Health AreasMaternal & Child Health

Bouncing back; the ‘flat tummy’ mirage

It was going to be a tough battle for Agnes to bounce back after pregnancy.  She had shed most of her post-baby weight on all areas except one; the tummy.  The protrusion was her greatest concern. The wide-gaping pouch on her abdomen had refused to melt away. And it conspicously reminded her of the need to lose it.

Not even after the committted gym sessions, hiking the hills and worshipping the morning-runs. The diets also disappointed her. The tummy was too obstinate. She sought medical advice and weeks later, she is making  progress. Agnes is one of the many women whose abdominal muscles don’t shrink back down on their own. She has  Diastasis Recti.

                                                                       Dr Esther Dindi, a consultant physician and fitness coach

The rebound

The airwaves, timelines, secret online groups and phone screen-time are filled with quick-fixes for that bulging tummy. Diets have been hailed, protein shakes promoted and prolonged fasting regimes encouraged to get that elusive flat tummy.

Fad diets are spreading like quick fire and this has registered a growing rush where women are making up deficits in their diet through taking vitamins only and religiously taking supplements. In fact, worry caused by the pouches on women’s tummies has been described as the stomach’s worst poison.

And indeed, the concern among women to bounce back to shape especially after pregnancy is growing. The search for the elusive ‘flat-tummy’ is one of the most relatable issues raised by women in the months, sometimes a year or two, after pregnancy. However, did you know that failure of the abdominal muscles to fall back into place could be due a condition known as diastasis recti?

Photo on normal abdomen (right) and another with Diastasis Recti. Photo courtesy of wellness Mama

How does diastasis recti look like?

Have a keen look at these two abdominal muscles above and spot the difference.Next, let’s take a simple short journey to understand the anatomy of our abdomens.

A thin fibrous band of connective tissue brings together the right and left muscles on the abdomen. During pregnancy, this thin sheet separates leaving a gap that later becomes a condition known as Diastasis Recti. The cause of this separation is not fully understood but in most cases, the gap is usually about 2 to 3 cm and this leaves enough space for two fingers to fit.

Dr Muthoni Gichu, a clinical exercise physiologist defines diastasis recti as an abdominal separation that mostly occurs after pregnancy. A paper in the Physiotherapy journal by D.R Benjamin and colleagues at the Angliss Hospital in Australia further observed that the condition is due to hormonal elastic changes of the connective tissue, mechanical stresses placed on the abdominal wall by the growing fetus and displacement of the abdominal organs. In some cases, newborns have also been found to have this condition but mostly, it goes away on its own.

The British Journal of Sports medicine observes that the major cause of the back pain could be due to a change of posture that gives more back strain due to reduced strength and function. A surgeon’s diary on diastasis recti cases reviewed over time showed that the condition occurs most frequently during pregnancy and regresses spontaneously after childbirth in most women. However, 12 months postpartum, 33% of women still experience diastasis Recti observed by Dr Sperstad and colleagues.

                                                                       The gym routines should be monitored.

Signs and symptoms

The persistent signs and symptoms that could point towards a diastasis recti on the condition include, back pain, constipation and leaking or urine. In some cases, Dr Gichu notes, can cause a hernia. What is a hernia? A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. Interestingly, women are more prone to the condition if they are;

  • Women above 35 years
  • Women who deliver baby heavier than 3.5 Kgs
  • Multiple pregnancy (twins, triplets or quadruplets)
  • Having children very close together

For a condition that affects self-confidence due to the protrusion on the stomach, a pair of expert eyes are necessary for an assessment that should later provide a trail to recovery. Dr Gichu advises that to manage diastasis recti, exercise should be well monitored and this can begin with avoiding heavy lifts and weights especially in the gymnasium.

Checking for Diastasis Recti

Dr Gichu gives a word of caution that if you suspect that you have this condition, you should avoid all activities that stress the midline and stretch or expand the abdominal wall further. “You can check for this condition through a manual check, a tape measure or an ultra sound,” she said adding that professional advice is encouraged for a proper diagnosis.

                                                                            Consultant physician Dr Esther Dindi 

Consultant physician Dr Esther Dindi prescribes a simple test to self-assess whether you could have diastasis recti. However she warns that for a person with abdominal fat, it may be harder to diagnose the condition.
“Lie on a mat with the head facing up. Bend your knees and have your soles firmly on the ground. Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline-parallel with your waistline- at the level of your belly button.

Then, Dr Dindi advices, while still in a relaxed mode, gently press your fingertips into your abdomen while moving your fingertips to the front and the back of your midline. This enables you to feel for the right and left sides of your rectus abdominis muscle. While here, check for separation at, above, and below your belly button,”

According to Dr Dindi, a diagnosis of diastasis is given when the space is about 3cm, the gap does not shrink when you contract your abdominal wall and when the protrusion is seen on the midline of your abdomen.

                                                                                 The abdominal space (diastasis recti) measures about 3 cm.

So, what next after a diagnosis?

Dr Dindi advises that exercises like swimming and regular aerobics like leg crunches, tummy vacuum exercise, squats, reverse and side crunches can be a step closer to managing diastasis recti, but this requires commitment and discipline.  And this means adopting a healthy lifestyle which means observing a healthy diet, exercise regime, and definitely having a positive attitude.

Dr Dindi further noted that some persons may need to use external abdominal support known as binders to support and encourage the gap to close.There is also hope for persons who wish to reduce the risk of developing diastasis recti after pregnancy?

                                                              Dr Fitness is a lifestyle coach & a consultant physician

In their research published in the Physiotherapy journal, Benjamins and colleagues note that that exercise helps to maintain tone, strength and control of the abdominal muscles consequently reducing stress on the linea alba. Linea Alba is an anatomical junction of the abdominal muscles.

“Women who exercise during pregnancy generally also exercise prior to pregnancy and, therefore, may be fitter and have better conditioned abdominal muscles compared with women who do not exercise during pregnancy,” noted another paper in the Physiotherapy journal

So what is the way out? Dr Muthoni Gichu advises that strengthening core muscles before you get pregnant or early in the pregnancy may help prevent abdominal separation.

Treatment and management

Dr Gichu gives three ways to manage diastasis recti;

  1. Leave it as it is. It will go away on its own.
  2. Supervised exercise regime
  3. Surgery (laparacopic)

Physiotherapy is an alternative to surgery for patients who are unable or reluctant to undergo surgical intervention.  A recent study observed that surgery only corrects the widening of the linea alba and will not influence the general laxity of the front abdominal wall. One of the setbacks of the surgical option is that insurance companies do not pre-qualify a surgery to manage diastasis recti citing that it is done for cosmetic reason. Both surgery and physiotherapy can be used together to achieve a satisfying functional outcome.

                                                            Dr Dindi notes personal discipline in exercise is important.

Another disclaimer for the management of this condition is that one size does not fit all hence the type of exercises used to reduce the gap, the frequency of the exercises, the total number of sessions within a training programme varies from one person to another.

Dr Gichu concludes that whichever decision you take, it is importance to uphold self-confidence that enhances body image.







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