Abdominal Separation

Understanding and Managing Abdominal Separation

Abdominal separation, or diastasis recti, is a condition where the abdominal muscles separate along the midline. This issue is common among women, particularly during and after pregnancy. Understanding how to manage this condition effectively can help improve abdominal health and overall well-being.

What is Abdominal Separation?

Abdominal separation occurs when the connective tissue (linea alba) between the right and left sides of the rectus abdominis muscles stretches and weakens, leading to a noticeable gap. This condition can result in both physical and cosmetic concerns. Importantly, abdominal separation does not represent a true abdominal wall hernia, as there is no fascial defect and no risk of incarceration or strangulation. However, a ventral hernia can coexist with abdominal separation, especially if there has been a previous laparotomy, making differential diagnosis crucial.

Causes and Risk Factors

Several factors can contribute to abdominal separation:

• Pregnancy: The growing uterus places considerable strain on the abdominal muscles.
• Multiple Pregnancies: Higher risk with multiple pregnancies.
• Obesity: Excess weight increases pressure on the abdominal wall.
• Heavy Lifting: Frequent lifting of heavy objects can weaken abdominal muscles.

Recognising the Symptoms

Common symptoms include:

• Visible Bulge: A bulge or dome in the midline of the abdomen, especially when straining.
• Lower Back Pain: Associated with weak abdominal muscles.
• Core Weakness: Difficulty with core exercises or balance.
• Digestive Issues: Possible digestive discomfort.

Diagnosing Abdominal Separation

Diagnosis typically involves a physical examination by a healthcare professional, who will assess the separation by pressing on the abdomen while you engage your core. Ultrasound may be used for further evaluation if needed. Abdominal separation is typically considered abnormal if the separation between the abdominal muscles is more than 2 cm.

Treatment and Management Options

Managing abdominal separation involves a multi-faceted approach:

1. Consult a Healthcare Professional: Get evaluated by your gynaecologist or healthcare provider to assess the severity and plan appropriate treatments.
2. Weight Loss: Gradual weight loss can reduce strain on the abdominal muscles and support overall health. However, significant weight loss often does not improve the separation itself. If considerable weight loss is achieved and maintained, elective plication of the linea alba can be considered.
3. Abdominal Wall Strengthening Exercises: Focus on exercises that strengthen the abdominal wall without increasing the separation. Examples include:
   • Pelvic Tilts: Engage the lower abdominal muscles.
   • Transverse Abdominis Activation: Target deep core muscles.
   • Modified Planks: Begin with simpler variations and gradually advance.
   • Avoid Certain Exercises: Avoid exercises that increase intra-abdominal pressure, such as traditional crunches. Postpartum exercise programs, such as draw-ins while on knees and hands, draw-ins while prone, half plank, side plank, oblique sit-ups, and straight sit-ups, can help regain midline strength after delivery, though their effectiveness in improving abdominal separation specifically has not been definitively determined.
4. Electrical Muscle Stimulation:
   • Tone by InMode: This advanced technology uses electrical muscle stimulation to:
     • Strengthen Deep Core Muscles: Enhances the strength of the core muscles, including those not easily targeted by conventional exercises.
     • Improve Muscle Tone and Definition: Helps to firm and define the abdominal muscles.
     • Complementary Exercise: Acts as a helpful adjunct to your core rehabilitation program by enhancing the effects of exercises such as pelvic tilts or other low-impact workouts.
     • Enhance Rehabilitation: Boosts the results of core strengthening exercises by working in tandem with them.
5. Physiotherapy: A physiotherapist can provide a customised exercise program and techniques to strengthen the core effectively and address the specific needs of abdominal separation.
6. Supportive Garments and Non-Surgical Methods:
   • Abdominal Binders and the Tupler Technique: Both methods provide additional support to the abdominal area. Abdominal binders aid comfort and posture during recovery, while the Tupler technique uses an abdominal splint or binder-like device to support the connective tissue repair. The Tupler technique involves an 18-week program with a modified exercise regimen starting at 6 weeks. However, there is limited data on the effectiveness of this technique.
7. Surgical Repair: Surgical intervention may be considered for significant symptoms, especially if the condition is unlikely to improve with conservative management or if there is a loss of abdominal musculature following multiple pregnancies. Larger separations can be repaired if the patient has significant symptoms, but smaller defects may not require repair. For females who do not resolve their separation in the postpartum period, surgical repair can improve pulmonary and abdominal wall function. Repair is often performed as a cosmetic abdominoplasty by plastic surgeons, though plication alone can be an option for those without excessive skin laxity. The procedure may be done in an inpatient or outpatient setting depending on the complexity.
8. Preventative Measures:
   • Maintain a Healthy Weight: Follow a balanced diet and regular exercise to manage weight.
   • Proper Lifting Techniques: Use correct lifting techniques to avoid excess pressure on the abdomen.
   • Good Posture: Support recovery and overall health with proper posture.

Conclusion

It’s important for women experiencing abdominal separation to consult with a healthcare professional who can provide personalised recommendations based on their medical history and individual needs. Dr Sharon Li offers comprehensive consultations to discuss the most appropriate treatment options, ensuring that each patient receives the care they need to improve their quality of life.

If you have any questions or concerns about abdominal seperation or wish to schedule a consultation, please give us a call on 07 3219 6868.

 

-Dr Sharon Xian Li (MED0001402739)

Registered Medical Practitioner, Obstetrician and Gynaecologist

Bachelor of Medicine and a Bachelor of Surgery (MBBS)

Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists