Separated Abdominal Muscles (DRAM)

Separated Abdominal Muscles (DRAM)

This information is provided as a general information and a guide only and clients are advised to consult with their own caregiver for further advice.

During pregnancy, due to your baby’s growth, your abdominal wall needs to stretch. The superficial abdominal wall is made up of 2 flattish strap like muscles (Rectus Abdominis muscles) that are joined, together with the other abdominals,  in the middle by a softer, ligamentous type structure. This is usually like tight elastic between the muscles.

 Hormones produced in pregnancy allow the elastic tissue and the muscles to relax and soften which often results in a gap like depression between the 2 muscle bellies referred to as a separation. Note that it is not a split as the muscles are intact but just set apart wider than usual.  It becomes more like well used elastic. In pregnancy the gap is often noticed as a central bulge or 'tenting' when sitting up from lying down, or when standing, the baby appears to be sitting very low.

The abdominal wall is a major part of the supporting structures for the back and pelvis and is also involved in breathing, maintenance of bladder and bowel function including evacuation and frontal abdominal wall support.

 The gap is accentuated in particular groups of pregnant women;

  •  Older women
  • Women having twins, triplets etc
  • Women who have had 3 or more babies
  • Large babies; ie, > 4 kg
  • Small pelvic brim or inlet to pelvis
  • Women who gain a lot of weight
  • Women with a poor level of fitness and/ of exercise level
  • Repeated high abdominal pressures; eg, straining on toilet or lifting
  • Genetic disposition to general ligamentous laxity (note; also tend to have pelvic joint pain and/or pelvic floor dysfunction
  • Previous separation

 

However it is common in pregnancy, occurring in up to 66% of women in the 3rd trimester. Recent research suggests that women who do appropriate exercise in pregnancy sre less likely to have a separation than those who do no exercise.         

 

It may become more obvious postnatally as a bulging or protrusion of the tummy. Some women complain that other people notice a bulge in the tummy which can be embarrassing.

Most gaps do resolve within a few weeks or even days after giving birth however while the abdominal muscles are not as strong a unit, the muscles cannot function normally to protect your back from injury or strain. 

It is considered normal to have a persistent gap of around 1-2 fingers width. However, sometimes the tissue between the 2 muscles is very thinned and weak and even small gaps can still be considered a problem if it is aesthetically displeasing to you, or you can see a bulge or a 'tenting' on sit up movements.

Very few women are left with a wide permanent gap, which may reduce over time. Further intervention may then be required if the woman requests it. A surgical opinion may be sought.

Physiotherapy can assist you with assessment, advice and exercises to help retrain the strength and function of all the abdominal muscles and prevent exaggeration/accentuation of this gap and assist in preventing back and pelvic joint pain and dysfunction.

 Most women recover well with time and a little care. To assist with the recovery…

 avoid straining such as

  • lifting. Ask for assistance with lifting prams, washing baskets, vacuum cleaner, toddlers! This is a time when your partner must be supportive of you to allow the abdominal to heal with minimal strain.
  • toileting strain(eg constipation)
  • straining on movements such as sitting up type movements(eg getting out of bed)ROll and push up on your side.
  • inappropriate exercise(s) to avoid putting the abdominal muscles and tissues under undue pressure; ie no sit ups, no double leg off floor exercises, no heavy weights.

 If advised, Support tubigrip or firm pants may help in pregnancy or postnatally. Seek advice on type and fit as these can be detrimental or useless if not fitted appropriately. I have a few favourites and some braces that I consider not helpful at all. Please consult us before spending your hard earned money!

 Appropriate exercise such as water based aerobics or Funky Mama Pilates allows continuation of fitness without undue strain on the abdominal wall.

 Specific exercises such as pelvic floor and deep abdominal exercises such as Funky Mama Pilates will assist in preventing back pain whilst strengthening the deep abdominal muscles. Individual treatment can allow you to learn these exercises more efficiently.