During pregnancy, the growing baby and hormonal changes cause the tummy to stretch. As the baby continues to grow, the tummy muscles (rectus abdominus) may start to stretch apart or separate and a ‘gap’ can form where the muscles join down the centre of the abdominal wall. This gap is known as diastasis of rectus abdominus or ‘DRAM’ and occurs in at least 30% of women during pregnancy, particularly during the third trimester and can be completely normal.
In the immediate postnatal period it is also normal to have a small ‘gap’ or DRAM. Within six weeks this should slowly resolve by itself, although it may never go back together completely.
When is a ‘gap’ not normal?
In a small percentage of women, the gap may be much larger or may not resolve. This may not cause any symptoms or some women may experience hip pain, groin pain, back pain, weak floppy tummy muscles or pelvic floor problems (such as incontinence or prolapse).
A big belly does not mean you have a DRAM. Likewise, a flat tummy does not mean you do not have a DRAM.
More than a 2 finger gap at 6 weeks postnatal is not normal and specialist advice should be sought.
You can check for a gap yourself.
Lie on your back with your knees bent and your feet flat on the floor.
With your tummy relaxed gently press your finger tips in the middle of your tummy, above your belly button.
Lift your head and shoulders slightly off the floor/ bed (that is, do a crunch or sit up) while feeling for a gap between the abdominal muscles.
What can you do to help?
- Maintain good posture. Try to sit, stand and walk tall, eg. when feeding your baby or pushing the pram.
- Focus on keeping the tummy tucked in and avoid letting the tummy sag or bulge.
- Do pelvic floor exercises.
Try to avoid
- Strong abdominal exercises eg. crunches or sit ups in the early postnatal period. These may actually make things worse and prevent the gap from closing.
- Straining. Reduce heavy lifting as much as possible, eg. lifting older children or heavy shopping.
- Abdominal corsets or belts. These are rarely required and can make your tummy muscles weak and lazy.
When you start to do more exercise…
- Start gently- walking, swimming and gentle postnatal exercises are good suggestions
- Continue to strengthen your pelvic floor
- Check your gap is closing before gradually progressing your abdominal exercises.
When do you need help?
If you are concerned about your ‘gap’ or if you are experiencing any symptoms (such as groin, hip or back pain, incontinence or heaviness down below) an assessment by a Pelvic Health Physiotherapist would be recommended. I can check your gap, assess your pelvic floor, treat any underlying symptoms you may have and advise you on safe exercises to help.