Abdominal Separation or Diastasis Recti (DRAM) in Pregnancy

Diastasis recti abdominis muscles (DRAM) is the widening and weakening of the linea alba, a collagen structure at the front of the pelvis. This is also known as abdominal separation and is a common condition that affects almost all pregnant women by 36-weeks’ gestation. Your body goes through many necessary changes during pregnancy to allow for the growth of your baby, including increased intra-abdominal pressure, increased weight and movement of the expanding uterus and an increase in the pregnancy hormone relaxin. All these changes are likely to result in abdominal separation. The good news is that for many women, it will resolve itself within the first 6 weeks postpartum.  

The important thing to recognise is that it’s not just about the gap! The inter-recti distance is not the problem, or something to be concerned about. It is worthwhile noting that the distance between the 6-pack muscle in the average population (not even postpartum women!) can vary between 1-3cm. Our focus is what can be compromised as a result of a weakened linea alba, including:  

  • Ability for the abdominal wall musculature to produce forces 
  • Stability of trunk and ability to transfer load in larger motor tasks 
  • Ability to control intra-abdominal pressure  
  • Synergy of pelvic floor muscles and deep core muscles, including transverse abdominis  

We are often asked – how can I prevent abdominal separation during pregnancy? Unfortunately, there may actually be NOTHING you can do to prevent abdominal separation entirely. However, it isn’t something to be scared or fearful of. We may not be able to prevent it entirely, but there are certain ways we can minimise the effect it has on your function!  

Our top tips for minimising abdominal separation:  

Keep active during pregnancy!  

Studies have shown that prenatal exercise was protective for the development and/or reduction of abdominal separation antenatally more than postpartum rehabilitative studies by up to 35%! This means that maintaining strength and control during pregnancy is more beneficial than postpartum attempts. Consider joining a pregnancy exercise class run by a qualified health professional as they will tailor appropriate exercises to ensure you continue to strengthen your body and abdominal muscles safely.  

Modify movements to control intra-abdominal pressure. 

Work and exercise within your comforts and avoid those where you can see physical ‘doming’. This can be a clear indicator that you are not maintaining your intra-abdominal pressure with your breath. However, don’t panic if you see some doming, you may just need help with your breath work from a qualified health professional. Modify your exercises or follow some of these tips to help maintain your IAP:  

  • Reduce overhead work if poor biomechanics displayed 
  • Include transverse abdominis and oblique sling work  
  • Support optimal fetal positioning 
  • Incorporate breath work and pelvic floor muscle training 

Keep your bowel habits in check. 

Constipation in pregnancy is common. However, straining to open your bowels can increase the pressure on the abdominal tissues. Make sure you’re sitting correctly, feet on a stool, leaning forward and relaxing your abdomen with deep breathing to prevent excessive straining.  

See a women’s health professional if you have any concerns.  

Women’s health exercise physiologists and physiotherapists can assess your abdominal muscles and recommend appropriate exercises, supports and garments which may help if you are concerned about your function. Book an appointment with Millie, our women’s health exercise physiologist, to undergo an assessment.  

Remember, everyone’s genetics and linea alba (the connective tissue between the abs) are different, so the amount of separation in response to pregnancy changes will vary, as well as many other factors outside of our control. The main takeaway is to not be fearful of exercise in pregnancy! There are many benefits that outweigh the risk of abdominal separation, a condition we can safely manage. Just be mindful, modify and seek advice if needed.  

By Millicent Christou