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Rectus Abdominis and pregnancy

What is the Rectus Abdominis?

The Rectus Abdominis is a paired muscle that runs vertically down the abdomen of the body. It runs from the bottom of the ribs to the top of the pubic bone. It is located on the anterior (front) side of the abdomen and is the most superficial (closest to the surface) muscle of the anterior abdomen. The Rectus Abdominis muscle is separated on each side (left and right) by a band of connective tissue that runs in the middle of the muscle called the linea alba. This muscle can be trained with exercise and may also be known as the “six pack” when the muscle becomes clearly defined.

Why is the Rectus Abdominis important?

The role of this muscle is to flex (forwardly bend) the trunk and spine. Therefore, it allows people to perform movements such as bending over the pick-up objects off the floor, sit up from the ground/bed or perform a crunch/sit-up exercise. It also acts as another protective layer of muscle to hold the abdominal organs within the abdominal cavity. If increased pressure is placed upon the Rectus Abdominis then you can develop a condition called Recti Diastasis. This is where a separation of the paired Rectus Abdominis muscles occur through the linea alba. In severe cases, bulges can occur where abdominal organs (such as the intestines) can push through the separated muscles. The most common cause of Recti Diastasis is pregnancy. Other causes include; obesity, frequent or rapid changes in weight, weightlifting, some abdominal exercises without correct muscle activation, abdominal swelling (caused by certain medical conditions), genetics. Diastasis Recti can also occur in newborn babies (predominantly premature babies) as their abdominal muscles haven’t completely developed.

What happens to the Rectus Abdominis in pregnancy?

During pregnancy, a baby grows in the uterus over the period of 9 months before it is born. Each month the baby grows bigger and a woman’s body adapts to these changes by expanding. This happens as the woman’s body releases hormones that allow the soft tissue and skin to relax and expand. During the later months, the uterus places more pressure through the abdominals, specifically the rectus abdominis. All women will experience some degree of separation during the pregnancy. Most will usually be non-significant which will allow the Rectus Abdominis to rebound to its original shape and position post-partum. In some cases, these muscles separate more than what is considered normal and they don’t rebound back to their previous shape or position. This means that there is a separation of their Rectus Abdominis and it is greater than 2cm. The greater the amount of separation, the more severe the diagnosis. You are more likely to sustain Diastasis Recti if you have one or more of the following factors; if you have had more than one child, are over 35, have a pregnancy with more than 1 baby in the womb (e.g. twins, triplets, etc.), are a small statured woman having a larger than average baby or with performing certain core exercises during pregnancy. Research is starting to suggest that women should be strengthening their core muscles during pregnancy as it seems to decrease their risk of developing Diastasis Recti, although if you are performing the incorrect core exercises then you actually increase your chance of developing it. Therefore, speaking to a qualified Physiotherapist or Exercise Physiologist can be very beneficial so they can determine the correct exercise program and advise which exercises need to be avoided.

What happens if you develop Diastasis Recti?

Diastasis Recti is not fatal and cannot cause severe complications to your own health. Although, it can cause long term pain and some complications as you age or grow your family. The good news is that Diastasis Recti is reversible in majority of cases. Diastasis Recti can lead to; lower back pain (starting with intermittent pain and can develop into chronic pain if left untreated), a feeling of weakness of the trunk muscles/forward flexion of the trunk, a lack of support in the anterior abdomen, constipation and at worst (severe cases) may mean you are not safely able to carry another pregnancy.
There are treatments for Rectus Diastasis though. It is important to seek advice from your GP or physiotherapist if you believe you may have Diastasis Recti so that you can be physically tested to be diagnosed. Physiotherapists will educate you on the correct techniques when lifting your baby/necessary objects, how to get in and out of bed and which exercises you can perform. Appropriate core exercises will be prescribed as part of your treatment to help develop the deep core muscles (Transversus Abdominis) to help treat your Diastasis Recti. And in some cases, bracing/compression may be prescribed to help with the Diastasis Recti but it is different for each patient and physiotherapist. Majority of patients respond well to a conservative approach of core exercises (this can also be done through Pilates as long as it is run by an accredited Physiotherapist or Exercise Physiologist). In severe cases (e.g. if the fascia/muscle tears), you may be referred to a surgeon to have the separation repaired.
If you ignore your Diastasis Recti, there is a very good chance that the separation will get worse and you will start to develop more signs and symptoms of the condition.

Core Strengthening

Most women are advised of core strengthening and exercise post childbirth when the stress has already occurred to the muscles. Some women also don’t realise they have Diastasis Recti when it is mild and perform incorrect exercises that increase the separation. Preventative programs are shown to be the most beneficial. Therefore, the best advice that can be given to pregnant women is to start gentle exercising and strengthening of your core muscles as soon as you find out you are pregnant under the guidance of a Physiotherapist or Exercise Physiologist. And if you are a younger woman reading this article and haven’t had children, start exercising your core now.
Core strengthening can be performed with or without the use of equipment (e.g. swiss balls, sliders, etc.). Majority of the time, there is a program given for you to follow to ensure you are activating the correct muscles and to increase the strength. Plus, there are other tools, such as real time ultrasound which can help to give you a visual as to whether or not you are activating your deep core muscles (Transversus Abdominis).
Therefore, it is best to see your physiotherapist or Exercise Physiologist to get yourself a core exercise program to ensure you understand how to exercise your core and the best strengthening program for you. Make sure when you are calling your Physiotherapist or Exercise Physiologist that they understand and can perform women’s health treatment if you are pregnant or post-partum. And if you fall into a severe category of Diastasis Recti (e.g. tear), then you may first need to see a surgeon to determine whether or not a surgical intervention is the most appropriate treatment. It is better to treat these conditions earlier rather than later. So, if you know anyone looking to become pregnant, who are pregnant or who are suffering from Diastasis Recti, then please forward this article through to them.

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