Divarication of the rectus abdominis

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1 Divarication of the rectus abdominis Advice and exercise What is divarication of the rectus abdominis? Divarication of the rectus abdominis is a condition where the abdominal (tummy) muscles become separated in the middle.this leaflet will help you correct this condition and get your body back to normal after giving birth. The separation can vary in size, from a small vertical gap 2cm-3cm wide to a large gap of 12cm-20cm wide, extending the whole length of the abdominal muscles. A divarication of the abdominal muscles is common during and after pregnancy and will normally be assessed by a physiotherapist. Abdominal muscles before and after pregnancy Before pregnancy During/after pregnancy Why does it occur? A hormone, called relaxin, is released during pregnancy. This may cause an increase in the elasticity (stretchiness) of the connective tissue that joins the abdominal muscles together. As pregnancy progresses the womb expands and the abdominal muscles become stretched and elongated until they are unable to stretch any further and may have to separate to allow room for the baby. Page 1 of 5

2 Factors contributing to divarication of the rectus abdominis large baby (8lb plus) small frame/petite woman (small pelvis) multiple births well defined abdominal muscles skin tone position of baby. Effects of divarication of the rectus abdominis risk of developing a hernia if divarication remains increased risk of injury to back due to decreased stability loose appearance of the tummy domed appearance of the abdomen, noticeable when moving from lying to sitting and with a cough, laugh or sneeze muscle weakness. The following exercise is to help to avoid these problems and reduce the divarication after the baby is born. You are able to start the exercise straight away: lie on your back on a mat, bed or on the floor with your knees bent up without a pillow cross your arms and place each hand either side of your abdomen (tummy) take a deep breath in and as you breathe out lift your head towards your chest and lift your shoulders three inches off the mat/bed. Use your hands to squeeze your abdominal (tummy) muscles together and across your body. slowly lower your head and shoulders back to the mat/bed and relax your hands. Repeat this exercise five times 3 times a day and progress to 10 times three times a day. Self check your progress in reducing divarication lie on your back with your knees bent roughly measure three fingers up from your navel and then place three fingers across the middle of your stomach breathe out while lifting your head towards your chest and lifting your shoulders slightly off the mat/bed. Page 2 of 5

3 You should be able to feel either side of the abdominal muscles under your fingers. If you can get more than one to two fingers between the muscles continue with this exercise. Your body's ligaments and connective tissue will still be softer and more elastic than before your pregnancy and it can take four to five months for a full recovery. You should start to notice a reduction in your divarication after two to three weeks of performing this exercise. Safeguarding your rectus abdominus It is important for you to safeguard your tummy muscles after the birth of your baby as they may have separated during pregnancy to allow your baby to grow. This gap should close up spontaneously, however you will need to be careful not to put too much strain on your tummy muscles too soon. If you find that your tummy domes when moving about or lifting then you are putting strain on your tummy muscles so If this happens stop the activity and ask to be referred to a Physiotherapist. You may be given a tummy support to protect against strain but also some appropriate exercises to strengthen your muscles. If you have not been referred to a Physiotherapist but are worried about straining your muscles you could try wearing some support knickers after your birth. In conjunction with this exercise please ensure: you are maintaining a good posture to improve your back strength practice core stability exercises (see separate leaflet) maintain good back care at all times support your abdomen with your hands when coughing or sneezing. Page 3 of 5

4 Poor posture Good posture Permission to use pictures given by Womens Health Department.Southend Hospital Benefit of this exercise This exercise will reduce the gap between the abdominal muscles. Risk from this exercise Women experience neck pain and should be advised to roll their head from side to side after each attempt of the exercise. Any one suffering with neck pain should not do this exercise and should consult a physiotherapist with regards to alternative treatment. Your NHS number When you attend hospital you will be asked for your NHS number and other information such as your address. Please be patient with this procedure it is to ensure our records are kept up to date and to protect your safety. However, if you do not know your NHS number, please do not worry you will still receive care! Concerns or complaints If you have any concerns or worries about your care please contact the department responsible. However, if you are unable to resolve your concerns or wish to make a formal complaint, please contact the Integrated PALS (Patient Advice and Liaison Service), Complaints and Litigation Service on or ask any member of staff for a leaflet, which will describe how you may make a complaint. Your views Page 4 of 5

5 If you or a family member has recently been in either Colchester General Hospital or Essex County Hospital for any reason, you can tell us about your experience by visiting the website and then click on the "Comments" section, or you can write to the address on the front of this leaflet or your comments to info@colchesterhospital.nhs.uk Women s Health Physiotherapy Colchester General Hospital Turner Road Colchester CO4 5JL Tel: Page 5 of 5