Abdominal diastasis and muscle problems after childbirth

We have been talking about abdominal diastasis for days because I am working my postpartum in the center Onetraining. Jorge, who is my personal trainer, is guiding me in all the needs that come with recovering the structure of my body after such an important change as pregnancy and childbirth. I am not talking about doing sports, trying to regain weight or aesthetic form, it goes further, it is to recover the structure so as not to have problems in the future such as urine loss, prolapse, etc. But the best person to talk to you about all this is our physical therapist, Laia.

What is an abdominal diastasis?

Thanks to the hormonal changes of pregnancy, the abdominal wall gives way and stretches to adapt to the baby's growth. After delivery, it does not always return to its former shape ... it sounds familiar to you, right?

One of the most common consequences of the musculoskeletal disorder caused by pregnancy in the abdominal wall is the diastasis.

The abdominal diastasis (or diastasis of the rectums) is the separation of the rectus abdominis muscles (better known as those of the chocolate bar) due to stretching and consequent damage to the alba line, which is the fibrous connective tissue that joins the two rectus abdominis, which gives way to allow the growth of the fetus, leaving the abdomen looking flaccid.

The increase in this distance between these muscles can appear during the second trimester, but it is especially during the third trimester of pregnancy when the incidence is total.[1]. Natural recovery and the greatest decrease in diastasis occurs between the first day and the 8th week after delivery. When there is no decrease in the distance between the rectus abdominis in a natural way, we have to put ourselves in the hands of specialists to provide a solution since it is not just an aesthetic issue, it is a health issue.

It is estimated that around 66% of women have diastasis associated with pregnancy, but it can also appear at other stages of life, also in men or even babies.

What can make us suspect a diastasis?

As we have already said, diastasis is a health problem, since it has repercussions at a functional level and is related to problems in the pelvic floor. So we can suspect diastasis due to the presence of:

  • Urinary, fecal incontinence or some type of sexual dysfunction.
  • Prolapse of the abdominal organs.
  • Pelvic pain.
  • Digestive problems such as: gas, problems with digestion, constipation ...
  • If when we join, when we cough, laugh or sneeze we notice that one or more lumps come out, it is that there is a possible hernia and the abdominal wall cannot adequately contain the organs.
  • Altered breathing pattern.
  • If it has been a multiple pregnancy, the child has been large or if it is the second or third pregnancy.
  • If you have gained more weight than recommended.
  • If there is abdominal flaccidity.
  • Low abdominal tone prior to pregnancy.
  • Prolonged labor, with a lot of work during the expulsion phase.
  • If there are previous caesarean sections (since this intervention involves separating the abdominals just by the alba line and involves a change in muscle biomechanics)

There are those who also associate it with back pain due to its involvement in body posture, but numerous studies, for the moment, rule it out as a direct cause.[2].

How do I know if I have a diastasis?

If you have answered yes to some of the above items, it is time to do a simple orientation test at home:

Find some firm surface where you can lie down (the ground already works). We stand with our knees bent and our feet flat on the ground. We raise an arm and place the hand behind the head. With the other free hand, we put the fingers on the abdomen, at the level of the navel. With the accompaniment of the nape of the neck, we will make a small abdominal, it will be enough to raise the head from the ground.

With the fingertips we will look for a gap between the two rectus abs (the chocolate bar). If two fingers fit in this hole or we calculate that it is equal to or greater than 2.5 cm, it is that we can have a diastasis of the rectus abdominis.

Who and how is it diagnosed?

If the previous test was positive, it is not necessary to run to the doctor, but take it into account to discuss it in the postpartum review or make an appointment, either with the gynecologist or with a pelvic floor physiotherapist.

Looking at the state of the abdominal wall and the condition of the perineum is an assessment that should be included in the protocol of the postpartum check-ups of the gynecologist or obstetrician and, referring us to the physiotherapist if necessary, this would allow us to remedy it as soon as possible. But unfortunately, this is not always the case ... Many times we hear about diastasis on the first day of the gym where we go to solve abdominal flaccidity. For this reason, more and more, they have very well-trained personnel in this field who will tell us to go to the physio or gynecologist, in order to later coordinate part of the treatment with them.

In addition, many doctors incorporate ultrasound to finish making sure that the diagnosis is correct, although it is not always done if they already see it very clearly.

What to do when it has already been established and measures to avoid or reduce the impact of diastasis after delivery:

There are a series of guidelines that we can follow that our pelvic floor and abdominal wall will surely appreciate:

  • Maintain good posture when standing, sitting or breastfeeding.
  • Having the crib, the stroller and changing table well graduated at our height so as not to make efforts.
  • Not standing still for a long time during the first week after delivery.
  • Perform circulatory exercises.
  • Avoid carrying weights.
  • Don't do the traditional sit-ups.
  • Take measures against constipation.
  • Get up from the bed or sofa properly so as not to make an abdominal hyperpressure and try to contract the pelvic floor to protect it.
  • Avoid waltzes (efforts with apnea, holding your breath)
  • If possible, avoid a second pregnancy before full recovery.

What does a good treatment have to contemplate?

A good treatment always starts from a complete previous evaluation. A specialist physical therapist will do us:

  • The palpatory test of abdominal diastasis, evaluating the three key points of diastasis to determine length and severity.
  • A comprehensive global assessment of the musculature and posture, taking into account our morphology, previous lesions that affect biomechanics and the state of caesarean section.
  • It will pay special attention to the superficial and deep abdominal muscles, the pelvic floor, the lumbar muscles, the diaphragm and the state of the pubic symphysis.

Only with a good assessment can we determine if our diastasis is functional or if it requires specific treatment, ruling it taking into account all these factors and determining the state of our pelvic floor.

From here, the treatment usually includes:

  • Guidelines for good postural hygiene and work to re-maintain a correct posture.
  • Hypopressive abdominal exercises. Its objective is to strengthen the transverse muscle, in charge of containing the abdominal organs and closing the gap between the rectus abdominis[3]. They are complicated to perform correctly, so it is essential to learn them under the supervision of the pelvic floor specialist.
  • Exercises to tone the pelvic floor. Kegel exercises are very popular and, like hypopressives, they are very difficult to do correctly due to the type of muscle fibers that compose it. They require us to make sure that we contract what we need and in the right way.
  • Electrostimulation: the deprogramming in the activation of the abdominal and pelvic floor muscles makes it often easier to contract them.
  • Use of specific belts: not always necessary.
  • Measures to avoid constipation.

It should be noted that there are not enough scientifically valid studies to support whether one method is better than another. It has been found that just performing hypopressives or just pelvic floor exercises is not enough. The researchers point out that with the evidence that exists, to recover from a diastasis and from the alterations of the pelvic floor after pregnancy, it is necessary to do a global treatment, starting with a re-programming of the motor control more than with a muscular re-training.

Diastasis is a very common and easy to observe problem, it is important not to make the mistake of overdiagnosing or trivializing, and to obtain a reliable diagnosis.

It is important to note that a good review and adequate treatment by health specialists is the key to recover from pregnancy and diastasis. When it requires treatment, remember that it is exactly this, a treatment and not a training, since it is a health issue and I recommend that it be evaluated and prescribed by a physiotherapist specialized in pelvic floor or obstetrics, as they remind us from the Professional College of Physiotherapists of the Community of Madrid[4] or the Spanish Association of Physiotherapists[5] among others.

Laia Maseras Salvadó
Col. 7098

[1] Benjamin D, Van de Water A, Peiris C. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: A systematic review. Physiotherapy, 100 (2014) 1-8. United kindom

[2] Sperstad JB, Tennfjord MK, Hilde G, et al Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain Br J Sports Med Published Online First: 20 June 2016. doi: 10.1136 / bjsports-2016 -096065

[3] Benjamin D, Van de Water A, Peiris C. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: A systematic review. Physiotherapy, 100 (2014) 1-8. United kindom

[4] http://www.consejosdefisioterapia.org/la-fisioterapia-previene-una-de-las-consecuencias-fisicas-mas-comunes-tras-el-embarazo/

[5] http://www.aefi.net/fisioterapiaysalud/fisioterapiapostparto.aspx

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