Post-Partum “Bulge”: What new moms should know

By Stacey Hendricks, PT, DPT, WCS

Childbirth can wreak havoc on a woman’s body—just ask any new mom. But many women worry about that post-baby belly because they don’t like how they look. In reality, that bulge might be signaling a bigger issue—diastasis recti—a condition that requires help from a pelvic floor physical therapist.

Diastasis recti (DR) is when the left and right sides of the rectus abdominis, an abdominal muscle that stretches vertically from the base of the ribs along the midline of the abdomen to the pubic bone (a.k.a. the “six-pack” muscle) pull apart from stretching or tearing of the fascial connective tissue between them. This allows the contents of the abdomen to protrude through the opening, creating that post-baby bulge or “mummy tummy.”

Many women are concerned about the aesthetics of having a DR, but what they don’t realize is that its presence indicates dysfunction in the coordination of the stabilizing muscles of the trunk, consisting of deep lower abdominals, the pelvic floor muscles, deep back muscles and the respiratory diaphragm. These muscles work in a synergistic fashion to provide stability to the spine and pelvis in the transfer of loads between the right and left sides during movement such as walking, reaching or carrying. Poor coordination of these stabilizing core muscles puts women at increased risk for having back pain or pelvic floor dysfunctions, such as bladder or bowel leakage, pelvic organ prolapse (dropping of the bowel or bladder), pelvic pain (vaginal or rectal pain), or sexual dysfunction (decreased sensation or increased discomfort with intercourse).

A pelvic floor physical therapist has specialty training in assessment and treatment of a wide variety of pelvic floor and abdominal muscle dysfunctions. These specialists can accurately assess a DR by measuring the distance between the left and right rectus abdominis at the navel, above it, and below it while the patient is lying down and while doing a crunch. A DR is present if the separation is greater than 2 cm. There are specialized exercises of the abdominal and core muscles that help improve diastasis recti, however it’s important for women to seek a specialist, as doing these exercises incorrectly (or doing the wrong exercises) can cause more damage.

There is a common misconception that because childbearing is a “natural process,” that the muscles of the abdomen and pelvic floor will return to their pre-pregnancy state on their own. Research shows that 66% of women have a DR in the third trimester of pregnancy, 53% continue to have a DR immediately postpartum, and 36% have a DR after 7 weeks postpartum. Women who continue to have a DR at 2 months postpartum have no further improvement without intervention of exercises or physical therapy.

Stacey Hendricks, PT, DPT, WCS, is a doctor of physical therapy and a board-certified Women’s Health Clinical Specialist practicing with Lisa Larkin, MD, and Associates in Mariemont, OH.

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