Fit Momma Question: Separated Ab Muscles

Perhaps this post applies to you, perhaps it doesn't. I decided to post it since I've received several emails about it as of late. This is regarding a condition called diastiasis recti -- basically the separation of the stomach muscles typically due to pregnancy.

From Personal Training pics

Here's the question:

I have quite a "gulf" in between my muscles--about 1-2 finger breadths wide over the umbilicus--where my rectus abdominis separated. Here I am, 15 months post-partum and I still have very little core strength.

So, I was wondering how *you* go about training someone with the same problem. I've heard the ab work like crunches and even pilates can make it worse. Because of that information, I've been afraid to do any typical ab exercises because I don't want to make anything worse! Do you have any suggestions for a mama who needs so help knitting those muscles back together?

A good friend of mine, J, had triplets and had a pretty severe case of the rectus abdominis separating. Her husband is a surgeon as well, so they did a lot of research before jumping into this surgery. I will just cut and paste her email to me. She just went through the surgery about a year ago and she's pretty candid about it:

TM: Is it true that any ab work will make this situation worse? Make the abs separate even more? It seems to be this way as I research this.

J: From what I understand, any ab work makes it worse. I know I had that problem until my husband researched it and I stopped. A friend of mine had the same problem and crunches made her situation SOOO much worse!

TM: What kind of exercise could you do pre-surgery? What would recommend to her?

J: I could do all kinds of cardio stuff, small weights, leg work, etc. Mine was pretty severe so that I was having back problems with the muscles in my back because of the separation in the front, so I had to be careful with that. Also, it was very difficult for me to even DO hard core ab work because my muscles were not functioning normally.

TM: How was the surgery? Would you recommend it?

J: The surgery was awful and I won't lie about that. I think you have to have a pretty severe problem or be a body image perfectionist to make it worth it. I am happy now, but still have a lot of numbness in my ab region that I will probably always have.

TM: How is your ab/core strength now?

J: I am still cautious about how I work out in that area, but I am getting braver as time goes on. It is definitely better, but the recovery was very painful and I had to wait until my 6 month check up before my Dr. approved any ab work. And, honestly, I didn't even want to attempt it for a long while! :) Now it is better and in the future it will be even better.

TM: Can a mom have the surgery and then get pregnant again? What are the chances they will separate again?

J: Again, this may just be my situation, but the Dr. told me to be done having kids when I got this done. I think you CAN get pregnant afterwards, but if you do it too soon, it is not a good situation because your skin obviously needs to stretch for pregnancy and it has just been really really stretched to capacity by the procedure. Also, I was told that you can only have this surgery done ONCE, so if you do it and then get pregnant and have the same separation problem, you are out of luck. I think it may be because of the scar tissue and circulation issues, among other things. I know I had some healing problems where I had circulation issues with my C-section scar and the new scar...

So, to sum up, I would only recommend the surgery to women who have a severe problem, who don't intend to have more kids, who are capable being "down" for a few weeks (i.e. have help and/or can take off work), can afford it (insurance usually doesn't cover any of it--even if you have had multiple births and are having physical problems due to it), who have support from a significant other, and who don't expect miracles!! :) I know that doesn't very positive. Again, I am glad NOW that I had it done, but it was a lot more than I bargained for. And again, mine was severe due to the triplet pregnancy, so someone else may have an easier experience, but I don't know... And, my stomach is not perfect. The scar is huge and I have the numbness and still some skin that isn't perfectly taut. And, that is considered a good result from a very good surgeon!

Exercise is not off limits for those of you dealing with this at all. It just needs to be appropriately modified. Do your cardio, your weight lifting -- but steer clear of any direct ab work. When you are lifting, I would always make sure to support your back (sit down on a bench with back support if possible) while doing upper body exercises, since typically the core is engaged in stabilizing your body when you do that. You will have to protect that back, since your abs won't be able to protect it for you.

There are some websites out there claiming to be able to "reattach" the ab muscles. I believe this is physically impossible, but what they mean is work your transverse abs --your core -- to strengthen that girdle area. Before doing this, I strongly advise you to get your doctor's opinion about this. I would hate for you to be doing more damage (see this link).

I really don't post this to cause you to be paranoid, just educated. It is what it is. It does happen to about 1/3 of all pregnant women out there to some degree, so we might as well get a game plan, right?

If you'd like to know if you have diastiasis recti, here is a link with some techniques to use to determine that.

Any thoughts, Fit Mommas? Your experiences here are worth more than my research...