen. However, with Diastasis Rectus Abdominis (DRA) these abdominal muscles split into left and right halves.
“I was able to run my first 50 mile ultra marathon so I figured I was fit, but I still looked like I was four months pregnant,” said Paige, a mother of three. “I wanted to fix the pooch as much as possible, but also knew that I was going to run into problems, such as back pain, if I didn't strengthen and fix my problem as much as possible.”
Men, women, and children can experience DRA for different reasons, such as genetic predispositions, excess abdominal mass, poor core exercise flexion technique, and heavy lifting. However, the disorder is most common among pregnant or postpartum women, when the abdominal wall is stretched by the growing uterus. Especially susceptible are women over 35 and/or those who have had multiple births and/or C-sections. More than half of all pregnancies may result in DRA. Premature babies may also develop the condition when the rectus abdominis is not fully developed and sealed.
Health risks aren’t normally associated with DRA and in most cases the condition usually heals on its own, although if pain is present, surgery may be needed. While DRA can be considered cosmetic, the disorder can result in lumbar (lower back) pain, weak and often tight abdominals, pelvic floor dysfunction, and postural misalignments. Not to mention that a gap in the muscles makes for a weak core and a weak core makes one more susceptible to injuries. According to an article by Mayo Clinic obstetrician and medical editor-in-chief Dr. Roger W. Harms, DRA can impede simple daily activities, such as lifting heavy objects or other routine activities.
DRA and Exercise
Think of DRA as a broken zipper that has split down the middle. When you hunch, rotate or arch your back, the motion increases pressure and pushes your internal organs forward where they can poke through the “split zipper,” resulting in a bigger abdominal gap. This is why, when exercising with DRA, it’s important to avoid movements that exert pressure on your core, such as crunches and leg lifts. These movements will not help firm your “mummy-tummy” but will actually exacerbate the condition.
“I didn’t know that some exercises can actually make the condition worse for new moms,” said Paige, whose youngest child is three. Her doctor recommended a tummy-tuck, but the Montara resident chose to explore exercise as a corrective measure. “My trainer is helping me tone my stomach so I don’t do additional damage,” she said. “The process has been slow, but I’m seeing huge improvements with my swimming and especially with my running. The surrounding muscles definitely feel stronger.”
Certain exercises, like Pilates and yoga, can help you regain abdominal strength. If your health care provider confirms you have DRA, your next step is to find a physical therapist, personal trainer, or wellness guide who is versed in DRA rehabilitation. A professional can teach you how to gently and safely perform appropriate exercises.
Dealing with DRA: Listen to Your “Gut”
What is your emotional state? Negative emotions are known to slow down or negate physical healing because the body is consumed with anxiety. Alleviate stress with soothing practices like taking a walk, doing Qigong, or meditating. Engage in cardiovascular stress busters such as indoor cycling, but be sure to avoid activities that encourage forward-lateral movements, like tennis or volleyball.
How is your diet? Good nutrition is always important, but never more so than when healing from an injury. Maintain a healthy balanced diet that keeps stools moving and promotes optimal tissue healing. Steer clear of processed foods, stay hydrated, and eat smaller and more frequent meals.
Pull yourself together with a DRA splint. Ask your health care professional about a splint, which will help close your outer muscles and hold them together in the correct position so that connective muscles and tissues may begin healing. However, bypass corsets or compression belts. These items might compress, but won’t reconnect your muscles and tissues.
Strengthen your core. Splinting alone won’t cure DRA but, in tandem with a strong core, will help support your internal organs.
Recovering from DRA varies with each individual. Some might need a combination of resources, including the surgery better known as a tummy-tuck. Being attuned to your changing body’s needs and working with professionals are your starting point from which you can begin to heal.
SIDEBAR (Photos with captions)
Under the guidance of a wellness professional, learn how to perform basic movements that will strengthen your core and help facilitate recovery.
This simple exercise provides little to no pressure on the DRA and also engages the psoas (hip flexor) muscle that helps stabilize the torso. Lying on your back, lift one foot off the ground with knee bent, then control its slow descent and repeat with other leg. Keep abdominals braced and don’t tilt hips.
This exercise helps you feel the connection of your transversus abdominis while engaging the glute of your moving leg. Lying on your back, feet on floor, knees bent, inhale to prepare. Exhale and slide one heel forward along the ground; inhale draw it back again. Keep hips level and steady, so you feel like you are pulling your hipbones towards each other with your abdominals.
This final position is not an exercise, but a reminder of the importance of good posture. A healthy body alignment is essential for keeping your core and internal organs toned while moving. Whether slouching with hips thrust forward or sticking out your ribs in military stance, either position will be exaggerated when you have DRA. Instead, stack your head, shoulders, ribs, hips, and ankles in one straight line, your tailbone neither tucked nor sticking out. Keep your gluteal (rear end) muscles engaged when you walk, brace your abdominals lightly, imagine the front of your ribs lining up with your rectus abdominis, and relax your shoulders. This alignment keeps your abdominals working optimally as you move throughout the day.
Monique Molino is a Pilates instructor at the Peninsula Jewish Community Center (PJCC) in Foster City. She holds a Bachelor of Arts in Dance from Mills College in Oakland, CA.