Connection Between Abdominal Separation (DRAM) & Urinary Incontinence - How Mamas Can End DRAMas.

Understanding and Addressing Diastasis Recti Symptoms

For many women, the postpartum period is a whirlwind of changes—physical, emotional, and mental. While some aspects of recovery from pregnancy and childbirth are widely discussed, others remain underexplored. One such issue is Diastasis Recti Abdominis (DRAM) or abdominal separation. Often associated with the persistent "mummy tummy," can have serious implications beyond aesthetics, affecting physical health and overall well-being. This article aims to unpack the condition and explore why it’s essential for postpartum women to understand and address it.

What is Diastasis Recti?

Diastasis Recti Abdominis refers to the separation of the rectus abdominis muscles—the pair of muscles that run vertically down the abdomen. These muscles are responsible for supporting the torso, assisting in breathing, and stabilising the core. In cases of ABDOMINAL SEPARATION, these muscles are pulled apart due to the stretching and thinning of the linea alba, the connective tissue that joins them.

During pregnancy, a combination of hormonal changes, weight gain, and the growing uterus increases pressure on the abdominal wall. Over time, this can stretch the linea alba, creating a gap of 2.7 cm or more between the muscles. This gap, while common, can persist postpartum, leaving many women with a noticeable bulge in their abdomen. While often dismissed as a cosmetic issue, the effects of abdominal separation can be far-reaching if left untreated.

Who is Most at Risk?

While nearly all pregnant women experience some degree of abdominal separation during the later stages of pregnancy, certain factors increase the likelihood of developing more severe ABDOMINAL SEPARATION. These include:

• Multiple pregnancies: With each pregnancy, the abdominal muscles are stretched again, increasing the risk of separation.
• High birth weight: Carrying a larger baby puts additional strain on the abdominal wall, making separation more likely.
• Improper lifting or straining during pregnancy: Heavy lifting or other strenuous activities can further stress the abdominal muscles.
• Excessive weight gain during pregnancy: Rapid or excessive weight gain can exacerbate abdominal wall stretching.
• Inadequate core strength before pregnancy: Weak abdominal muscles before conception can make it harder for the body to withstand the pressure exerted by a growing foetus.

Research indicates that 53% of postpartum women experience some level of abdominal separation, with 36% still showing signs of abnormal separation 5-7 weeks after delivery. This condition underscores the importance of recognising and addressing it early on in postpartum period.

Beyond Aesthetics: Why ABDOMINAL SEPARATION Matters

The primary visible sign of abdominal separation is the bulging or doming of the abdomen, often referred to as the "mummy tummy." However, its effects are more than just skin-deep. abdominal separation compromises the integrity of the core, leading to functional issues that can significantly impact daily life. These include:

1. Core Instability: The abdominal muscles, along with the pelvic floor, form the foundation of the body’s core. A gap in these muscles can lead to a loss of stability, making simple tasks like standing, walking, or lifting objects more difficult. Women may notice that their posture becomes compromised, with increased lower back curvature and weakened support for the spine.
2. Lower Back Pain: With the core muscles unable to provide adequate support, the lower back compensates for the instability. Over time, this overcompensation can lead to chronic lower back pain, a condition experienced by many postpartum women with abdominal separation.
3. Pelvic Floor Dysfunction: The pelvic floor muscles work in tandem with the abdominal muscles to support the internal organs and maintain continence. When abdominal separation weakens the core, the pelvic floor may also become strained, contributing to conditions such as urinary incontinence, faecal incontinence, and pelvic organ prolapse. Research shows a strong correlation between abdominal separation and pelvic floor dysfunction, with a 2007 study reporting that 52% of women with diastasis recti symptoms had at least one pelvic floor disorder.
4. Severe cases of abdominal separation can increase the risk of ventral hernias, where part of the intestine or other abdominal contents protrude through the weakened abdominal wall. This complication requires surgical intervention and highlights the importance of addressing abdominal separation early to prevent further injury.

Psychological and Social Impacts

The physical consequences of abdominal separation are only part of the story. For many women, the visible bulge of diastasis recti can be a source of frustration and emotional distress. The negative societal emphasis on "bouncing back" after pregnancy often puts pressure on new mothers to quickly regain their pre-pregnancy bodies. When abdominal separation prevents this, it can lead to feelings of inadequacy, low self-esteem, and anxiety.

Moreover, the pain and physical limitations caused by abdominal separation can interfere with a woman’s ability to care for her baby, further compounding the emotional toll. The combination of physical discomfort, body image concerns, and the challenges of new motherhood can create a sense of isolation. As a result, it’s essential to promote open discussions about abdominal separation and other postpartum issues, creating a supportive environment where women feel empowered to seek help.

Preventing and Treating Diastasis Recti Symptoms

While abdominal separation is common, there are steps women can take to minimize its severity and promote healing. The most effective approaches combine prevention, rehabilitation, and supportive care.

Preventive Measures During Pregnancy

1. Core Strengthening Exercises: While it's important to avoid/limit excessive abdominal exercises during pregnancy, maintaining core strength can help support the growing baby and reduce the risk of severe muscle separation. Gentle diastasis recti exercises that focus on deep core muscles, such as pelvic tilts, cat-cow stretches, and modified planks, can be beneficial.
2. Avoiding Heavy Lifting: Women should avoid lifting heavy objects or performing activities that put undue pressure on the abdominal muscles. Instead, focus on proper posture and lifting techniques that engage the legs and reduce strain on the abdomen.
3. Wearing a Compression Garment: Maternity compression garments can provide extra pelvic support, particularly in the later stages of pregnancy. 

Postpartum Recovery and Rehabilitation

• Physical Therapy: One of the most effective ways to treat abdominal separation is through a personalised Pelvic Health Physiotherapy program. A physiotherapist specialising in ante & postpartum care can guide women through diastasis recti exercises designed to gradually close the gap between the abdominal muscles and restore core strength. These exercises often focus on the transverse abdominis, the deepest layer of abdominal muscles, which plays a key role in stabilizing the core.
• Pelvic Floor Exercises: Since abdominal separation is closely linked to pelvic floor dysfunction, strengthening the pelvic floor through Kegel exercises or guided pelvic floor therapy is essential. These exercises not only improve bladder and bowel control but also support the abdominal muscles during recovery.
• Compression Garments: Compression garments, such as SRC Recovery Shorts and Leggings, have been shown to promote healingby providing continuous gentle compression to the abdominal area. 

• Virtual Physiotherapy Consultations: Many Pelvic Health physiotherapists provide virtual consultations for ante and post-partum women who are unable to attend a physical location due to time or geographical issues. 
• Online Programs: For women who are unable to attend regular physiotherapy sessions, online programs like Restore Your Core offer a convenient alternative. These programs provide structured diastasis recti exercises, video demonstrations, and resources to help women regain core strength from the comfort of their homes. Developed by physiotherapist Shira Kramer, Restore Your Core is designed specifically for postpartum women dealing with abdominal separation and related issues.

The Road to Recovery: A Holistic Approach

Healing from diastasis recti symptoms is not just about closing the gap between the muscles—it’s about restoring function, strength, and confidence. Recovery requires a holistic approach that addresses not only the physical aspects of abdominal separation but also the emotional and social challenges it presents. By combining physical therapy, core-strengthening diastasis recti exercises, and supportive garments, women can rebuild their core, alleviate pain, and prevent further complications.

Equally important is fostering a supportive environment where women feel comfortable discussing postpartum issues without shame or embarrassment. Open dialogue about abdominal separation, pelvic floor dysfunction, incontinence and prolapse can help break down the stigma surrounding these conditions and empower women to seek the help they need.

Ultimately, raising awareness of diastasis recti symptoms and its impacts is crucial for promoting better postpartum care. With the right resources and support, women can take control of their recovery and move forward with confidence in their bodies and health.

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