"Congratulations! When will it be time?" Many a new mum has heard sentences like this. This is usually followed by an awkward silence, as the child's first birthday may be just around the corner. Mums who look "pregnant" for a long time after giving birth often have rectus diastasis. This phenomenon, also known as out of alignment, means that the abdomen bulges forwards and feels very soft because the two straight abdominal muscles are further apart than usual on either side.
These two straight abdominal muscle cords are known in Latin as the rectus abdominis muscle and run vertically between the sternum and pelvis. "Diastasis" is the medical term for the gaping apart of muscles or bones, for example.
How does rectus diastasis occur?
In principle, every woman experiences this during pregnancy: The baby grows in the uterus, gets bigger and bigger and takes up more and more space. Increasingly, everything that is "in the way" has to make room for it: the mother's internal organs, but also her straight abdominal muscles. These move to the side. This is also possible because pregnancy hormones have loosened the entire musculature in the mother's body.
The straight abdominal muscles are connected to the so-called linea alba. This is a kind of vertical "strip of tissue" made up of tendons and fascia and contributes significantly to the stability of the entire centre of the body. During pregnancy, the linea alba is stretched considerably by the bulging abdomen.
Now you might think: No problem! Once the baby is born and the uterus has contracted back to its original size, the straight abdominal muscles can move back into their old position and the linea alba can contract. This happens almost automatically during the first six to 12 weeks after the birth and is normally supported by postnatal exercises.
Unfortunately, this is not the case for 60 per cent of all mothers. For them, the rectus muscles are still separated six weeks after the birth - and for 32 per cent of mothers even on their child's first birthday. This means that a gap remains between their straight abdominal muscles. This is called rectus diastasis.
If you also have such a gap, you could even feel it. To do this, lie on your back with your legs bent and raise your head and shoulders slightly to tighten your abdominal muscles. Now, with two fingers pressing firmly into the abdominal wall above and below your belly button, you can feel whether you are hitting muscle cords or a gap between the two cords.
CAUTION: However, please do not repeat this test, as the straight abdominal muscles must not be loaded with straight movements. Otherwise, you will further increase their drifting apart.
The midwife or doctor can also feel a postnatal rectus diastasis.
What symptoms can occur with rectus diastasis?
- Pain, Mainly back or "low back pain", but also headaches or abdominal pain
- Loss of strength of the fuselage
- Other: involuntary urination, incontinence, prolapse of internal organs, digestive problems, etc.
All of this is unpleasant and can have a very negative impact on life in the long term. To make matters worse, affected women often suffer greatly from their bulging tummies, which do not want to flatten out despite exercising and losing weight. As an extreme example, I would like to tell you about a now 34-year-old mum. She gave birth six years ago, so her daughter is about to start school.
This mum - let's call her Karola here - actually wears a size 40/42 today, so she has a normal "build". In reality, however, she still has to resort to 50 sizes because she continues to suffer from a "noticeable pregnancy belly". Karola has tried everything to combat this: she has been on countless diets and done long, intensive workouts at the gym, but nothing has helped. She had actually already given up and resigned herself to baggy jumpers and trousers in XXXL.
In my online midwife counselling we were then able to gently work out together that no attention had been paid to a possible rectus diastasis during her postnatal recovery and that she had been doing all the wrong exercises at the gym. All of this made Karola's problem worse.
For many weeks now, she has been taking part in my online postnatal course and also trains intensively every day at home - with the right Exercises for rectus diastasis. The actual problem lies not only in the appearance, but above all in the impaired stability of the centre of the body. This stability is created by the fact that the strip of tissue (linea alba) is integrated into a sophisticated interplay of straight and oblique abdominal muscles, back muscles, pelvic floor and diaphragm. If this system becomes and remains unbalanced, as in Karola's case, the body's overall stability is weakened.
The first successes have given Karola new courage - for example, she already has much less headaches and back pain! And I'm sure that her stability will return and her stomach will become flatter if she keeps at it and is patient, even so many years later.
Aim of the exercises
According to the latest findings, the primary goal is not to close the gap completely but, as with Karola, to regain and strengthen the stability of the centre of the body. To do this, you need to do very specific training sessions. Even if you don't start until years after the birth, this will help your body.
Very important: Don't start with any ambitious exercises on your own! Otherwise, like Karola, you will do more harm than good. For example none exercises on the training plan that specifically target the straight abdominal muscles.
If you have the feeling that you might be affected by rectus diastasis, or if you have felt it on yourself, don't be afraid to do something about the consequences even years after the birth! The best thing to do is to contact a physiotherapy practice that can offer you specific therapy and show you appropriate exercises. Of course, you can also contact me.
Only in rare cases is consistent training not enough. In this case, an operation is necessary to get the muscle gap and its consequences under control again. Unfortunately, health insurance companies do not usually cover the costs of such an operation.
Does prevention help against rectus diastasis?
Pregnant women with above-average weight/large foetuses or multiples have a higher risk of rectus diastasis. The same applies to very slim, athletic women and expectant mothers who are overweight or gain a lot of weight during pregnancy. Women who have already had one or more births are also more likely to be affected. Factors that are sometimes difficult or impossible to influence also play a role here.
And regardless of this, rectus diastasis cannot be completely prevented in advance - but it can at least be minimised.
There are a number of things you can do during pregnancy and after the birth to minimise the gap between the straight abdominal muscles or to close it more quickly. This includes, for example, not overtraining your abdominal muscles during pregnancy. Also get into the habit of lying down on your side and standing up on your side. This also applies to the postnatal period. This will take the strain off your straight abdominal muscles. Also avoid heavy lifting. After the birth, regular Postpartum and postnatal gymnastics. Talk to your midwife about specific exercises for rectus diastasis that you can do on your own.
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