By Rose Wrona, PT, MS
I’ve come across a few articles lately that have been suggesting that one can simply treat a “Mommy Tummy” with exercise alone. Perhaps a sagging pooch can resolve with exercise, but a true “Mommy Tummy” generally refers to a condition called diastasis recti abdominis or DRA.
It sounds like a mouthful, but can be explained simply as the stretching of the connective tissue of the abdomen, or more specifically, the linea alba between the six-pack muscles. A woman who has been pregnant with twins, has had multiple births, has delivered a large baby, or who has had multiple children is more at risk for this condition. Other than the aesthetics of having stretched, thin skin and looking like you may still be pregnant, DRA presents some health risks to postpartum women.
The most common complaint is of having low back pain. If you think about your body as being a tube filled with liquid, you can visualize the effects of an area unable to sustain the effects of increased pressure. I often use the example of an inner tube being inflated that has a thinned area in the rubber that bulges before it pops. A DRA is the area of the bulge and the low back is the structure that must maintain the integrity of the tube. Because the abdomen does not supply the necessary counter pressure to maintain muscular balance within the trunk, the low back becomes overworked and painful.
Core strengthening is beneficial if done correctly, but relieving this pain also involves restoring symmetry of the pelvis, identifying the specific muscles that have become weak, and treating the effects of the overused muscles. That is where our expertise as clinicians becomes paramount in treating this condition. We teach you activities you should and should not do, we work to teach you proper breathing, we correct your posture and we use skilled bodywork to treat your joints and muscles.
Another disorder that can result from a DRA and weakness in the abdomen involves the pelvic floor. We have talked about the role of the abdominal muscles in supporting the core around the circumference of the trunk. Now let us switch focus to the floor of the core.
The pelvic floor is composed of a series of muscles that function to keep the internal organs where they should be and to provide stability within the pelvis. As you can see from the above model, the pelvic floor also contains openings for the urethra, the vagina and the rectum. When the core cannot function properly to provide support of the trunk, the resulting pressure drops down onto the pelvic floor. If these muscles are weak, it will alter the function of the bladder, the bowels, and/or the uterus. The bladder can become displaced into the vagina, the uterus can drop into the vagina and the rectum can shift forward into the vagina. These scenarios are diagnosed as prolapse.
It sounds very disturbing and we often are confronted with fear and anxiety from women surrounding these diagnoses. Symptoms commonly associated with these diagnoses are stress incontinence (involuntary urination with coughing, laughing, sneezing or jumping) urge incontinence (not being able to maintain bladder control when the bladder is full) dyspareunia (pain with intercourse) constipation or fecal incontinence, and vaginal pain.
Kegels are the exercises most people are instructed to do to help strengthen the pelvic floor, but how do you know you are doing them correctly? There are also situations in which Kegels can make your painful symptoms worse. What we’d like you to know is that any of the above symptoms are not normal and you should not buy into society’s lackadaisical attitude about putting a pad in your underwear to fix the problem. If you are experiencing these types of symptoms, please know there are alternatives to surgery that can help you. Most importantly, we are here to offer you help and support. We realize that there is comfort in knowing you are not alone and that there is no replacement to direct human contact for treating these symptoms.
In returning to our topic of postpartum women, there’s another obvious challenge: caring for a child. Life becomes a bit more chaotic, you get less sleep and there is little time for yourself. The simple motion of lifting your baby (especially combined with a car seat) is enough to put pressure on a DRA and can undo the positive changes that have been made with core strengthening. I want you to pick your baby! However, learning correct body mechanics, alternative patterns of movement, and how to breath properly are imperative to a comprehensive DRA rehab program.
There is a lot of information out there and the simple fact that you have read this article shows that you are trying to find answers. Know that there is no quick fix to this problem and it takes purposeful practice and patience. If you are interested in seeing a skilled clinician who will create a personalized comprehensive plan for you, then check us out at Restore Physical Therapy and Wellness.