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The Post-Pregnancy Body Changes That Nobody Talks About

By Amalah

Hi Amy – I have a two part question related to postpartum abs.

I am 99% sure I have diastasis recti (separation of the abdominal muscles) after having twins (who were 7.5lbs EACH at 37 weeks delivered vaginally) and being on bedrest for 5 months before and 2 months after. This was actually baby number 3 & (surprise) 4 and not one doctor ever mentioned this condition to me. I wonder if other women have the same problem and don’t know about it… My question is – there is conflicting advice about how to help correct it. I have been exercising for 3 months now doing pretty much everything you can traditionally think of (pilates, running, stairs, lifting weights, eating right, drinking water, etc.), lost all the baby weight and then some and am in the best shape of my life – but I still look about 3- 4 months pregnant! And we are talking 2nd baby 3-4 months! BUT a minor number of fitness instructions on the internet argue if you have diastasis recti and do traditional ab exercises (crunches) you actually make it worse because it causes the muscles to “bulge”. They employ the Tupler method and stress recovery of the transversus abdominis muscle (TVA) first. I have asked my OB/GYN, GP and a couple of different fitness instructors and they don’t know what the world I am talking about! Now, let me stress – I have realistic expectations here. I don’t expect to look like I did before ever being pregnant. But I sure as hell don’t want to be spending my precious time on exercises that make it worse! Is surgery the only thing that will correct diastasis recti?

Speaking of surgery – how can I tell if I have an umbilical hernia? My stomach is a mess of excess skin (that children’s book the saggy, baggy elephant comes to mind) and I just assumed that was it. But above my belly button there is a protrusion. It doesn’t hurt at all but…it’s odd. With all the pushing I did with the twins, could that have caused one? Because you mentioned those were kinda like sleeping giants that are going to wake eventually. And if it just excess skin – is the only way to correct that surgery? Yeah, everyone is different and give it time, etc., etc. But…really…what is the deal??? Twins is just an entirely different ball game compared to my two singles.

Thanks for any help you can send my way!

L

So I experienced diastasis recti right out of the gate, with pregnancy number one. Being a smallish person carrying a 9 pound, 15 ounce baby will apparently do that. It never corrected itself, but I at least didn’t notice it ever got worse after my subsequent pregnancies (with more reasonably sized 7 pounders).

I, too, got a lot of conflicting advice and recommendations from doctors, trainers and the Internet. Here’s my basic take: For some women, the separation can be improved through exercise, and for some women, the separation is permanent and requires surgical correction. I was in the latter group, personally.

I actually think the Wikipedia page on diastasis recti (I KNOW I KNOW) is pretty darn realistic, particularly the “treatment” part. There are a list of generally approved exercises that may or may not “fix” the problem, but are at least known not to make things worse. Incorrect exercises that involve pushing the muscles out (like crunches) have been found to make the problem worse in many women. That could just be anecdotal (since as you’ve learned, this just isn’t a problem that gets a lot of attention and grant money to study!), but I personally erred on the side of caution and chose other exercises after coming across that theory. Core strength exercises that focused on pulling my ab muscles in, mostly.  I HAD done a lot of crunches after baby number one because that’s what my OB/GYN suggested, so who knows. Maybe that’s why my separation remained so prominent.

When I consulted plastic surgeons, though, I learned that my diastasis recti was really pretty bad. Like over three solid inches of separation, so my “abs” were basically way over on my sides. I also had that lovely pouch of saggy, stretch-marked skin around my belly button. I’d lost weight and gotten in fairly good shape, and if anything my stomach looked WORSE, because without a little excess weight around my midsection it was so much more obvious that nothing was where it was supposed to be. So I don’t know. I honestly feel like I’d done everything I could and the choices were either to live with it, or fix it.

And I was okay living with it, except that after Ike was born my OB/GYN pressed on my belly button and told me I had an umbilical hernia. This is ALSO a super common thing that no one warns you about. They typically happen to women who have been pregnant a few times, or who have a multiple birth pregnancy. You’ve had four children via three pregnancies, so it’s entirely possible the protrusion you’re noticing is a hernia. Or not! Sometimes stuff just settles back weird in that area. The only way to know is to consult a doctor and have them feel around your belly button. (My hernia was not at all visible, but only noticeable if you pressed on it.)

My hernia became increasingly tender in the years after my third son, Ike’s birth — tender to the touch, but also bothersome when I bent over to pick something up, or had to carry anything heavy (like my toddler). This was evidence that the hernia was worsening, and after talking to my doctor and  reading up on the complications that could happen down the road (think emergency surgery to correct a puncture wound in your intestines!), I decided to get it fixed. Surgery is the only way to fix an adult umbilical hernia. Babies are born with them fairly often and those can heal without surgery, but for ones that develop later in life that doesn’t happen. Again, you need to talk to a doctor and have them assess your own personal risk and make their own recommendation.

So after three pregnancies, three c-sections, and now a need to go back under the knife for ANOTHER abdominal surgery, I made the call that I would get the tummy tuck at the same time. Goodbye extra skin, goodbye diastasis recti. It’s a big decision, a major surgery with significant recovery time, and (obviously) a big out-of-pocket expense. My insurance covered the hernia repair part, which lowered my personal costs (since the insurance pay out shoulders some of the anesthesia and OR fees), but it’s not something I would be all, “OH JUST DO IT YOU’LL BE SO HAPPY” to everybody struggling with diastasis recti and other post-pregnancy body changes. Personally, I am thrilled and entirely comfortable with my decision. Pregnancy — while wonderful and amazing and all that — broke a few things that I was unable to fix on my own. Plastic surgery is often reconstructive surgery, which is how I view mine.

Ladies out there — did your ab muscles separate? Did it ever improve on its own?  Have you been able to improve it with exercise? If so, what kind, how often, how long? If not, any other tips for minimizing the pooch or feeling better/stronger in general? Anything else that the miracle of life did to your stomach that you would like to rant about?

Amazon Mom

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Comments

  • Melissa

    I had two births and self diagnosed diastastis recti.  Mine doesn’t sound as bad, and I am pretty sure I don’t have an umbilical hernia.  I used Mutu, System, which are gentle abdominal exercises specifically for diastasi recti, and many women have had good results.  So, I would check it out if you aren’t comfortable with the idea of surgery. 

  • Amy

    I had moderate diastasis recti with my first baby and also an umbilical hernia.  I was especially prone to diastasis because I have a short torso and I had very tight abs from weightlifting.  It was moderate, and I closed it completely with the Tupler technique (I have heard good things about other diastasis-specific techniques too).  It was a pain in the ass, but non-negotiable for me as I wanted to have a strong core and be able to brace properly as I got back into lifting heavy.  
    Now I am in month 8 of baby#2 and I definitely have it again (damn you, short torso!).  I may end up fixing the umbilical hernia at some point because it’s super sensitive, but I’ll wait and see what happens post-baby.  My plan is to do the Tupler exercises or something similar again to close the diastasis.  But a really important component of recovery is what NOT to do.  I can’t believe doctors are recommending typical “ab work”, as that is the worst thing you can do.  Anything in a crunching movement will only further separate the abs.  Anyone who has had diastasis should avoid those movements pretty much forever.  Really, say goodbye to situps.

    Situps and crunches are a bad idea anyway.  The best way get and keep strong abs (after healing/closing diastasis recti) is to use them for bracing, not for initiating movement.  That is their functional purpose.  To strengthen your core, do things like (weighted) squats, presses, kettlebell work, and stability bodyweight stuff like planks and push-ups.  Think of your core as muscles that wrap all the way around your middle and protect your spine and keep you straight and stable for picking things up and moving your body around.  

    As someone who coaches weightlifting for regular people, I personally don’t care how flat someone’s stomach is.  Some of the strongest people in the world have a gut.  It’s what’s underneath that counts.  Having a strong core will help you do so much more in life, and will protect you from injury.  

  • Hey! This is a large part of what I do for work- correcting DR. Amy’s advice is spot on- transverse ab work is the very best thing to do (pulling abs up and back, or thinking of hollowing out). I think it’s most important for you to see how severe your split is- a small split (under 2 fingers width) will often correct on it’s own but a larger split will usually need some PT and/or surgery. I also reallyrecommend finding a PT to work with – google women’s health PT and see if there is one nearby. I’m so sorry your doctor has been so dismissive of this- it’s really not just a vanity issue. It can cause all sorts of back and pelvic issues if left untreated. Here’s a post I wrote with some info and a way for you to check yourself and see how severe your split is. http://blog.ohbabyfitness.com/postpartum-tips/the-basics-of-abdominal-separationdiastasis-recti Feel free to email me through my company/website if you have any more questions or if I can be of any further help. Good luck!!

  • I used this lovely lady’s workout plans to heal up my particular diastasis, and it worked like a dream. She’s all about easy repetition of low impact work-slow and over time, but healing none the less.  She is very faith-based, so be aware of that going in. I just love that it’s like using Netflix as my gym!!

    http://Www.fit2b.us

  • Kelly

    Seconding whoever recommended Women’s Health PT. 
    You can search here: http://www.apta.org/apta/findapt/index.aspx
    Or ask your PCP.

    • Autumn

      I’ll Third the PT recommendation!

      I’ve found that my primary isn’t very sure about what to do and I have a specialist I wanted to see, she was more than happy to give me the referral to the person I researched – a referral is frequently needed for insurance purposes- and I got the treatment I wanted (my case was a fluky calf injury, but lots of MDs are very under informed about post partum stuff)

      The other thing about a course of PT is some insurances will require a trial of therapy before they are willing to pay for surgery, if that becomes needed

  • Both my midwife and my pilates instructor were very vocal about diastasis recti, so I think it might be something that has become quite the focus in the UK nowadays. I was lucky not to suffer from it.

    My rant about the body changes nobody talks about?

    Posterior prolapse. Because there’s nothing more attractive than acknowledging the proximity of *that* to *there*.

  • Kristen

    I had a pretty gnarly separation after my first 9 pound son.

    It was about 2-3 finger tips wide (I could literally lay on my back and put my fingers between my ab muscles). I crossfit, so I’m in pretty good shape, but the separation really weakened my core.

    I wore a belly bandit (tummy binder) for about 5 weeks at a trainer who had also had a baby’s suggestion.

    They are a little pricey (55$) but I lost 3 inches around my waist and it helped to close it to just smaller than a finger tip.
    I also did exercises for diastasis recti (very unreliably) from you tube videos.

  • Caroline

    I am totally ON this question!! I have only had 3 babies, and no twins, but my 3rd baby was nearly 12lbs so I think it counts hehe! I had virtually what you describe, though not the actual hernia and I have it on really solid authority from a physiotherapist, a pilates instructor and a plastic surgeon that… the answer is in fact surgery. Yes. I know. I was left with not just a bit of a ”mommy tummy” but sagging lumps of scarred, misshapen… flesh and a major, major separation all the way up my abdominals, like, right up to my ribs. I won’t lie, the abdominoplasty was SORE. I have had 3 sections and was fairly blasé BUT OH MY WORD SO MUCH MORE PAINFUL THAN THAT. If you go this route, your stomach will look better than it has in years (yay!) BUT you absolutely absolutely MUST have proper, serious bed rest for at least 2 weeks. No driving, no cooking, no hauling kids, so install a granny or do what you must, but do not think ”oh we’ll muddle through”. It is no joke. Totally worth it, but no joke. I lost over 7lbs during that op, just the scar tissue and lumps of uneven fat…
    And also, very wonderfully, my nagging lower back ache that had been my intermittent companion since my first baby… gone. Totally. Like it was never there. Don’t beat yourself up re your stomach, there is not one thing you can do via exercise, it requires surgical intervention. On the upside, your love handles can be removed at the same time…

  • Max

    First of all, God bless you. 7 pounds each?! I had twins who were 5lbs combined at birth and felt like I was going to burst near the end.
    Check out http://www.butiyoga.com or search for Buti Yoga on FB. There are tonnes of women in the forums who had DR and Buti helped them a lot. Plus it’s a fun kick ass workout!

  • Shelley

    I’m a pelvic health physiotherapist in Canada and I so empathize with your course of postpartum recovery (or lack there of). There’s so much conflicting information out there..some good, some bad and some that’s just straight up dangerous. Promoting recovery through the abdominal wall requires balanced activation through the upper and lower abdominals and optimal functioning of the core system including the diaphragm and pelvic floor. It really requires professional guidance and is worth the investment. 

    There’s excellent physiotherapists who specialize in this type of rehab and can walk you through a safe and customized program. Look for someone who has training in ‘pelvic health, pelvic floor rehab or women’s health’. 

    Julie Wiebe is one therapist in the States who’s doing great work with postnatal rehab. She may be able to give you a recommendation of a well trained physiotherapist in your area:

    https://www.juliewiebept.com/diastasis/diastasis-zip-it-up/

    Until you find someone who can provide you with a comprehensive assessment, I’d err on the side of playing it safe and recommend staying away from abdominal flexion work (i.e. sit-ups). 

    Good luck!

  • Selene

    Thank you L, Amy, and commenters! I do have DR and didn’t know it. I wish my doctors would have given me some basic information about this. I also have a belly that looks 3-4 months pregnant although my youngest is 3. I have been asked when I’m due. Awkward!

    This post was so, so, so, sooooooooo helpful for me!

  • S

    Yo. I’m there with you! At 20 weeks pregnant, no one could even tell I was pregnant. I’d lost 15 lbs due to barfing. And then came the bedrest and the twin pregnancy starvation. I thought that would be the worst of it – withering muscles and waking every hour throughout the night for another bowl of rocky road – but the diastasis recti that accompanies two full term babies and two placentas and all the fluid that comes with them and then all that pushing of said things out the hooha? That’s the worst. I mean, yay for no NICU time. Seriously, yay. I get that that’s the best. But it does suck now that my abs are over ten cm apart. Nothing fixes it. If you can afford the surgery, do it!!!! I look seven months pregnant. Always. My kids are 3.5 years. Moms of singletons will say things like, “Yoga!” Just, no. Slice up that belly. You’ll get all the plastic surgery recommendations you could ever need from your local twins club. If they have the money, they all do it.

  • KR

    I don’t have bad DR, but I do have a belly that just won’t stop, on a moderately slender/athletic body.  Youngest is 21 months, and I get asked when I am due at least once a month (and that’s after making a concerted effort to build a wardrobe of tummy-disguising separates). It’s so very discouraging. I think a pudgy tummy is THE ONLY body shape that is considered socially acceptable to inquire about.  I dream of working up the courage to respond with “Nope, not pregnant. When is your surgery to remove the very large tumors in your butt(/whatever body part is large on the asker)?”

  • Katy

    Why worry about what you look like? You have four beautiful children to take care of.
    LOL JK OMG I feel your pain! I do not have the severity you are experiencing, but definitely after three kids it’s been tough to get back in shape just to keep up with the little boogers. I kick myself for the partying and letting it go in the twenties that I did. Pregnancy, childbirth, and now caring for three under five, I wish I had invested in a personal trainer before I even went off birth control in the first place! Hope you are able to get some medical attention to your belly and whatever decision you are able to make–exercises, plastic surgery–it works out for you. Good luck OP!

  • Melissa

    I’m scheduled for surgery next week.  I have an 11cm diastasis (4.3 inches) plus the umbilical hernia that also doesn’t bulge but started to hurt a few months ago when I would bend down or pick up the baby (2 years) a certain way.  I’ve had four kids and two of them were nearly 10 pounds, add in a short torso and bam, DR city.  I’ve been doing the specialized techniques for more than 2 years and it’s barely closed, if any.  So I’m onto surgery now.

    I knew it was a wide diastasis, I did NOT realize it was 11 cm.  My surgeon said that I’ve compensated all this time by really strengthening my side ab muscles and so he’s going to slightly “clip” those to release their hold on the middle muscles or they will pull everything back apart when it gets fixed.  Yeah, not looking forward to surgery at all but hope to (a) not worry about having no protection in my middle, (b) looking 6 months pregnant, and (c) doing exercises that clearly aren’t working and being super frustrated with it.

    I will not miss people constantly asking me when the next one is due.