You may have heard of abdominal separation during pregnancy. Sharp stomach pain during pregnancy is quite common. The term can be frightening and confusing for mothers to be. However, this is a commonly assessed and treated condition by Physiotherapists.
Diastis of the rectus abdominal muscle (DRAM – Diastis Recti) refers to a separation of the connective tissue between the two halves of the rectus abdominus muscle down the middle of your abdomen. This occurs in pregnancy due to hormonal changes, rapid weight gain and the increasing size of the baby and uterus. This results in stretching of this muscle and connective tissue, as seen in the video below. Following birth, the muscle often remains separated and does not autonomously return to its pre-pregnancy function and strength.
How Common is Sharp Pain in the Abdomen During Pregnancy?
Separation occurs in 2 out of 3 women during pregnancy, being a very common and normal part of pregnancy.
Does pain in the abdomen matter?
Despite this being normal, it can have various effects on the body. The abdominals work in synergy with the pelvic floor for important functions for posture, trunk and pelvic stability, respiration, load transfer, trunk movement and support of the abdominal viscera.
They create stability between these parts of the body by creating something known as force closure. Force closure refers to the effect the contraction of a muscle has on it surrounding joints and ligaments. When the muscle contracts, it pulls firmly and stiffens the area, creating a natural bracing. This is important for spinal stability and also pelvic floor activation.
Diastis Recti can weaken these functions which is a contributing factor for lumbo-pelvic pain, pelvic girdle pain, incontinence and increased prevalence for lumbo-pelvic injuries. This can lead to lower back or pubic pain and pelvic pain in pregnancy.
Specifically, because the abdominals have widened, their ability to carry the load is somewhat compromised. This can also lead to a feeling of bulging as more pressure is put on the connective tissue.
Most DRAMS realign close to a natural position within the first six weeks of delivery. However, factors such as pregnancy number, pre-pregnancy fitness and weight, race can affect this. Some DRAMs fail to heal and can require further rehabilitation and intervention.
What can a Physiotherapist do for pregnancy abdominal pain or separation?
A Physiotherapist can complete a comprehensive prenatal or postnatal assessment which will include assessing for a DRAM. This assessment involves the Physiotherapist gently measuring with their fingertips for a gap along the abdominal wall. This is a simple and pain-free assessment which allows the physiotherapist to gauge size, significance and location of the DRAM. A significant DRAM has been shown to be a separation of greater than 2.5cm. A larger DRAM is considered more significant and requires a longer time period to heal.
If the Physiotherapist deems that the DRAM is significant the following treatment can be delivered:
Severity, width and incidence of Diastis Recti has been shown to be reduced by completing physiotherapy led abdominal exercises in the ante-natal period.
Depending on individual assessment a Physiotherapist will prescribe some tailored exercises including light walking, activation of the pelvic floor and deeper abdominal muscles. A Physiotherapist will assess individual strength and activation of these muscles and then prescribe appropriate dosages and progressions.
Following correct activation of these muscles clinical pilates can be commenced in our studio. We offer Pre-natal and Mums and Bubs classes which focus on building strong physical foundations so you can avoid injuries, pain or discomfort and importantly do all required activities in a busy day. Importantly you can bring your baby along postnatally and exercise in a safe and supported environment.
We also offer prenatal and clinical pilates and have a nannying service who can happily care for your baby while you participate.
In the video below, we set out 3 fantastic core strengthening and stabilising exercises. These are 3 examples of exercises we run in our pregnancy pilates classes, under physiotherapist guidance.
Some women may find comfort in wearing an abdominal support, such as tubi-grip or high/firm compressive underwear or shorts. This is for temporary comfort and does not assist in faster recovery or realignment of the muscle. If the birth was via caesarian care should be taken wearing these garments to ensure they do not place extra pressure to the healing wound.
Don’t make the same mistake a lot of women make in pregnancy and immediately post-natally. In order to avoid bulging of the stomach muscles and increasing stress on the healing separation, skip the following exercises.