Post-baby tummy that no amount of workouts can banish
WHen I discovered I was pregnant last February, I knew I’d have to wave goodbye to the flat stomach I’d worked hard to achieve — at least for a while. For the first few months, I continued exercising: running, cycling, and doing sit-ups in the hope that staying fit would make it easier to spring back into shape post-birth.
But four months in, I was doing a few stretches when I noticed my now-rounded belly seemed to protrude, in a straight line running down from just below my ribcage to beneath my belly button.
When I touched it my fingers almost disappeared into what seemed like a 4cm concave dome. Instead of the firm muscle I used to have, there was just soft flesh.
Worried something was seriously wrong, I made an urgent appointment to see the midwife. ‘You have diastasis recti [DR],’ she said. ‘It’s common in pregnancy.’
It occurs when the rectus abdominis muscles, which sit either side of the abdomen, pull apart under the strain of the growing baby, leaving a gap.
As I reached the seventh month of my pregnancy, the separation down my belly had opened so much that whenever I got up from a lying position, what was behind the gap was pushed through it — it looked as if a small mountain was trying to force its way up and through.
About two-thirds of women develop DR during their pregnancy or post-birth.
It is most common in women who have had previous pregnancies as their muscles have already been weakened, and in women carrying twins or triplets because the size of their bumps puts even more strain on the abs.
Those over 35 are more vulnerable, too, as their muscles may have naturally weakened with age.
It’s not only a condition of pregnancy — theoretically anyone can get DR simply by doing sit-ups or weightlifting incorrectly.
Symptoms include a ‘ripping’ sensation and pain in the abdominal area when standing, bending and walking, although most are unaware they have developed it until they notice a bulge between the split muscles. BeIng
fit doesn’t necessarily offer any protection either. The midwife suspected that my abs were so strong pre-pregnancy that they’d pulled apart as there simply wasn’t enough ‘give’ for them to stretch.
Although not life-threatening, it can lead to long-term problems if not properly managed. The weaker the abdominals, the more other muscles have to work to compensate, causing pain, especially in the back and hips.
During birth, it can make a vagifirst nal delivery more difficult, and afterwards may cause constipation and incontinence — as the abdominal muscles normally work together with the pelvic floor muscles to support the bladder and bowel. DR may even make it harder to breathe, as the rib muscles become too tight.
While severe cases may need surgery to reconnect the muscles, the condition can be improved with the right exercises. All my midwife advised me to do was stay away from lifting anything heavy or doing abdominal exercises, saying my tummy would probably just ‘go back to normal’ after birth.
But months after my emergency caesarean in September 2016, the muscles still weren’t knitting together, even though I quickly lost most of the weight I had gained.
In fact, DR rarely ‘fixes’ itself once your belly shrinks. Studies show that without corrective exercises, it can last for years and cause chronic back and pelvic girdle pain, poor posture and even a hernia, where organs protrude through the torn abdominal wall.
The nHS recommends physiotherapy — though this can be hard to get a referral for postnatally — and pelvic floor exercises.
But all too often women attempt the wrong type of exercise on their own, and this can make the condition much worse.
‘Doing tough workouts postbirth is precisely where many women go wrong,’ says Katelyn Faison, a private postnatal exercise specialist based in london.
‘Putting too much pressure on the abdominal muscles can cause them to separate further, which can cause more weakness, pain, and long-lasting injury. Anything that causes doming of the belly — like a sit-up — is a no-no.’
Sometimes midwives and gPs also give affected women the wrong advice, says Kim Van Deventer, a physiotherapist at the Vanbrugh Physiotherapy Clinic in london, who set up her professional website Mastermum.
‘Most of my clients are told by their gP or midwife that they need to see a physiotherapist to “close the gap”,’ she says. ‘The problem with this is that the focus is placed solely on the gap and not why the gap is there in the first place.
‘Women assume that once the gap is closed, either naturally, through specific exercises or with surgery, they have won the battle.
‘This is not the case, as if the muscles aren’t strong enough, they won’t stay knitted together.’
The key is to slowly rebuild allround strength in the abdominal muscles — which even with exercise can take up to 12 months.
‘Your abdominal wall is part of a bigger system and if it can’t do its job of withstanding the forces it is meant to when you are moving, then you will end up with dysfunction in other areas of the body, too,’ explains Kim.
This is what happened to Pilates instructor Julia Trinder, 45, from Oxfordshire. She suffered a diastasis recti of 2cm during her pregnancy with her daughter, ellie, nine.
But after an emergency caesarean when she had her son, Daniel, now seven, she was left with a huge 12cm-wide gap running down the inside of her belly, which led to a lower abdominal hernia.
‘It was like there was nothing holding everything together apart from my skin. I could fit ten fingers into the width of the space. It was horrific,’ says Julia.
She had surgery to repair the hernia and stitch the muscles together. ‘even then, it didn’t fix the problem,’ she says. ‘It returned because the muscles were too weak to stay together with stitching alone.
‘I still had a pretty bad gap, no abdominal strength for years and back pain. When I bent down to pick something up, I felt an odd pulling sensation in my belly.’ JulIA
tried Pilates and even wearing a special belly splint. But nothing worked. ‘ Four years later I still had the awful hanging, loose belly and back pain. It made me self- conscious around my husband, Steve.’
It wasn’t until she stumbled upon an online postnatal exercise plan, the MuTu system ( mutusystem.com), three years ago, that things improved.
The 12-week programme, created by trainer and former DR sufferer Wendy Powell, is designed to help rebuild a body post-birth, using exercises such as controlled knee raises performed lying on the floor and postural correction.
It proved the answer for Julia. ‘I noticed results within two weeks,’ she says. ‘now my tummy is a lot flatter, my abdominals feel strong and the back pain is gone.’
Some say gPs and midwives need to take DR more seriously. However, Sarah Fox, a clinical midwife and policy adviser for the Royal College of Midwives, says there is no clear list of exercises to recommend or advice midwives could give to significantly reduce the risk and severity of the condition.
Five months after the birth of my son, Milo, I was still getting searing pains in my pelvis, hips and back. I saw my gP, but was told the nHS does not usually provide postnatal physiotherapy. So I sought postnatal trainer Katelyn Faison’s help, who devised exercises to strengthen and rebuild my core.
After five months, slowly my abdomen is knitting together — although I have some way to go before I will get back to the flat stomach I had of old.
2.5cm Distance the pelvic floor drops during pregnancy