I received this message today from a friend and it is a question I get a lot from mums in our group classes so I thought I would share it here for anyone else who may have a similar question.
"I have a quick question. How long is normal for abdominal separation to heal? I still have 1.5 fingers width of separation despite avoiding sit ups etc and doing exercises to try and heal it. My daughter is 7 months old now and I'm wondering if it's something a physio or someone can help me with or if I need to look at having it repaired surgically." Lucy (not her real name)
Unfortunately Lucy, this isn't a quick answer, but let's break it down so we can cover all our bases. Also, I am sharing here what I have learnt through my postnatal trainer qualifications and personal experience but I am not a medical professional and strongly encourage all women to see a women's health physiotherapist or their GP if they have concerns about their abdominal separation (diastasis recti).
I am not going to go through the ins and outs of anatomy in this post (there is plenty on the internet). But in a nutshell, separation of the rectus andominis muscles (see picture below) happens in most women during pregnancy to accommodate the growing baby (kind of essential don't you think?). In some women it comes back together quickly after birth and for others (like me) it does not. Diastasis can be a cause of back pain and have an impact on your pelvic floor function as it is part of your core. It can also make you look pregnant when you are not (which can be distressing for some mums). You can click on the picture below for a more detailed explanation of diastasis recti.
So let's get started on answering Lucy's query:
1. How long is normal for abdominal separation to heal?
It depends. That is annoying right! Each person's recovery will differ depending on factors such as genetics, how many kids they have had, how wide their separation is, the tension of their connective tissue (see pic above), their diet, their posture, how they exercise and even how they breath.
2. I still have 1.5 fingers width of separation despite avoiding sit ups etc and doing exercises to try and heal it.
First off, good job on avoiding the sit ups. They aren't your friend when you have abdominal separation and neither are planks so it is always a good idea to see a physio, postnatal pilates instructor, exercise physiologist, or personal trainer for diastasis friendly core exercises. Poor exercise selection can definitely prevent healing, increase the gap or cause a hernia so it is important to move wisely.
Women can get pretty obsessed about 'closing the gap' but I have good news. You don't have to completely close the gap to have a functioning core and no symptoms, but you do need to know how to manage the pressure that is generated internally when you move in order to prevent further damage. This largely goes back to the breathing, posture and exercise selection factors we mentioned in point 1.
For you Lucy, a 1.5 finger gap is considered pretty small and probably won't prevent you from doing the exercises you love in the future. It is best to see a women's health physio that specialises in diastasis recti though for a full assessment of your core function and advice going forward.
3. My daughter is 7 months old
Congratulations on surviving the new baby stage! In terms of abdominal healing this isn't actually a long time. They say it can take up to two years for a woman's body to fully recover after childbirth so don't feel you should be further along in your recovery than you are right now.
It is also never to late to improve core strength and improve a diastasis so any mums out there who are further down their postnatal journey, you can start now! However, in some women, no matter what they do, they will never be able to heal their diastasis without surgery (see below).
4. I'm wondering if it's something a physio or someone can help me with or if I need to look at having it repaired surgically.
Yes, see a physio!! I recommend to all my clients that they have an abdominal and pelvic floor assessment with a women's health physio at around 6 weeks postpartum or at any time they are concerned about their recovery/pelvic floor health. Knowledge is power! Knowing your own body, how it is currently functioning and how it should be functioning will help you identify when something doesn't feel right and prompt you to seek specialist help.
As for surgery, I recently went to see a surgeon about my umbilical hernia and while I was there I quizzed him about all things diastasis recti. It is major surgery with a long recovery time and requires the insertion of mesh to hold the two sides together. If you have a significant diastasis that hasn't responded to exercise, a hernia, or are experiencing pain due to your diastasis then surgery might be for you. By the sounds of it Lucy, your not a candidate for surgery but your physio can provide further advice on this.
So Lucy, I hope that has helped to answer your question, even if I can't give you a definitive answer.
What you can do if you have diastasis recti
Here are some quick tips to help your recovery process:
If you have a question you would like answered then please get in touch. If we can't answer it directly, we will get on our local experts to answer it for you. You can also use the search function on our site to look for more blog articles on diastasis and core strengthening.
About the Author
Christine is a pregnancy and postnatal trainer with a passion for pelvic floor and abdominal friendly movement. Her interest in this area was sparked after her own battles with prolapse and diastasis.
Christine holds a Cert III and Cert IV in Fitness and has undergone specific training in exercise for pregnancy, postnatal pelvic floor and abdominal recovery and group exercise instruction. Christine is registered with Fitness Australia (Reg No. 095064) and a member of the Continence Foundation of Australia. She also holds a Master of Business Administration (MBA), a Bachelor of Leisure Management and volunteers as President of Friends of the Birth Centre to advocate for improved maternity services for women in Queensland.
This post follows on from our post on Pelvic Floor Exercises, Are you doing them correctly? Once you have mastered your technique and are engaging the right muscles, you might be wondering what exercises you should be doing and how many. Remember, we always recommend having an internal exam from a Women's Health Physiotherapist so you know how your pelvic floor is performing but here are some general guidelines on the types of exercises that can help and how many we should be doing. If you are in Brisbane, we have a list of pelvic floor physios here.
Ideally our pelvic floor should react to various real life situations. We should therefore train our pelvic floor in different ways and in different positions. You can do these exercises lying on your side, on your back, kneeling on all fours (cat position), while sitting, standing or while walking. Here are 5 different exercises women should be using for their pelvic floor:
1. Lift and Hold
While coordinating your pelvic floor lift with your breath, lift and hold for up to 10 seconds while continuing to breath. You may only be able to hold it for 2 seconds to start with but once you feel like you are no longer holding the lift, relax, rest and try again. Gradually over time, with consistent training your endurance will improve.
2. The Quick Flicks
Lift then relax (don't hold the lift at the top). Repeat 10 times.
Imagine you are going to sneeze and you have to lift your pelvic floor quickly before your sneeze.
3. The Elevator
When your pelvic floor is fully relaxed it is on the Ground Floor. As you exhale gently and slowly lift your pelvic floor to Level 1, Level 2, Level 3 then as you inhale slowly lower you pelvic floor back down through the levels, Level 2, Level 1, Ground Floor. Remember to fully relax your pelvic floor for 10 seconds before attempting another set.
4. Relax it!
We have said it before, but we will say it again. Being able to relax your pelvic floor is just as important as being able to contract it. We want our pelvic floor to have a wide range of motion. Here are three great pelvic floor mobilisations to help your pelvic floor chill out. A great relaxation exercise is to lie on the floor with your feet up the wall (bottom will be up against the wall). Be warned though, if you have a crawler or toddler in your house you might want to do this when they are asleep as they will see it as an invitation to lie on your face!
Squats can be a great exercise for your pelvic floor. Let's compare it to a bicep curl. As you straighten your arm, the muscle stretches, and as you bend your arm to lift the weight, the muscle shortens. This is the same action that happens to the pelvic floor as you squat. As you descend in a squat, you stretch/lengthen the pelvic floor, and as you rise back up, the pelvic floor shortens. And not a single kegel in sight! The trick though is in the squat technique. You can read more about pelvic floor activating squat technique here.
How many Pelvic Floor Exercises should I be doing?
Treat your pelvic floor like any other muscle group. If you were wanting to strengthen your biceps you wouldn't do a set of bicep curls in the morning, then one at lunch and one at night. You would do all of your sets in relatively close duration. Treat your pelvic floor exercises the same way.
General pelvic floor guidelines:
Technique No Nos
Want to know more?
Our friends at Pelvic Floor Exercise have lots of info on pelvic floor health and also sell a range of devices to help with pelvic floor strengthening and incontinence management. Of course, it is best to see your local pelvic floor physio so you can have a full assessment first. You can find a list of Brisbane pelvic floor physiotherapists here. You can also find useful information at the Pelvic Floor First website. Your Go Mum trainer can also work with our physio to ensure your workouts are safe for you.
The guidelines above are of a general nature and may not be right for your specific situation. Please see a women's health physiotherapist.
If you would like more postnatal exercise tips and to connect with a group of like minded mums, then join us in our closed Facebook group.
If you have been pregnant, then chances are at some time in your pregnancy or postnatal journey you have been advised to do pelvic floor exercises (aka kegels). In my role as a postnatal trainer I follow up with PT clients on how they have been going with the pelvic floor exercises they have been prescribed by their physiotherapist. Nine times out of ten I hear "Good, but I haven't been doing them as often as I should". This is usually code for, I haven't been doing them at all! I get it, I have been there myself. But the reality is, if you want it fixed, then you have to do the work, and consistency is key.
In my experience, there are two main reasons why women don't do them regularly:
In this post, we are going to show you a clever trick to help your brain connect with your body to maximise your pelvic floor exercise training.
We are going to use our breath along with a visualisation of a peanut and an elephant. Yep, an elephant. Here is how it works:
1. Get into position. You can do this sitting, standing or kneeling on all fours, but for beginners it helps to lie on your back with one hand on the side of your ribs and the other on the middle of your belly. Try to rest your elbows on the floor and relax.
2. This is where the elephant comes in. An African elephant has two 'fingers' on the end of its trunk that it uses to pick things up (an Asian Elephant only has one finger so he is no good for this exercise). Visualise that your back passage (anus) and front passage (vulva) are the lips of the elephants trunk.Still with me?
3.As you inhale just relax your pelvic floor and breath into your ribs (letting them expand out to the sides) and gently into your belly.
4. As you slowly exhale, close your anus and vulva as if you are trying to pick up a peanut with your 'trunk' then gently suck the peanut up your trunk (pelvic floor lift) as you continue to exhale. It is important to relax your buttocks and tummy. There should be no contraction of the buttocks or six pack during this exercise. You may feel a very slight tension between the hip bones, this is OK (this is your transverse abdominis engaging).
5. Inhale, and let everything drop down again.
So to recap, here is the wording to help talk you through the exercise. "Inhale, relax. Slow exhale, close front, back, pick up the peanut and suck it up, inhale relax." Repeat 4-5 times.
So how did you go? Now, if the elephant doesn't float your boat, you can try other visualisations and find one that works for you. Here are a couple I have heard of:
If you are having trouble feeling any contraction or relaxation through your pelvic floor, it is definitely worthwhile making an appointment to see a women's health physio that does internal exams so you get a good idea of where your pelvic floor is at.
Keep an eye out this week for other follow up posts on pelvic floor exercises such as:
About the Author
Christine is a pregnancy and postnatal trainer with a passion for pelvic floor and abdominal safe movement. Her interest in this area was sparked after her own battles with prolapse and diastasis.
If you have any questions about postnatal exercise or exercising with prolapse or abdominal separation feel free to contact Christine.
Our Go Mum trainers love connecting with women's health physiotherapists both in Brisbane and around the world. One of our favourite local physios has written this article on one of our biggest pet peeves. Thanks Bronwyn!
I have a small confession to make.
I tear pages out of magazines in waiting rooms. And it’s not because they are articles about how to look 30 when you’re 55 or the latest on Angelina or even 101 recipes with quinoa.
I rip out advertisements about continence pads for ‘Light Bladder Leakage’ or ‘LBL’!
You know the ones: ‘It’s okay women – leaking is fine – just wear a pad’. And the models in these ads have been getting younger and sexier - no longer is it only the ‘senior’ looking lady! Now it’s younger women in tight dresses. Disclaimer: I have nothing against continence aids. It’s the normalisation of incontinence that makes my blood pressure rise.
Have you noticed how subtly in the feminine hygiene aisles at the supermarkets, products progress from tampons and menstrual pads to continence pads? LBL is being used to normalise a very real problem.
Here is my advertisement: leaking urine is never fine, never okay, never normal. It is a sign that something is not quite working to its full potential in the pelvic area of the body. That wonderful hidden part that contributes so much to our quality of life. It is often a sign of pelvic floor dysfunction.
As a physiotherapist with a special interest in pelvic health, I care a great deal about those bits ‘down there’ and their impact on women’s health.
How should a normal bladder behave?
Well we should have the ability to control the functions of our bladder and bowel throughout all stages of life. This is continence. Incontinence is any loss of bladder and bowel control, irrespective of amount or frequency.
Here is a breakdown of the facts: normal bladders should hold approximately 500 mls. Each emptying of the bladder is 350-700 mls of urine. We wee four to seven times a day and may wake to go once at night.
Going to the toilet should not be urgent – rushing off, feeling you can’t hold on – nor frequent (going to the toilet more often than outlined above). The bladder should fully empty with a strong, continuous stream and no strain. And there should no urinary leakage. Yes, that’s right, you should be able to jump on the trampoline with the kids!
Your bladder should be functioning efficiently in the background. So if you have read the above paragraph and can’t recognise your bladder, you may have a problem.
What should you do?
Well consulting with a physiotherapist experienced in pelvic health is a great starting point. This involves detailed history taking and assessment of what exactly is happening for you. Treatment is based on your individual needs and may take three to four appointments over several months. And there is good research to prove it works!
Now, while I’m not advocating carte blanche magazine destruction I am suggesting that next time you are in a waiting room, spend some time thinking about your bits ‘down there’.
About the Author
Bronwyn Jest is a physiotherapist with a special interest in Women's, Men's and Pelvic Health.
Bronwyn has a positive approach to pelvic health concerns and is passionate about getting the message out that these issues can be treated effectively and people should not have to suffer in silence.
She provides management for bladder issues: stress and urgency incontinence, pelvic organ prolapse, bowel issues: constipation, urgency and incontinence ,sexual dysfunction and pelvic pain, guidance for pelvic floor safe exercising, problems during pregnancy and after childbirth, advice before and rehabilitation after gynaecological and other pelvic surgery including for the bowel.Bronwyn works in her own private practice at Chermside - www.bronwynjestphysiotherapy.com.au
When not working, she enjoys exercising, reading, music, admiring (and collecting!) pottery, swimming at the beach and spending time with her husband Martin and three adult offspring.
Should you go to the toilet “Just in Case”?
The answer = A BIG NO!!
A bladder, when functioning normally, gives us two signals to go to the toilet. The first is the “gentle warning” that gives us a vague sensation that we need to go and you can think of this as your “warning system” that within the next hour or so, you will need to find a toilet. We can resist this first urge if our bladder is healthy. The second signal is a stronger and urgent feeling low in the abdomen, that tells us we need to find the nearest toilet asap.
If you go to the toilet “just in case”, you are emptying the bladder before either of these signals have occurred. If you do this frequently, and over an extended period, the bladder becomes used to this lower threshold for capacity and the “I’m full” signal will be sent sooner and sooner. Hence, it becomes a vicious cycle of you emptying when you don’t actually need to, and your body telling you that you need to empty when the bladder is at low levels.
What you should do if you feel your bladder control is not what it should be:
Seek help: A physiotherapist with pelvic floor experience can give you the education you need and discuss your individual circumstances!
When you feel the urge to go….ask yourself if it is a “warning” and if you can, try to hold or distract yourself and the urge may pass. A legitimate “I’m full” signal will NOT pass. When you empty your bladder, always sit down and fully relax (close the door because the you know the kids are going to come in with a crisis the minute your pants are down!). No hovering in public toilets by the way! Ensure that you fully empty your bladder by relaxing your tummy and pelvic floor.
Caffeine, alcohol and fizzy drinks are all bladder irritants so you may want to cut back on these.
And please, let’s not teach the next generation of little girls to go to the toilet “just in case” before they leave the house. You will be doing them a huge favour!
About the Author
Kate Boucher is a physiotherapist with over 14 years’ experience and mother of 3. She is a strong believer in a comprehensive, integrated approach to health. Kate enjoys working with mothers both pre and postnatally – whether it be to treat back and pelvic pain and instability or in addressing pelvic floor and core strength. She also understands the desire some have to return to high level sport and exercise and has intricate knowledge in establishing safe pathways for these goals to be reached.
You can find Kate at Go2 Health at Everton Park.
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