What is Diastasis Recti (abdominal separation) and how to treat it

What is Diastasis Recti (abdominal separation) and how to treat it

Diastasis recti abdominis (or DRA) is a condition where the tissue between the straight abdominal muscles separates. Diastatis literally means seperation in Latin and recti abdominis are your abdominal muscles. It is therefore sometimes also referred to as abdominal separation. This condition is most common in pregnant and postnatal women, because the growing uterus stretches the abdominal muscles. However it can also affect every man or woman for various reasons.

I was very careful to not develop diastasis recti during my pregnancy, and yet I am still facing a small gap between my abdominal muscles three months after giving birth. Therefore I am writing this blog post to explain the causes of DRA, how I tried to prevent it and how I am trying to treat it.

Note: I am not a doctor or health professional. Everything in this article is about my personal experience only.

How to diagnose diastasis recti

You can easily test yourself if you have DRA (unless you are currently having a baby belly). Just lie flat on your back and find your navel with your fingers. Press your fingers into your belly slightly below and above your belly button. Now lift your head. Your abdominal muscles should contract and you should be able to feel (or not feel) a small gap with your fingers.

In this Youtube video you can see an example how you can check for DRA.

Causes of diastasis recti

Pregnancy hormones and a growing belly

Diastasis recti abdominis occurs in more than half of all pregnancies. The reason is that you growing baby and uterus expand and put pressure on your abdominal muscles from the inside. The muscles and ligaments are already soft because of a pregnancy hormone called Relaxin. It is absolutely normal and okay for your abs to separate a little bit during pregnancy. However it is important to not aggravate the situation and to rehab it after giving birth. (see below). This is even more important when having several kids, as every pregnancy increases the likelihood of DRA.

Accidents with strained abdominal muscles

The tissue between your straight abdominal muscles can also stretch when you put too much load on it. This sometimes occurs with bodybuilders or power lifters, but also with everyone lifting heavy objects without the right technique (like lifting your kids or heavy furniture)

DRA in newborns

Diastasis recti is also quite common in newborn or premature babies, simply because their abdominal wall is not fully developed. This is not dangerous and most of the time it should go away on its own.

Prevention of diastasis recti

The biggest factor of preventing diastasis recti is to exercise your straight abdominal muscles the right way at the right time.

Always use proper technique

As DRA can also happen by accident, it is important to always use proper technique when lifting heavy objects. Always engage your whole core, and pick an adequate weight. Sometimes also belts and bands can help to stabilize your core, but they should not be used to lift weights that are too heavy otherwise.

Also when you are pregnant and already having a baby belly it is important to not engage your straight abdominal muscles. Therefore always use the right technique when getting in and out of a lying position. Never do it straight as you were used to, because this puts too much pressure on your straight abs. Always get up and down via your side. This means that when getting up, roll onto your side first and then push yourself up. When lying down lye down on your side first.

Train your straight abs before pregnancy, but stop after the first trimester

A strong core is beneficial for a lot of things, like better posture and less back pain. Therefore it is recommended to train your abs before pregnancy, but to stop after the first trimester or as soon as your belly starts to show. This also includes stability exercises like planks or other exercises that require engaged abs. You will see that when doing these exercises your belly will form a bulge outwards which is a general warning sign for DRA. Once your diastasis recti has disappeared you can train your straight abs again.

Train your obliques and transversus abdominus muscles during pregnancy and afterwards

While training your straight abdominals is not recommended later in your pregnancy as it can increase diastasis recti, you can and should train your side abs (also called the obliques) and your transversus abdominus. This is the muscle that spans your tummy horizontally and which is not very well known. But we use it everyday for example when coughing. The best exercises to train it however are breathing exercises that are also useful to recover from DRA after giving birth.

A study of the Columbia University also has shown that doing the right abdominal exercises during pregnancy can reduce the risk of diastasis recti compared to no exercises.

Treatment of diastasis recti

To treat diastasis recti abdominis you should first see a health professional, most likely a physiotherapist. Very often this is done in the hospital after birth or during a postnatal rehab course. In some countries this service is often covered by public or private health insurance.

I was assessed by a physio three days after giving birth, as well by my midwife in the weeks after. In addition I have completed a postnatal rehab class. In total I was given the following exercises to help with my diastasis recti:

  • Belly breathing: when lying on our back practice active belly breathing. This means that you lift your belly when inhaling, and pull it towards your spine when exhaling. You can also imagine that the sides of you belly will move closer together, and that your belly button will contract towards your pubic bone.
  • Belly breathing advanced: like with the exercise above, start with simple belly breathing. Now do a few sharp exhales while making the sound of the letter “F”. You can also try the letters “P”, “K” or “T”, and contract you pelvic floor upwards and inwards at the same time.
  • Leg extensions: Lie on your back with your legs bent. Now slowly slide one leg to a straight position parallel to the floor, and pull it back.

 

I hope that with all that extra knowledge you will now be able to prevent and treat your diastasis recti. As always please contact a health professional if you have any questions.

6 things you need in your hospital bag that nobody told you about

6 things you need in your hospital bag that nobody told you about

If you are expecting your first child you are probably equally nervous and excited about it. And you wonder about a thousand things at the same time. Congratulations, this is absolutely normal. You will do great. And do make things even easier for you, here is a short list of things for your hospital bag that I really needed as a new mom, and that nobody told me about before. All of these are super helpful either for nursing, at the hospital or to recover from birth.

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How Marathon Running has prepared me for giving birth, and how it didn’t

How Marathon Running has prepared me for giving birth, and how it didn’t

“Giving birth is like a Marathon” is something you would hear frequently from non-marathon running people. Yes, both are tough, exhausting workouts, with a great reward at the end and a long, painful recovery. So when I ran 12 Marathons for charity in 2018  and got pregnant after Marathon no. 9, I thought I was overly prepared for childbirth and labor. I thought I would easily go through that painful process and have a speedy recovery because of my fitness and mental toughness. And I can say that this was at least partially true.

How Marathon running has helped me prepare for childbirth and labor

Training

Everybody knows that you need to be fit and physically prepared to run a Marathon. Giving birth is not that different. It is a physical workout. Luckily your body will automatically train for birth. Your uterus will go through some “practice” contractions, also called Braxton Hicks contractions, before actual labor starts. This will prepare your uterus, which is in the end just a muscle, for real contractions.

In addition to my natural uterus contractions I tried to maintain my fitness throughout my pregnancy with moderate running, indoor cycling, and strength training. This helped avoiding back pain and excessive weight gain. And my arms and upper body were much stronger to carry my baby afterwards (which you have to do constantly as a mom). Here you can read my blog post on benefits and risks of exercising during pregnancy.

Nutrition

If you have ever run a Marathon you know that nutrition can heavily influence your race. It is recommended to eat a light and easily digestible breakfast low in fiber, and to take in easily digestible carbohydrates throughout your race. In addition you should stay hydrated. So I basically followed the same strategy when giving birth. I still had a light dinner when I was admitted to the hospital (while I had light contractions), and later during labor I fueled my body with a special sports drink that contained easily digestible sugars and electrolytes. I only changed my fueling strategy later when I had to get an IV.

After the race you should try to refuel properly with carbohydrates and protein. And this is also what you should do after giving birth. In my case I chose the healthy, fiber rich options from my hospital menu. The additional fiber was especially helpful to ease up my stool to avoid pain after my episiotomy.

Gear

Every Marathon runner knows: training and nutrition are important, but so is having the right gear on race day. And birth is similar in a lot of ways. You want to be equipped with the right tools to give you the birth you want. This could be a birth stool, a big gymnastics ball, a CD player or bluetooth speaker, a chair, a bath tub, massage oil or even just a baby toy to squeeze during contractions. You want to wear something that you feel comfortable in, but that can also get dirty. And just like in a Marathon: Don’t forget that hairband! Because you don’t want your sweaty hair all over your face.

Recovery

If you remember your first Marathon you also remember the recovery afterwards. It is really hard. You were probably not able to walk for days, and you felt exhausted for a few weeks. Maybe you were in pain, and you could not properly sleep because of all the adrenaline. Giving birth is similar, no matter if naturally or via cesarean. Recovery will take a while, so don’t rush it. Stay in bed for as long as you want and need. Try to get good sleep and eat nutritious and healthy foods. Be proud of what you have accomplished. Soak up that feeling as much as possible. Soon you will be back feeling stronger than before.

Support crew

Having a good support crew is important for your Marathon. You want people to take your anxiety away before the race, cheer you on during the race when you are feeling low and celebrate with you afterwards. Also for birth you need a support crew. This could of course be your doctor, your midwife, your doula etc. Bust most importantly it is your (birth) partner. You want to work together as a team in this very important workout. Ideally your birth partner should support you with whatever you need and lift your spirits when you are feeling low. Because running and giving birth is really a team challenge.

Mental training

Nowadays mental training is considered a cornerstone of how professional Marathon runners and other athletes prepare for competitions. Maybe you have seen a professional skier on TV who imagines skiing the race and also moves the body accordingly. And it has been proven that their various strategies of how to visualize themselves in a competition before the event can increase the physical performance. And even though I am not a professional runner, I believe that the right mindset and mental training can improve not only your results but also your experience on race day.

And this is also true when it comes to labor and giving birth. There are a lot of visualization techniques that you can practice before your actual due date. Some techniques are quite simple like imagining a blooming flower or waves in the ocean. Others are marketed with fancy names like Hypnobirthing. I personally read a few books and picked the things that I liked. And I think that it has helped me at least a little bit during my extensive labor.

 

How Marathon running could not prepare me for birth

The pain

I will not lie about it: giving birth is way more painful than running a Marathon. There is no way to describe the feelings if you have never experienced it before. It probably is the MOST PAINFUL WORKOUT you will ever do in your life. But even if it is really painful, there is nothing to worry about. As a woman you will develop female superpowers and will find strengths that you never knew you had. Trust me, you’ve got this.

The duration

A Marathon has a fixed distance of 42.195 km. You probably know your pace, and know you can finish it in around x hours. With giving birth it is not the case. If you are giving birth naturally you don’t know when it will start, when it will end and how long it will take. It could be two hours or two days.

For me this was a bit worrying. My baby was already overdue and I was scared to have an induction. Even when it came naturally I did not know how long it would still be until I would be finally be done with all the pain (see point above). I did not know if I still had enough gas left in my tank, especially because I had never done it before. In the end, my labor lasted nearly 24 hours. Even if I have done longer races than a full Marathon and even one 24 hour race, I was completely unprepared for this.

The joy

When you finish a Marathon you are happy. Happy that you are done, happy that you have accomplished your goal, happy about the medal you get. But all the joys of Marathon running are so small compared to the feeling you have when holding your baby for the first time. When you hear your baby scream for the first time. And when you smell that precious baby scent for the first time. That feeling of joy is beyond everything you can ever imagine. And it is definitely worth all the long hours of pain and complications you might have gone through to get there.

Marathon Gear Essentials – the ultimate shopping list

Marathon Gear Essentials – the ultimate shopping list

If you have ever run a Marathon you know that racing is not only about training and nutrition, but also about your gear. Wearing the wrong outfit, getting blisters from the wrong shoes or chafing can not only ruin your Marathon goals but also take all the fun away. So I have compiled this list of the most important Marathon gear essentials. Proven in more than 20 Marathons that I ran, including the 12 Marathons that I did in 2018.

The most important thing to remember is to try all your Marathon gear before the actual event. Always remember the rule:

Nothing new on race day!

So here are my Marathon essentials, that I always pack into my bag when I travel to a race:

Shoes

Shoes are the first item on my Marathon gear essentials list. Some people might find them optional, as people have run Marathons without shoes. Like Abebe Bikila, who won the 1960 Olympic Marathon barefoot. But as a regular runner I assume you don’t want to even try running that distance without good running shoes on your feet.

Picking the right shoes

This could fill up a full blog post on it’s own. And there are definitely a few out there. How to chose the right shoes for you has become nearly rocket science. I would recommend a simple 3 step strategy to find the right shoe for your needs:

  • Take your old running shoes to a professional running shop
  • Have a video analysis done of yourself running in your old and various new shoes
  • Pick the ones that looks right on video and that also feel good

Training in your running shoes

Even if you have picked the right shoes for you, you still need to train in them (aka run in them properly) before the race. This will break them in so you don’t get blisters or black toe nails on race day. I recommend running at least 100 km over a few weeks in them.

Running outfit

Unless you are up for a nudist race, or chose to run in a costume, a proper running outfit is part of your Marathon gear. It should comprise of running shorts or leggings and a running top depending on the temperatures. As with running shoes there are two important factors to consider:

The right outfit for the right temperatures

Your running outfit should fit the temperatures on race day. As you want to go fast, you should wear an outfit that you would freeze in at the start line. If you are not a little bit cold at the start, you are definitely wearing too much for later on.

But what if I am getting really cold at the start line? There are always options for that. Wear old clothing that you can toss away before the start. Most of it will be collected by charities afterwards. Another option is to wear a thick black trash bag to keep warm.

Another thing that I learned when it comes to Marathon outfits is to always have several options available depending on the weather. The same race can have extremely different temperatures in different years. So bring various outfits to the race in case the weather forecast changes.

Training in your race outfit

The logic is the same as for running shoes. You need to train in you race outfit (that includes costumes) before the Marathon. By running in your outfit you will find out potential problems like chafing or wardrobe malfunctions. You want to sort out these things before the race, and not be surprised during your Marathon.

Underwear

Yes, some people also think underwear is optional. Especially if the undergarments are part of the running shorts. But I really disagree. First, the underwear in your running shorts might not be the right one for you. Second, if you are a woman you definitely need a good sports bra to support breasts. As with shoes and running outfits you need to test your underwear before race day. I personally am a big fan of Runderwear, a British startup that makes really soft and comfy running underwear.

Socks

Running socks are an often neglected, but very important Marathon gear item. With all the developments in recent years socks have become a major part of the running apparel industry. The options nowadays are endless: short, long, thick, thin, colorful or plain black. One of the most recent developments is the use of compression socks to enhance performance. If you want to keep your old socks, but still want to try compression gear, you can also wear compression calf sleeves.

GPS sports watch

If you want to run a Marathon for time and aim for a new personal best, a GPS sports watch is also a Marathon essential. In the past GPS watches were heavy, huge and fairly ugly, but recently the manufacturers have focused more on design. The options nowadays are also endless. Most GPS sports watches also include a heart rate monitor, either with a chest band or a visual one included in the watch. When choosing a sports watch you should look at the following factors:

  • size and weight
  • design
  • price
  • features like Wifi, Bluetooth, multi sport functions

Running belt or pouch

If you decide to carry various items during your race, like your mobile phone, gels or even just a tissue, you might find that the pockets in your running gear are too small (even if you are lucky to have some). So you might want to consider a running belt or arm pouch. The choice is completely yours, based on what you feel more comfortable in. I personally have chosen a running belt that not only fits my phone but also some gels and where I can attach my race bib. You can find it here.

Alternatively there are also pouches that you can wear on your upper arms. Some people find them more comfortable than belts, but usually they only fit a mobile phone.

Note: bringing your phone to a race is a controversial topic. Yes, listening to music with headphones is often forbidden at races. But even if it is I bring my phone to take a lot of pictures before, during and after the race. It is an essential part of my Marathon gear because I love to take pictures as a souvenir. Plus you get to see them on my blog later on.

Hydration kits

Depending on the race you might want to bring a hydration kit. In some races, like longer trail races, hydration packs are even mandatory. In others like the NYC Marathon only bottles are allowed. As with everything, there are advantages and disadvantages when bringing your own hydration kit. Even if it could slow you down, it will keep you hydrated in hot weather. Plus it is good for the environment as you are using less plastic bottles or cups at the water stations.

Hydration kits come in various options and sizes. You can run with a water bottle in your hand, wear a running belt with bottles or even a hydration pack on your back. Just make sure that you cleanse and dry them thoroughly between runs.I personally use this race vest/hydration pack from Inov8 because of the 4 pouches in the front. (Yes, I always carry a lot of stuff)

Accessoires like hats, gloves or sunglasses

Depending on the weather you might need some accessories to protect you from the sun, rain, heat or cold. This could include sunglasses, hats, gloves, rain jackets or a scarf. I recommend investing in a few that have been especially designed for running. Yes you could wear your normal ones, but it is nicer if they are moisture wicking and light weight. My personal favorite are tube scarves, as they can be worn as scarves, beanies, headbands or wrist sweatbands.

Anti-Chafing solutions

If you have ever had a really bad blister, or chafing, or even bleeding nipples as a man, you know how painful it can get. Chafing can really ruin your race. So how can you avoid it?

I recommend applying a lot of anti chafing balm to all the potential areas affected, like between your thighs or around your armpits and even your most sensitive parts around your underwear. For feet I would either go with balm or special blister plasters. If you are a man, putting tape or plasters onto your nipples is also a good idea. Ladies: you don’t need to cover your nipples if you are wearing a good sports bra, but applying balm around and under the bra seams is a good idea.

I personally like these brands for blister plasters and anti-chafing balm. But there are also low cost options like normal tape and Vaseline. Whatever works for you is great as long as you stay chafe free!

 

Did you like this post? Then check out my Marathon race reviews!