Abdominal Discomfort, Pregnancy, Low Back pain, Pelvic pain, and Abdominal Weakness are they all related?

The simple answer is yes they are all related! These symptoms are common complaints among every hard-working American Citizen. However, all of these can be related to one key problem Diastasis Recti Dysfunction. Now if you haven’t heard of this term before it is okay. In fact, the Diastasis Recti plays a key role in abdominal musculature stabilization and strength. Diastasis Recti Dysfunction involves “a separation of the rectus abdominis muscle along the band of connective tissue that runs down the middle of the rectus abdominis known as the Linea Alba”. [6] This separation is commonly seen during the 2nd and 3rd trimester of pregnancy. Of course, this is due to the fact that your adorable baby needs additional room to grow inside the tight abdominal wall. Also, the hormone Relaxin, that is heavily secreted during those trimesters, make ligaments and connective tissue more lax during pregnancy. Now ladies the pregnancy process is beautiful so don’t panic. A small amount of widening of the abdominal midline is normal. “In fact, a diastasis recti occurs in about 30% of all pregnancies. Although some women’s midlines spontaneously close to less than a 2 finger-width after labor”. [6]  The problem begins when the “midline separation is more than 2 to 2.5 finger widths or 2 centimeters.” [6] This problem not only affects pregnant and post partum women but, it can also affect men and children.

How does it develop in men?  

Many males develop this after having prostatectomy surgery via the Da Vinci Robotic method which involves making an incision along the midline of the abdominal area. Weight lifting using improper body mechanics or posture and performing sit-ups vigorously can lead to diastasis recti. If you have gained weight in a short period of time it can add additional pressure on the abdomen causing separation to occur. Lastly, if your mother or father has suffered from this condition you are at higher risk for developing this.

 

How does it develop in children?

When we are born our abdominal muscles are separated in the beginning. “Usually around 3 years old after the development of the nervous system, the abdominal muscles come together but don’t fully close since, the belly button in the connective tissue are just starting to join the outermost abdominal muscles (rectus abdominis)”. [5] This in turn makes the muscles more susceptible for separation and opening. In addition, the way kids are being taught in school to strengthen their core by performing abdominal crunches increases their risk for developing diastasis recti since, it ultimately adds more stress on the abdominal area. “If a child has separated abdominal muscles, his or her developing spine and organs won’t be supported. Diastasis Recti has also been linked to Central Coordination Disorder (CCD), a condition that results in delayed motor development”. [5]

Signs and Symptoms of Diastasis Recti  [6,1,4]

• Abdominal discomfort with certain movements, such as rolling over in bed, getting in/out of bed, and lifting heavy objects.
• Umbilical Hernia
• Pubic Symphysis pain
• Sacroiliac joint pain
• Low back pain
• Pelvic floor dysfunctions, such as urinary, fecal and flatulence incontinence and pelvic organ prolapse
• Severe Abdominal weakness and visible abdominal skin drooping
• Constipation
• Trouble breathing

Risk Factors

• Obesity
• Multiple Birth pregnancy
• Abdominal wall laxity from previous pregnancy or abdominal surgery
• Increased BMI

How can I be sure that I have this? [6]

1. Lie on your back with your knees bent, and your feet on the floor.
2. Place your fingertips of one hand at your belly button and while your abdomen is relaxed, gently press your fingertips into your abdomen.
3. Lift the top of your shoulders off the floor into a “crunch” position.
4. Feel for the right and left sides of your rectus abdominis and take note the number of fingers that fit into the gap.
5. You will want to test this again approximately 1-2 inches above and below your belly button to determine the length of the gap.

How can I correct this problem?

Thankfully there are some basic exercises that can be performed at home to help decrease the abdominal separation and increase core strength and decrease pain.

For men: [1]

Exercise One

• First lie down on the floor with both legs bent and both feet on the ground.
• Put both of hands on the lower stomach and point fingers downwards.
• Breathe in and out in a steady stream.
• Slowly lift the head and shoulders off the ground.
• Press down on the lower abdomen using hands and fingers.

Exercise Two

The more you strengthen the muscles that are involved in diastasis, the more difficult it is to divide the muscular tissue.

• Lie on the ground on the back with knees bent and feet on the floor.
• Tighten the muscles in the lower abdomen and lift your hip at the same time.
• Do 10 reps or as directed.

Exercise Three

This is the third exercise for diastasis recti in men and do as instructed:

• Lie down on the floor, knees bent and feet on the floor.
• Inhale and when exhaling, slowly straighten out one leg and slide it down on the floor.
• Straighten your leg as far as you could. Then inhale and bring the leg back to its starting position. Repeat with the other leg.

Exercise Four

• Sit on the floor and put both hands on the abdomen.
• Take small breaths and slowly contract abdominal muscles, pulling them toward the spine.
• Hold this position for 30 seconds while keep your breathing under control.
• Do this exercise 10 times per day.

Exercise Five

• Lying down with knees bent and feet on the ground.
• Lift head slowly with chin downward the chest.
• Slowly contract the abdomen towards the floor and hold it for 2seconds.
• Lower your head to the starting position and hold it for 2 seconds.
• Repeat this exercise 10 times

For Women [3]

Research has shown that pregnant mothers who engaged in a 90 minute exercise class over 6 weeks made improvement by performing the following exercises:

First, make sure your abdomen is drawn in at the umbilicus to spine with all exercises to engage transverse abdominis muscle (a key abdominal stabilizing muscle). In order to perform this, try to suck your bellybutton in towards your spine.

While keeping that muscle engaged perform pelvic tilts in supine, standing, all fours and sitting

In sitting and using upper extremity exercise bands perform military presses, lateral raises, chest press and overhead pull sitting.

While laying on your side perform hip abduction, hip flexion, hip adduction.

While laying on your back, perform a bridge.

Take a towel or bed sheet and wrap it around your waist and cross it at the largest gap area. Hold the sheet nice and tight, making sure the sheet is in between the rib and hip bones and perform a mini sit up.  Perform this 30-60 times per day.

 

Make sure to AVOID performing any of the following activities as they can create further separation of the abdominal muscles:

• abdominal sit-ups
• crunches
• oblique curls
• double leg lifts
• upper body twisting exercises
• exercises that include backbends over an exercise ball
• yoga postures that stretch the abs, such as “cow” pose and “up-dog” pose
• pilates exercises that require the head to be lifted off the floor
• lifting and carrying heavy objects
• intense coughing without abdominal support

Now these exercises may be enough to begin strengthen your abdominals gradually but, not everyone responds the same way to exercise as others. This is simply due to the fact that when we are in pain we tend to substitute and avoid performing an exercise the right way to minimize the onset of pain. These compensatory movements only lead to more damage in the long run. Therefore, you can schedule an appointment at Bella Physical Therapy where a specialized Pelvic Floor Physical therapist can evaluate you and develop a customized exercise program just for you.

 

Exercise responsibly my friends,

❤ S

 

Cited References:

 

1. Causes and Treatments of Diastasis Recti Among Men. (2017). New Health Advisor. Retrieved 25 December 2017, from http://www.newhealthadvisor.com/diastasis-recti-in-men.html
2. For Medical Professionals – The Dia Method ®. (2017). The Dia Method ®. Retrieved 25 December 2017, from https://thediamethod.com/for-medical-professionals/
3. Gillard, S. (2013). Diastasis Recti Abdominis in Pregnant Women. Fitbackandbumps.co.uk. Retrieved 25 December 2017, from http://www.fitbackandbumps.co.uk/diastasis-recti-abdominis-in-pregnant-women/
4. Move Forward Physical Therapist Guide to Diastasis Rectus Abdominis. (2017). Physical Therapist Guide to Diastasis Rectus Abdominis. Retrieved 25 December 2017, from http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03
5. Tupler, J. (2014). Diastasis Recti in Children?. Diastasis Recti in Children?. Retrieved from https://saferide4kids.com/blog/diastasis-recti-in-children/
6. Wright, M. (2014). How to Fix a Diastasis Recti. As The Pelvis Turns. Pelvic Health & Rehab Center Blog. Retrieved from https://www.pelvicpainrehab.com/female-pelvic-pain/2306/fix-diastasis-recti/