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Diastasis Overview
After giving birth, your stomach will look and feel like gelatin, which can be quite a shock. There may be more at stake than appearance, though. Diastasis is a separation between certain abodominal muscles, and if it's not treated it can cause back and leg pain. Fortunately, the remedy -- exercise -- is cheap and easy. This article will show you how to detect diastasis and what to do about it. Here's a preview:- The Abdominal Wall After Delivery
Rectus muscles, obliques, pelvic floor -- the body is complicated in the area we think of simply as the tummy. Knowing what's inside will help you know how to tone it up properly. On this page you'll learn what the various muscles are and how pregnancy affected them. - Diagnosing Diastasis
Diastasis is fairly easy to spot -- you or your doctor can feel it with your hand from outside the body. A few days after giving birth, you'll be able to tell if you have diastasis or not. On this page, we will show you how to diagnose diastasis at home or what concerns you should bring to your doctor. - Exercises for Diastasis
Once you've detected diastasis, even light exercise can help you close the gap between your muscles. There are a number of exercises that will do the trick. Here are some exercises to get you started and some advanced ones for when your strength begins to return. - Recovery from Diastasis
Recovery time is different for every woman. It depends a lot on what kind of shape you were in before you were pregnant, and it can be as short as a couple of months or as long as a year. But the important thing is to keep trying, or you may overload your back. Find out why that is and how to get into recovery mode on this page.
The Abdominal Wall After Delivery
When choosing exercises after delivery, most new mothers think of achieving a flat abdomen as their first priority. Actually, the pelvic floor should receive prime attention with the abdominal muscles second. Strong pelvic floor muscles ensure good support of internal organs and sphincter control (urethra, rectum, and vagina). They also ensure pleasurable sensations during sexual intercourse for both the woman and her partner.After vaginal delivery, the pelvic floor may be bruised, swollen, and tender. After a cesarean section, it may be lax. In either case, the pelvic floor loses tone or elasticity from the weight of the baby and months of sluggish circulation.
You may be surprised at your initial attempts to tighten the muscles of the pelvic floor immediately after delivery -- you feel little or nothing! Your muscles have been torn or cut and nerves, damaged. It's no wonder you have little sensation. Perhaps, too, the structure of the pelvic floor was surgically repaired.
Exercise can improve all these situations by 1) alleviating discomfort (although it is uncomfortable at first to even gently squeeze those muscles) and 2) improving circulation to the area, which increases the oxygen supply, removes waste products, decreases swelling, and promotes the prompt return of urinary control.
If you neglect the pelvic floor area, the muscles remain stretched and loose. They become further weakened as you resume your usual schedule. The sooner you start to exercise the pelvic floor after delivery, the faster the muscles respond. Waiting only results in more time and effort necessary to strengthen these muscles.
The Abdonimal Wall
Right after delivery, you may wonder if your stomach will ever be flat again. If you begin an exercise program early (within 24 hours of giving birth) and are fiercely persistent with frequent repetitions of the appropriate exercises, your stomach will indeed be flat once more.
 ©2006 Publications International, Ltd. Many women wonder if their stomachs will ever be flat again after delivery, but with proper exercise it can be done. |
The internal and external oblique muscles lie on the sides of the rectus muscles. They cover the waist -- a hard area to tighten even when you haven't had a baby. The external obliques cover the front and sides of the abdomen from the rectus muscle to the back muscles. The external oblique muscles have a wide area of attachment: The top edges attach to the ribs, and they run from the lower eight ribs to the front surface of the pelvis and on down to the pubic bone.
The internal obliques are directly below the external obliques. Most of their muscle fibers are nearly horizontal, running at almost a 90-degree angle to those of the external obliques. The internal obliques run from approximately the waist area down to the pubic bone.
All this may sound unnecessarily technical when you just want to have a flat belly again, but knowing how your body is put together enables you to understand how the exercises work and what kinds of exercises you need to renovate those muscles after delivery. Learning to listen to your body is also a primary step in getting started.
The lower ends of the rectus muscles go through a slit in the deep abdominal muscles before they attach to the pubic bone. When the rectus muscles are relaxed, as they are when you walk and move around, they follow a curved line; they become straight only when they contract (when you consciously and tightly hold in your stomach).
Hereditary factors come into play in the deposition of fat in the lower abdomen, even when body fat is at an ideal level. Because the rectus muscles are curved and small deposits of fat are stubbornly held in that area, most women find their stomach is still slightly rounded.
Flattening your abs isn't just for appearance's sake -- a large gap between abdominal muscles can cause back pain and leg pain. Find out how a diastasis can hurt you and how to correct it on the next page.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.
Diagnosing Diastasis
After delivery, the abdominal muscles are always loose and soft. The abdomen looks and feels like gelatin, which can be quite a shock. It is important to check the linea alba between the rectus muscles for separation, called diastasis. The opening between the muscles may be slight or so large the uterus or abdominal contents can be felt bulging through the opening.Since a good balance must exist between back and abdominal muscles, a large diastasis eventually causes backaches (and possibly radiating leg pain) just from moving through the normal day's activities of caring for an infant or managing a full-time job at or away from home. If you make no corrective attempts to close the opening, reestablishing muscle balance and strength, you will have little support for a subsequent pregnancy. Your posture will be poor, and many aches and pains will develop, all from lack of abdominal strength.
Check for diastasis on the third or fourth day after delivery. Until this time, the area will feel too slack for you to get an indication of the state of the abdominals. Also, you will have had a few days' worth of abdominal exercises to help improve your strength.
To check for diastasis:
- Lie on your back with your knees bent. Place the fingers of one hand on your abdomen covering your navel (your fingers should point toward your pubic bone). Apply firm pressure.
- Inhale deeply. Then exhale slowly and at the same time lift your head and neck slowly. As you lift, you'll feel each of the rectus muscles tighten and pull toward the center (toward your fingers).
- Check to see how many fingers fit in the gap. One to two finger-widths is normal and to be expected; this gradually decreases with exercise. Three to four finger-widths require special attention from you to repair and rebalance the muscles.
Correcting Diastasis
The following special exercise is very effective for closing a large diastasis. Raising just your head in this exercise ensures you work only the rectus muscles. As they become stronger, you will be able to lift your shoulders, thus working the other abdominal muscles also. It is important to strengthen the rectus muscles first, thus ensuring their stabilization and alignment as the other muscles come into play.
 ©2006 Publications International, Ltd. The gap between abdominal muscles should be no more than half an inch. |
Because the other abdominal muscles are attached to the rectus muscles and because the abdominals in general are weak and out of balance, avoid the following exercises, which serve only to increase the diastasis: 1) those rotating the trunk of the body (waist twists), 2) those twisting the hips, and 3) those that cause the trunk to bend to the side (waist or side stretches).
Be sure to breathe out as you raise your head and shoulders; this prevents an increase in the intra-abdominal pressure. Increased intra-abdominal pressure just increases the diastasis, which defeats the whole purpose of the exercise and adds time to the muscle rehabilitation.
Do not let the abdominal muscles bulge. Tighten your abdomen any time you might strain.
There are many other exercises that can reduce your diastasis. The next page goes over several of them in detail.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.
Exercises for Diastasis
Your abdominal area may feel week soon after childbirth, but that's OK. Even light exercises will help you get back into shape. And if you do them regularly, you'll find you're ready to increase the intensity in no time. Here are a range of exercises to strengthen your abdominal, pelvic, and buttock muscles.Pelvic Rock
Perform at least 50 repetitions a day.
- Lie on your back with your knees bent. Cross your hands over the abdominal area so you pull the muscles toward the center of the abdomen as you slowly raise your head.
©2006 Publications International, Ltd. - Take a deep breath. As you slowly exhale, lift your head (and later your shoulders, to a 45-degree angle from the bed or floor), at the same time pulling the muscles together with your hands. Return your head (and shoulders) slowly to the bed or floor. Remember to keep your movements slow and controlled, your eyes on the ceiling, your chin straight up.
Continuing the Program
Once you have completed the appropriate exercises for your type of delivery, gradually replace the postdelivery exercises with the ones you did during pregnancy. These exercises also work all the muscle groups that are important during the postpartum period, with no muscle or joint strain.
The "Pelvic Rock," which you can now perform while lying on your back with your knees bent, improves posture and eases back strain. It is wonderful for working buttock, abdominal, and pelvic floor muscles all at the same time, and it provides a great back stretch. Remember to do the exercise slowly with control, and gradually increase the time you hold the tilt.
Be sure to warm up (walk or march in place for three to five minutes) and then stretch for five minutes before beginning any floor exercise. Turn on music with a strong, regular beat. Music helps you move smoothly, makes time pass quickly, and adds an element of fun.
Extra Help
The following exercises are good for a stubborn, protruding abdominal wall (a potbelly). Because the rectus muscles are long, vertical muscles that run from the breastbone to the pubic bone, you need to perform exercises that cause action at both ends of these muscles. To shape and to strengthen these muscles, you must perform at least two exercises: the "Reverse Sit-Up" and "Reverse Trunk Twist." You can alternate the "Reverse Sit-Up" with the "U-Seat," or you can perform all three during each exercise session.
For all these exercises, begin with 5 of each and gradually increase the repetitions as you get stronger. The key to success is controlled movements with no "sling and fling" moves.
Exercises to Develop and Maintain a Flat Abdominal Wall
Reverse Sit-Up
Start with 5 repetitions and increase gradually.
- Lie on your back with your knees bent and your arms at your sides, palms down.
©2006 Publications International, Ltd. - Keeping your knees bent, raise your legs until your knees are past the level of your chest or above your face. Raise your buttocks toward your upper body. Keep your head and shoulders flat.
- Return to the starting position and repeat.
Another hint: Start by getting only the hips off the floor. As you progress, lift more and more of the hips and lower back. Keep the movement controlled. You do not gain height by slinging or throwing your lower legs above the head. The action should be smooth and come from the abdominals.
This exercise works the lower fibers of the rectus muscles as well as the external obliques. To work the horizontal fibers you should also perform the "Reverse Trunk Twist."
Reverse Trunk Twist
Start with 5 repetitions and increase gradually.
- Lie on your back with your arms out to your sides, palms down, and your legs raised 90 degrees from the floor. Bend your knees slightly.
©2006 Publications International, Ltd. - Lower your legs to the right and touch the floor with the outside of your right foot. Keep your shoulders and arms on the floor at all times.
- Return to the starting position and repeat, alternating sides on each repetition. (After a time, you will notice increased flexibility of your midsection while performing this exercise.)
Begin with the same starting position but with your legs straight (but loose). Keep your legs straight as you lower them to the side. Be sure to press your back to the floor as you come toward the center each time.
Note: If your shoulders come off the floor as you drop your legs to the side, have someone hold them down. This person should be on all fours with his or her hands on your shoulder joints (not the neck area), arms straight, and shoulders directly above yours. As flexibility and strength increase, you will not need assistance.
If you have difficulty keeping your legs straight when performing the advanced exercise because of tight hamstring muscles, bend your knees slightly but keep your legs together. The more you bend your knees, the easier the exercise is to perform. Doing it in the straight leg position is the most effective, so try to work up to that.
The "Reverse Trunk Twist" works all portions of the internal and external obliques, tightening the front and sides of the abdominal wall much more than any other abdominal exercise. This exercise also strengthens the spine because it uses the small muscles -- both the deep and the surface muscles -- that hold the bony vertebrae together and twist the spine. Strengthening these muscles eases the typical overuse backache and may help prevent injuries that occur when you execute quick, twisting movements.
The U-Seat
Start with 5 repetitions; progress to a maximum of 20.
- Lie on your back with your arms behind your head, knees bent, and feet on the floor.
©2006 Publications International, Ltd. - At the same time, slowly raise your head and begin raising your knees toward your chest. Continue the movement, raising your shoulders and buttocks off the floor simultaneously. (Do not push your head and neck forward with your hands -- rest your head in your hands, and let your shoulders do the work.) Continue both actions and try to touch your knees to your chest. At the end of these movements, your pelvis and upper body should be off the floor. Do not lift your lower back from the floor.
- Return to the starting position and repeat.
Think of the exercise as two steps: 1) raise head and knees, then 2) raise shoulders and buttocks. This timing allows for proper coordination and smooth movement between pelvis and chest.
Performed correctly and smoothly, "The U-Seat" exercise maximally involves both the lower and upper portions of your abdominals.
How long it will take to work into shape depends on a lot of factors. Find out what to expect on the next page.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.
Recovery From Diastasis
Recovery time is very individualized. It depends on what kind of shape you were in before and during pregnancy, in addition to how much effort, time, and planning you are willing to now give to your body. If your abdominals were strong and you exercised them regularly before and throughout pregnancy, one to two months -- at the most, three months -- should see you back to normal.On the other hand, if your abdominals were not strong and you didn't exercise them regularly, then it may take between 6 and 12 months of regular exercise to get them into good shape. (These time frames assume you perform abdominal exercises four to six days a week.)
What if you took up regular exercise for the first time in your life during pregnancy? This gives you something of a head start for this postpartum period. However, the advancing growth of the baby did not allow as adequate a workout of the abdominals as if you had also exercised before pregnancy. In this case, achieving strong, firm abdominals should take between three and six months (which is still much faster than for someone who did not exercise during pregnancy).
 ©2006 Publications International, Ltd. The time it takes to get back into shape depends partly on what kind of shape you were in before your pregnancy. |
The abdominals do 40 percent of the work involved in supporting the trunk of your body as you move through your daily activities. If they do only 10 percent, the back muscles pick up the load -- or attempt to, anyway. The back muscles are responsible for 60 percent of the work of keeping the body upright and helping to lift, move, and bend. Increase that workload by 10 to 30 percent and the muscles respond by becoming fatigued faster and with the occurrence of painful spasms, especially in the lower back.
Sometimes the lower back muscles become so tight the angle of the normal pelvic tilt changes. These tight muscles squeeze or press on the nerves coming off the spine in the lower back area. These nerves, in turn, divide and branch out to each leg. You may feel pain in the lower back, one or both buttocks, and one or both legs (upper or full length). Don't allow this kind of problem to decrease the joy of those first beautiful months with your new baby.
Other factors to consider in estimating recovery time are how much weight you gained and how much your abdominal wall expanded (partially due to the size of the baby and how you carried the child). Additional factors include your diet, the amount of rest you get, and the types of activities you're involved in.
Diastasis after pregnancy is a fairly common occurrence. Though the complications can be severe, the treatment can be easy and fun. Following the advice in this article will help you get your abdominals back in prepregnancy shape in no time.
About the Authors
Alvin Eden, M.D. serves as a Clinical Professor of Pediatrics at the Weil Medical College of Cornell University in New York, New York. He is Chairman of the Department of Pediatrics at the Wyckoff Heights Medical Center in Brooklyn. Dr. Eden is also the author of a number of child care book, including Positive Parenting and Growing Up Thin.
Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.