Core Issue

Understanding, identifying and treating post-pregnancy diastasis

  • Category
    Health
  • Written by
    Amber Klinck

When it comes to a woman’s pregnancy, the range of what is considered normal is so wide it’s almost comical. Even when the same woman has multiple pregnancies, there’s no guarantee the second will be anything like the first. 

And then, of course, there are all the variants one may experience with delivery—followed by six mysterious weeks of postpartum. There is certainly nothing normal happening then.  

With all the variations surrounding the greatest physical transformation a woman will ever experience, paired with the centralized focus she is now—as a mother—giving to her newborn child, it’s easy to see how her own altered physicality could be overlooked, even when there are moments of discomfort. 

Lean and petite, it’s tempting to just politely smile and nod when Amy Granzow tells you how big her belly was during the last few months of her pregnancy. That is until she shows you a picture of her tiny frame supporting quite an impressive bump. 

“I had a really healthy pregnancy, but my belly just got bigger and bigger and bigger,” she explains. When the skin around her belly button started to look thin, Amy’s husband, Dr. Jay Granzow, suggested it could be diastasis recti.  

In layman’s terms, if you were to look at a well-developed abdomen, “the fascial line down the middle is called the linea alba, and that line should be shallow, firm and pretty narrow,” explains Jenni Gabelsberg, director of physical therapy at Women’s Advantage/Men’s Optimal Health PT. “During pregnancy, that connective tissue starts to stretch open and separate the long rectus abdominus muscles—this is true for all pregnancies.” 

It is when a significant separation remains after delivery that one could run into problems. “It can affect your daily life,” says Amy, who has to be completely cognizant of every move she makes that requires core strength—from picking up her children to pulling the groceries out of the car. 

Still, Amy was lucky. With Dr. Granzow’s early diagnosis, she began going to physical therapy with Jennifer and working with Lelia Parma, a Pilates instructor who specializes in postpartum strengthening. 

“I was getting the right care at the right time,” Amy notes. “I was able to do the right exercises to get me to a point where I felt good, and I felt strong. I still had a problem, but I was getting help.”

Of course, Amy is quick to emphasize, “You don’t have to be married to a doctor to get the right help.” But you do have to be willing to speak up and not accept certain physical ailments as the battle scars that come with motherhood. 

“Sometimes toughing it out isn’t better; it’s just toughing it out,” Dr. Granzow says. For women who are less affected with weakness but have a bulge that remains after delivery, the assumption is often that it’s solely fat. 

“People often think that they just need to lose more weight, do more sit-ups or train harder,” Amy explains. “What they don’t realize is what’s going on underneath.” 

Another side effect could be back pain. “You may hear someone say they have abdominal weakness and then mention having pain in their lower back,” Amy notes. “They’ll say, ‘Well, it’s because I’m carrying my child a lot.’ But when your core is weak, your back will overcompensate.”

During Amy’s second pregnancy, her diastasis came back, and it was worse. But now she knew how to handle it, and her postpartum condition was considerably more manageable. 

“Research shows that if a woman specifically trains the transverse abdominis muscle during pregnancy, she has a 70% less chance of developing diastasis after delivery,” explains Jennifer. That’s not to suggest, however, that you should be exercising at 100% during pregnancy. 

“Every trimester has its protocol,” Lelia says. “During the first trimester the focus is on strengthening the transverse abdominis, the pelvic floor and improving your posture.” 

During the second and third trimester the focus remains the same, but exercises that require lying on your belly are out. Stretches should be conservative due to “the relaxin hormone your body produces to prepare for delivery,” Lelia explains, and a pregnant woman’s heart rate should always stay below 140 BPM. With so many details surrounding the proper positioning for pregnant women to exercise safely, what Lelia ultimately recommends is for women to always “start with a doctor’s clearance and work with a certified instructor.”

“When you’re exercising with a woman , you can tell if they’re engaging their core properly or not. The most clear sign to keep an eye on is if you see a bulge pop up through the linea alba. If you see that, then you need to take a step back and modify the exercise to a gentler version,” Lelia continues. “I think that’s important to know because there are so many women who are either going to group classes or working out with DVDs. You need to make sure your abs are hugging in, because if they’re not, you’ve gone too far.”

With so many treatment options available—from physical therapy to surgery in the most severe cases—there’s no reason to accept diastasis as your new normal. But step #1 is identification. 

Indications you may need to be evaluated by a women’s health physical therapist could be “a feeling like your ribs are spreading to the point of discomfort, if you have a lot of overstretch, bulging or tenting near the belly button, or if you’re having spinal pain or difficulty with day-to-day activities,” Jennifer explains. 

If a considerable time has passed after delivery and physical therapy is no longer an option, a specialist like Dr. Granzow can “start with a diagnosis, followed by a plan based on what you’re trying to achieve.” Whatever your goals, stay in tune with your body, ask questions, and don’t be afraid to speak up if something doesn’t feel right.

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