Muscle separation / diastasis recti - any advice?

[NewRowSees]

Hi all,

I'm 24 weeks along now. But at about 16 weeks I realised I had a weird vertical "ridge" thing in my tummy whenever I did a sit-up. I was pretty alarmed so I asked the consultant about it at my next appointment - he confirmed that it was muscle separation and said it wasn't a big deal, and went on to say that if I had an ELCS, they could sort it out then.

I later mentioned it to a midwife and she was pretty shocked that he would advise this, and basically implied that there wasn't a chance that would happen (and that he shouldn't be recommending ELCS' without good reason anyway).

I've Googled a bit, and apparently there are exercises that you can do. From reading about other women's experiences, it doesn't seem that mine is too severe, but it's still a concern.

Does anyone have any experience of having muscle separation fixed? I'm really worried that it will cause problems after the birth. I've read about back pain and large bumps post-natally, and just want to know now if there's some way to avoid it all.

Oh, and I should say that this is my second pregnancy - I had pre-eclampsia last time and ended up having an EMCS. I haven't decided whether to go for an ELCS or a VBAC this time round, but this will definitely affect my final decision.

Advice please, lovely ladies!!

Anyone!?

Sorry, not got any experience of this, but could well have been the sit ups that caused it... I would stop those (if you're still doing them) and make sure you use your arms to do things like get out of bed...ie shuffle to the edge of the bed on your side and then use your arms to get to sitting rather than your stomach muscles. I did a course at the hospital I'm due to give birth on physical skills during pregnancy and the women's health physio who took it said we should see her if we got muscle separation so may be worth asking for a referral.

I've had this 3 times, so I know lots about it now. After prompting my GP after my third pregnancy, I was referred to a physio (bumps were huge, separation was enormous) and it's closed up fantastically using her exercises. At 16 weeks post-natal my stomach looks totally flat with clothes on, and gap has closed to 1-2 fingers from 5+.

My bump was shockingly big post-natal - on the post-natal ward I was getting funny looks from midwives like I'd wandered into the wrong place and was still pregnant!

There is so much confusing and contradictory stuff on the web / in courses, that I would thoroughly recommend getting a physio referral if you end up with a large gap (more than 5 fingers).

In the meantime, while you are still pregnant you should not be doing any sort of sit up or anything that vaguely resembles a sit up - keep the gap as small as poss by rolling over to your side to get up from lying, and wriggling to the edge of a chair or sofa, rather than throwing your legs forwards like counterweights. And try not to pick up heavy things (I had to pick up a 3 yo and 1 yo while pregnant, which wrecked my muscles).

I can't advise on post-natal actions after C-section though as I haven't had one & wouldn't want to tell you the wrong thing

Julie tulper has an excellent book - lose your mummy tummy. Stop doing sit ups as they make it worse. You can start her exercises immediately after birth. There is also the mutu programme but tis pricey imo.

There are some exercises on t'internet for diastasis recti that you can do through pregnancy and afterwards but it's definitely best to get professional advice.

Ah ok, thanks very much - I'll definitely ask about a physio referral then. I might just feel a bit silly as it seems like they'd shrug it off as a minor cosmetic thing.

Will check out the exercises too - I haven't done a jot (apart from picking up a toddler) since I realised it could get worse.

Thanks for the very helpful responses.

I had the same thing at 16 weeks caused by the same thing I am sure and am now 37 weeks so no idea as of yet how bad it is. I think you find out post birth.

I try and be really careful about not sitting straight up etc but slip up sometimes.

I'll have to get onto a physio if it's really bad post birth.

I had no idea this wasn't normal!

When pg with my first child I had a gap of maybe 6/7cm. But my bump disappeared very very quickly afterwards, I had a flat (but not toned) stomach within 2 weeks despite not having done anything in terms of exercise, so I'm not convinced the gap is related to the size of your belly after birth.

This time I'm 27+ weeks and currently have a gap of about 5cm. I didn't know there was any issue with it and that I should do anything about it so I'm glad I read this. I'll add it to the ever growing list of things to talk to my mw about next week!

You can do exercises now to help lessen the severity of diastasis in this pregnancy. Standing or seated abdominal compressions (baby hugs) and standing abdominal compressions with pelvic tilts (baby lifts) are very effective.
Avoid all traditional abdominal exercises, all exercises that lift the upper body off the floor, or against the force of gravity, moves that twist the spine, and lifting and carrying heavy objects.
Always perform abdominal bracing before/during lifting and always use the "log roll" technique when getting out of bed or rising from the floor.
Google my screen name to find out more.
BeFit-Mom

What I found puzzling was that I followed Julie Tupler and advice similar to that mentioned by BeFit-Mom after my first two pregnancies (ie no oblique exercises, no traditional crunches) and the gap didn't close much. Then after my third pregnancy, the NHS physiotherapist gave me exercises that pretty much did everything I thought wasn't supposed to do, but in a controlled way, and the results have been fantastic.

It's not really a purely cosmetic problem if you have a large gap... there is no support for your back muscles, and you are very aware of your organs 'popping out' through the gap, so don't worry about your doctor thinking it's silly. I think this is something they are supposed to check at 8 week post natal check anyway.

Can I ask, is this why my back hurts so much during pregnancy, when other women seem to be coping fine? I just made an attempt at measuring my gap at it seems to be about 8-9cm and I'm only 27+5. I'm really struggling with my job as it's in the evenings and by then my back's killing me and my SPD it at its worst.

I'm going to have to start doing these exercises or I'll be all gap and no muscle!

I had this after my first pregnancy. Post-natally I found doing sit-ups with a towel rolled up and pulled taught around my back and then forwards to meet at the front helped. It pulls the muscles back together so you can do efficient sit-ups.

Obviously didn't work that well though as am now 19 weeks with second pregnancy and they've separated again!

I'm not sure if I have this or not. So when I sit forward my bump goes very pointy is this it? I always thought that was normal! Sorry I'm an anxious wreck at the moment.

Practically everyone's muscles will separate during pregnancy - they have to or you wouldn't have a bump! (Maybe not really tall people) It's how separated they are afterwards that dictates if you might need special exercises before you get going with the exercises on the hospital leaflet.

NewRowSees I'd echo what Dark Matter said - the physio exercises after the birth do improve things a lot.

I had a separation of 4.5 after having DD and although the physio helped a LOT, my stomach still isn't right and the GP has said I will need surgery to fix this ...but there's no point in doing it till after I've completed my family.

So if you know that this will be your last baby then it might be worth considering the option the consultant gave you - you'd know exactly which day your baby was arriving, and you'd only have one operation and get both a newborn and a flatter tummy all at the same time which sounds good to me!

Next MW appt do ensure that she notes that you've seen the consultant for this issue, and that you are currently considering whether to have surgery or physio. Then once baby is here, you can breezily say "Could you confirm how I go about booking in for those physio sessions which were discussed and noted at the xx weeks appointment please?"

Thanks so much blondie - will definitely make a note to discuss it at my next appointment. Hope all goes well with yours too!