The little-known postpartum issue that you need to know and deal with.

By Gene Stark, SRC Health

The effects of DRAM or Abdominal Muscle Separation when left untreated may be serious and mums to be and new mums should be aware of what these are and what to do about them.

What is Diastasis Recti Abdominis or DRAM?
Also known as abdominal separation it is commonly defined as a gap of roughly 2.7cm or greater between the two sides of the rectus abdominis muscle. Commonly referred to as “jelly belly” or “mummy tummy” the condition can hurt a lot more than just your ego. It occurs when the abdominal wall muscles and their connective tissue attachments stretch. This is the result of the combination of abdominal weakness, hormonal changes, weight gain and abdominal wall stretch exerted by your growing baby.

You are more susceptible to developing diastasis recti when you have a child with a high birth weight and have multiple pregnancies, have strained or lifted heavy weights during pregnancy, had excessive outer abdominal exercises after the first trimester of pregnancy1 or even pre pregnancy.
53% of women suffer from Diastasis Rectus Abdominus Muscle (DRAM) separation postpartum and 36% of those remain abnormally wide after 5-7 weeks.

“As a result, DRAM can have a number of implications for pre- and post-natal women. It can affect the stability of the trunk and may contribute to pelvic floor dysfunction, back and pelvic pain and hernias. This may be a factor in persistent post-natal lumbar, pubic symphysis and sacroiliac joint pain and even incontinence due to the interaction of the pelvic floor and abdominal musculature as a stabilising unit” said Shira Kramer, Physiotherapist and founder of Be Active Physio and the Restore Your Core Program.

Incontinence – What it is and Why we need to talk about it
Incontinence is a term that describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence).4 Incontinence is a widespread condition that ranges in severity from 'just a small leak' to complete loss of bladder or bowel control. In fact, over 4.8 million Australians have bladder or bowel control problems for a variety of reasons. Incontinence can be treated and managed. In many cases it can also be cured.

Incontinence is widespread and the incidence is frightening with over 50% of women aged 45-59 years of age experienced some degree of mild, moderate or severe urinary incontinence. 

As uncomfortable as it is, talking about it now, as much as we may think “it won’t happen to me” or simply “I’m not going to worry about this now”, being informed is your best bet at prevention and or management.
Where should you start? If you have DRAM, it needs to be treated as a priority. The economic cost to our society and to the health and wellbeing of individuals suffering with symptoms of DRAM is simply too great.6
What is the connection between DRAM, incontinence, Lumbopelvic pain and Dysfunction?

The connection between DRAM and Lumbopelvic pain and dysfunction is now well researched and women need to talk about it, as it’s only then they can understand it and treat it with their health providers.
In one study researchers looked at 200 women with diastasis recti. They found the prevalence of incontinence was 45.5%. They found a significant difference in quality of life in the presence of low back pain and urinary incontinence. Also, of statistical significance was the relationship between the number of deliveries and the interectus distance. 

What to do next? End the DRAMa Mumma!
1. Do not begin any general exercise until given an all clear after the initial checkup around the 6-week mark
2. Avoid:
• Straining abdominal muscles
• Sit- ups
• Heavy lifting
• Pulling or pushing
• Straining causing bearing down
• Sitting straight up from lying down
3. See a Physiotherapist with experience in pre/postnatal care to get a personalised program for your post-partum recovery.
4. Make sure you have a specialist recovery compression garment like the one endorsed by the Australian Physiotherapy Association that will provide gentle compression to your abdominal muscles. SRC Recovery Shorts and Leggings have Anatomical Support Panels and the top front panel supports the upper and lower abdomen stimulating your muscles to be constantly active, decreasing inter rectus distance10 and helping you heal faster.
5. If you can’t get to a physiotherapist or find it difficult to attend a number of sessions at a PT studio, then a program like “The Restore Your Core” maybe your perfect solution. An 8-week online program to kick-start your recovery and fitness post-baby, it includes daily exercises, interviews and video resources designed to help you rebuild your core after pregnancy and beyond.


References:
1 Harms, M.D., Roger W. "Why do abdominal muscles sometimes separate during pregnancy?".
2 Spitznagel T, Leong F, Van Dillen L, Int. Urogyn J. 2007 Vol 18(3):321-328.
4 https://www.continence.org.au/pages/what-is-incontinence.html
5 Millard, 1998: The prevalence of urinary incontinence in Australia, Australian and New Zealand Continence Journal
6https://www.continence.org.au/data/files/Access_economics_report/dae_incontinence_report__19_april_2011.pdf
7 Prevalence, potential risk factors and sequela of diastasis recti abdominus. Gitta S, Magyar Z, Tardi P, Fuge I, Jaromi M, Acs P, Füge I4, Járomi M1, Ács P1, March 2017
10 Antonio I Cuesta-Vargas Cátedra de Fisioterapia, Universidad de Málaga, Andalucía, Spain. June 2017. In lab. testing SRC Recovery Shorts No. 8.0615.87.4707.

Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.

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