Belly after baby
Cyndy would have never thought that her belly could stretch and a baby could grow that big over 38 weeks. She was amazed what her body did, and with such brilliance that a beautiful baby was born. What she couldn't imagine now, however, was that her "poochy " belly wouldn't go away like she thought it would, and every time she moved it would stick out instead of go in. She became worried and frustrated. She had always had a tight tummy and now she felt like she wasn't herself.
So much change happens to our belly during this time frame and the four layers of our abdominals go through a lot of changes. The rectus abdominus muscles, also known as our "six pack", really take a hit and a significant amount of women develop something called a diastasis rectus abdominis (DRA). This occurs when the abdominal raphe (linea alba, linea semiluniaris) — which is the connective tissue that connects the right and left side of your "six pack" and runs all the way from your xiphoid process to pubic symphysis bone — splits, separates or thins. Most often it is due to the extra load that is placed on the structures as the baby is growing, but sometimes it is due to overtraining of the abdominal muscles, gaining weight rapidly over a short period of time, or lifting heavy weight repeatedly at home or work. This separation is considered significant when it is over two fingers in width upon examination.
Diane Lee, a physiotherapist in Canada, reported in a 2013 study of the DRA, that 100 percent of the women she examined who were in their third trimester of their pregnancy, had a DRA present. Another study reported that at 8 weeks postpartum, if the DRA was still present, there was a likelihood it would be exactly the same at one year after having your baby. That alone is an incredible reason to know what you need to do to retrain these muscles safely and efficiently after pregnancy, so as not to harm the core trunk muscles' ability to function long term.
To check yourself for a DRA, lay on your back and lay your fingers above and below your belly button region at midline. This will be where the raphe is located. Then gently lift your head only up, as if to begin a traditional sit-up. Feel for any space present between the recti muscles. This space should be under two fingers breadth in width. I have also had patients who had no split present with the head lift, but as soon as I had them lift both of their legs off the floor, the DRA appeared. So check each way to be sure.
Often if you have a DRA, the belly looks like you have a "pooch or dome" present along the midline of the "six pack." This weakened area needs to be retrained via the muscles and fascial component. Please avoid traditional sit-ups, crunches, traditional twist sit-ups or bilateral leg lifts to the "V" sit-ups. These exercises will only further disrupt the health of the DRA and will not reestablish the motor and neural control patterns needed.
So, at six weeks after having your baby (and once you have been released from your MD), it is time to see your Women's Health physical therapist. Your physical therapist will do an evaluation to determine how well the four layers of your abdominal muscles are functioning and if you have a DRA. It is common for you to still have a DRA at this time, but what you do during this next time frame is pivotal in the long term health of your abdominal muscles, your bladder, pelvic floor, back and hips. The muscles in these regions all work together, so if you do not correct the DRA, you could possibly have issues in these areas for years to come. Even if your children are older, it is never too late to try to resolve the belly after baby problems.
Make an appointment today in our offices, or join us for a special Pelvic 101 night talking about DRA next Thursday, April 28 at 5:45 p.m. at CrossFit Hayden, 190 West Hayden Ave. to learn more about Belly After Baby. Call to reserve a spot.
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Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she has a provisional teacher certification in Positive Pregnancy, Parenting and Fitness rehab. She and her staff are happy to help you restore your health after baby, whether it's been two years or twenty years ago. It's never too late for your health. Coeur d'Alene office (208) 667-1988, Spokane Valley office (509) 891-2623, Hayden office (208) 762-2100.