Abdominal separation – two words that create either a sense of fear or despair for so many pregnant and post-partum women I speak to.
But before we get into any detail of what exactly is going on, let’s cover
In pregnancy, almost all women - close to 100% by the final weeks of pregnancy - will experience some degree of separation. For some it may be temporary, and for others a little more (semi-)permanent. This is a simply the body's response to accommodate a growing uterus and baby, and to hormones which help the body’s tissues soften and relax for pregnancy and birth.
After birth, there is evidence to suggest that natural healing will occur within the first 8-10 weeks post-partum as a result of the intra-abdominal space reducing. I.e. baby out, uterus shrinking etc. However, past this point ongoing separation may need targeted exercises to help with these structures becoming more functional again.
I'll repeat – functional, because it is not just about the distance between the abs but how all the muscles and tissues work together in day-to-day whole-body movements and activities.
The healing of these tissues, along with the rest of the body's healing, needs a holistic approach. This includes adequate rest, good nutrition, hydration (especially because connective tissue involved in this separation is mainly protein and water), as well as individually appropriate exercise (which encourages increased blood and nutrient flow to these tissues).
WHAT EXACTLY IS IT?
So, let’s understand a bit about the structures involved and what “separation” actually means. I've talked before about the many layers of the core in ‘What returning to exercise actually means’, but today we'll look at the front portion of this core.
The “separation” of the abdominals refers to the gap between the outer layers of the vertical muscles – the Rectus Abdominis or the ‘six pack' muscles. These muscles are held together by other sheaths of fibrous connective tissues close to the Linea Alba (the central thicker fibrous structure that runs from the base of the sternum to the top of the pubic bone). The general role of these outer muscles, along with others in the same area, is to stabilise and flex the trunk – think movements like a crunch where the lower ribs and pelvis are brought closer together when these muscles contract (shorten).
Whilst there is mixed evidence for causes of abdominal separation, including age, pre-pregnancy weight, and weight gain in pregnancy and so on, there are some known causes that to increase the separation. When there is excessive loading of these Rectus abdominal muscles, the connective tissues that attach with them experience stretch related tension whilst the muscles contract around the outside of this increased space.
DO I NEED TO WORRY?
If all of this is starting to sound a bit morbid, the first thing to remember is, this actual separation is not painful. However, the presence of separation and severity may be linked to some degree with challenges like pelvic organ prolapse, reduced abdominal strength and low back pain as a result of all of these tissues and muscles of the core not communicating well (i.e. the messages from the brain to the muscles and tissues are not coordinated optimally).
CAN ANYTHING PREVENT OR MINIMISE IT?
Some degree of separation is almost inevitable, and if it is something that freaks you out, remember one good sign that baby is growing! I know – sounds obvious, but so many mums actually need to hear that from someone else to remember this amazing thing that their body can do – grow a human!
During pregnancy, the main things that can reduce excessive separation include:
Modifying daily activities or exercises that cause excessive loading of these outer abdominals. And I say modify because it is important not to fear movement and not to avoid it altogether. One of the signs that you need to modify is if you start to see any “doming” or “coning” between the muscles at the central line.
Manage issues like chronic constipation and chronic coughing and sneezing. Both of these normal bodily movements can place an extremely high load on the weakened abdominal wall, especially if they persist. See you doctor if you are concerned.
When to get support
After birth, the focus again should be on holistic recovery. As every woman’s body is different and every pregnancy is different, there can be variations in exactly how much and where the separation requires attention. For some, the gap may be the largest closer to the sternum, for others it may be wider at the belly button or closer to pubic bone.
BUUUTTT, it is not only the distance that matters. Yes! You can have a gap even a year after birth, and most women probably will have a slight gap compared to prior to pregnancy whilst still have a properly functioning core and body.
If you are suspect anything unusual in the months after pregnancy, or need a professional opinion, your doctor, local women's health physiotherapist or exercise physiologist can check the degree of separation and provide targeted care for you. You may also be recommended to wear a supportive brace or compression garments (such as SRC pregnancy and recovery pants) to help support your back, but targeted exercises at the same time will ensure that the body does not become dependent on these external supports.
Keep an eye out on Mummy Moves for upcoming tips on activities during and after pregnancy that can help you!
At the end of it all, this is a time for change. In your phase of life, in your body, and in so many other ways. A change where you have this wonderful new being. A being that grows and does get heavier everyday! All we should focus on is our doing the best with the demands post-natally, and do what is needed to re-gain confidence in your body's ability to do what it needs to as well as possible.