From this web page:

Diastasis Recti Self-Test


Two out of three women experience a separation of the rectus abdominis muscle, the long muscle located in the middle of the abdomen, during their pregnancy. This separation is called diastasis recti. The combination of abdominal weakness, hormonal changes, weight gain, and abdominal wall stretch exerted by your growing baby, can cause muscle separation along the centerline of the abdomen."*

All pregnant women and new mothers should check to see if they have diastasis recti. If you find you do have diastasis recti – DO NOT PERFORM SITUPS. Please begin performing the Transverse Abdominis Raise. (See BAC Training Tips for instruction)

Target Area: Rectus abdominis muscle, the long muscle located in the middle of the abdomen.

Benefits of This Self Test: To determine if you have a vertical separation of the rectus abdominis muscle. Once diastasis recti has been corrected, you will improve your posture, decrease your disposition to low-back pain, and enhance your aptitude to perform more difficult exercises correctly.

Avoid: Any strenuous activity or exercise until the diastasis recti is corrected to only two fingers width.



Instruction: Lie on your back with your knees bent. Place four fingers of left hand above belly button, and right hand below, see photograph A. Raise your head and shoulders off floor. Is there a vertical separation of the rectus abdominis muscle, causing a gap of the muscles, and/or a bulge to appear? If so, where does the separation occur–above or below the belly button or in a combination of these locations? Now place four fingers, pointing toward feet, in the area of separation.



Raise your head and shoulders off floor, reaching left hand out toward feet, see photograph B. How many fingers can you place in the gap, one – two – three – four? Placing one to two fingers in the gap is normal. If you can place more than two fingers in the gap, you have diastasis recti.

*The Diastasis Recti Self-Test and abdominal exercise progressions to correct it are found in Bounce Back Into Shape After Baby.

I don't know if this is any good, but thought I'd post it just in case:


Exercises for Diastasis Recti (separation of abdominal muscles)
By Lisa Stone, ACE

Q. I am one month postpartum, and my abdominal wall is separated more than two finger widths. What can I do about this?

A. Here are some exercises that a physical therapist and I have developed for diastasis recti:

1. Lie on your back with knees bent and feet flat on the floor. Place your hands on your abdomen with your fingertips pointing down toward your pubic bone. Exhale as you slowly lift your head (and shoulders, if you can) while pressing down and in with your fingers - that will urge the rectus back together.

2. Take a long towel and wrap it around your torso with the ends in front. As you perform a crunch, pull the ends of the towel towards each other in front of your belly button, which will also urge the muscle back together.

3. Lie on your back with knees bent and feet flat on the floor. As you exhale, slowly extend one leg along the floor, feeling your abdomen contract below your belly button. Inhale as you return to the starting position. Repeat with the other leg.

You can do these exercises daily. After one week, re-check for separation. Since you are only one month postpartum, you will probably find that the separation heals within a couple of weeks. At that point, you can resume normal abdominal exercises.

Another article:


FITNESS PROGRAMMING FOR POST-NATAL MOTHERS

By: Mark Occhipinti,M.S.,Ph.D., N.D. [candidate]

Did you know that the abdominal muscles stretch and separate during pregnancy? During pregnancy this muscle group seperates and stretches to accommodate the baby.

A condition known as Diastasis Recti occurs in many pregnant women. This is due to a seperation of the rectus abdominus at the midline of the belly.

This condition is more likely to occur in women that experience multiple pregnancy's along with being over-weight.
This condition can become permanent if the mother does not begin muscle group is centered a strengthening program no later than six weeks after delivery.

The proper post-natal exercise is encouraged to close this separation, and regain much needed muscle tone.
The rectus abdominus group is centered from the base of the sternum and middle thoriac cavity to just above the pubic bone.
During pregnancy this muscle group separates and stretches to accommodate the baby.

Beginner Abdominal Program for Pre-Natal Women

More likely than not it is to redefine their waists and tone their abdominal area. This can be achieved with the exercise outlined below without creating ribbon bulging in the presence of a diastasis recti and as you will read, this exercise also poses other very important benefits.

Diastasis Recti (stretching of the Linea Alba resulting in separation of the rectus Abdominus muscles) occurs in most pregnant women to some degree. Much controversy surrounds the significance of the role of exercise post-natal to help the separation to resolve as no research has been done to answer this question.

It would seem logical however to avoid activities and exercise that would cause visible ribbon bulging (this is bulging of the abdominal contents between the separation) and that such bulging would further aggravate the tendency for the rectus abdominus muscles to separate.

Sit-ups / abdominal curls etc is one particular exercise that causes visible ribbon bulging if present. In fact an abdominal curl is performed to actually assess the size of the separation.

This exercise program to strengthen the abdominal muscles is based on extensive research undertaken by G.A.Jull Mphty, MMPAA, FACP, M.Comerford BPhty), and C.A.Richardson (BPhty PhD), both based at the Department of Physiotherapy, University of Queensland (Australia).

They have found that dynamic support of the lumbar spine involves the co-contraction of the oblique abdominals, transverses and the lumbar erector Spinae (particularly multifidus) with a non-dominating contribution from the rectus abdominis muscle. This dynamic support acts like a corset for the protection of the lumbar spine, particularly during activities where the spine is loaded, such as when lifting.

During pregnancy the oblique abdominals and transverses abdominus (along with the rectus abdominus muscles) are stretched and weakened and thus their line of pull is altered.

This in turn can result in decreased lumbar spine support normally provided by these muscles and may ultimately lead to lower back pain. It would seem obvious then for the importance to strengthen these muscles back to pre-pregnancy strength to protect and support the lumbar spine, especially in consideration of the increased stresses posed on a new mother's back with frequent lifting and carrying of baby. Strengthening these muscles will also help re-define the waist and tone the abdominal area, which are of major importance to many women post-natal.

The best way to strengthen these muscles is to perform a technique where you make your lower abdomen "cave in" (abdominal hollowing) or where you draw your belly button up and in against your spine. The subject should be able to hold the contraction (brace) while remaining relaxed and continuing to breath. Holding one's breath is a trick movement and if a subject is doing so they will loose the contraction as soon as they breath out.

Initially I teach my patients to contract the muscle as they breath out as so they can not use this trick movement.

The above exercise can be done in any position.

A four point kneeling position is often beneficial initially as it provides a stretch facilitation of the muscles making it easier to perform. Once this has been perfected one can progress to kneeling and sitting positions with the aim to eventually incorporate the bracing into activities of daily living in particular when the back is placed under increased stress such as when lifting and coughing.

DOSAGE: Initially if the muscle is weak only a short contraction may be possible for example 1- 3 seconds. This should be repeated 10 times in one session. Each session of 10 reps should be repeated 3-4 times per day. As the muscles strengthen the contractions should be held for longer periods until the subject can hold the contractions for 10 seconds and repeat them 10 times in a session with ease.

Advanced Abdominal Program Pre-Natal

The current way that we teach our pregnant and postpartum clients to exercise their abdominals is similar to the way it was described in your article. However, the exercise prescription in your article is extremely conservative. We have our pregnant clients perform transverse training everyday during their pregnancy to keep the diastasis from increasing in size, increase truncal stability to decrease incidence of back pain, and to strengthen and increase endurance in the transverse muscle so it can be utilized for pushing during labor. Our exercise prescription starts out with the abdominal hold that was described in your article but that is used only initially to bring awareness to the transverse muscle which is hard to identify for most people.

We quickly progress to having women bring their belly button to their spine (transverse muscle) and have them contract the muscle backwards. Upon the release of the contraction, the women will release no further than their starting position of belly button at the spine. We have our pregnant clients start initially with a hold of 50 counts followed by 10 contractions.
They count out loud so they can not hold their breath. They then start doing their transverse contractions 300 minimum per day (one set equals 100 contractions). The recommended contractions per day after 1 week of training increases to 500 per day accroding to Gail Black, RN, BSN.

Professor Helen Varney, CNM,MSN, chairperson of the Maternal/Newborn Program at Yale University School of Nursing has found that when an exercise program is not initiated as soon as possible after delivery (usually not later than 6 weeks) to regain the muscle tone of the abdominal wall, complications can occur in the mother. The space that appeared during pregnancy in the rectus abdominals fills with peritoneum, fascia and fat. This can have a significant consequence that could manifest themselves as:

1. Reduced support for subsequent pregnancies.
2. Increased lower back strain during pregnancy and general activities of daily life.

In addition to the benefits of returning to or beginning an exercise program mentioned above, exercise offers the following:

1. Improve abdominal strength.
2. Regular exercise improves circulation.
3. Decreases fatigue, lessens lower back strain.
4. More importantly, and a factor that is often overlooked in the excitement after
5. Childbirth, a lessening of the emotional strain on the mother.
6. Exercise will help the mother take off the weight from the pregnancy more
7. Efficiently and effectively which will improve her self image.

Exercises for the Abdominals & External & Internal Obliques

Crunches: Remember to begin lying on your back with the knees bent (flexed), heels or entire foot on the floor. Hands or finger tips should be placed lightly on either side of temples. (This position removes the chance of using your arms to assist you in performing the crunch.) Gradually exhale first before you begin to pull your shoulders off the floor (this allows the diaphragm to move down and out of the way). Pull your shoulders,, off the floor gradually until the shoulder blades (scapula) have just cleared the floor. then return gradually to starting position (breath in on the way down).
1-2 sets of 8-10 repetitions are a good start. To make this more advanced: After exhaling, contract your abdominals isometrically first, then perform the crunch as described above. Talk about a burn!

Obliques: Lying On the floor in the same position. cross one leg at a 90 degree angle. Pull in a crunch movement the opposite arm to leg (example: right arm across the body towards the left crossed leg). Advanced techniques include the "jack knife." a movement that is accomplished by lying on your side and pulling your upper body off the floor. Slow and deliberate movements will really work the muscles. Again. 1-2 sets of 8- 10 repetitions.

Misconceptions Concerning Working the Abdominal Muscle Group

These muscles act to stabilize the torso to maintain upright posture whether we are sitting or standing. This means the abdominal muscles contract isometrically for 12-16 hours every day. The most pervasive misconception is that this area can be worked every day, and needs hundreds to thousands of repetitions. Done correctly with slow continuous tension, then adding resistance when an advanced level is reached will achieve more benefit with less strain on the lower back, the hip flexor group (which is already developed enough from walking, stepping and bending and flexing at the waist). It is amazing that in 1996, in the face of facts that an individual, contrary to the evidence available still believes that they can perform enough repetitions to reduce their waist. Only cardiovascular exercise and push-aways from the table can accomplish this feat.

And another...all this is making me think insurance really should cover MR:


Diastasis Recti – Prevention and Treatment

Diastasis Recti (DR) occurs in approximately 1/3 of pregnant women. It’s when the right and left sides of the rectus abdominis are stretched, separated or partially separated along the vertical midline called the linea alba. The abdominal muscles separate because of the increasing pressure of the growing fetus. It can occur during pregnancy or birth. DR is primary genetic, but it may also be caused by weak abdominal muscles or rapid abdominal growth. The latter is something that we can work on.

SYMPTOMS – DR doesn’t usually cause any pain or discomfort so it is often left unnoticed. You can have a physician, midwife, physiotherapist or personal trainer check for it. She will have you lay on your back (for just a few seconds) and come up into a crunch position. She will then feel for the edge of your abdominal muscles to see how wide the gap is. If you have DR, She will find:
bullet A space wider than 2 finger widths between the left and right sides of your rectus abdominis
bullet A bulging along the midline of your abdomen

If you think you have Diastasis Recti, visit your doctor before commencing any exercise programs. There are other problems, such as hernias, that have the same symptoms. It’s important that you have a physician diagnose your condition.

PREVENTION

As Diastasis Recti is primarily genetic, it cannot always be prevented. However, research shows that keeping your core strong before and during pregnancy can definitely make a difference.

Before becoming pregnant: Strengthen your core (abdominals, obliques, back muscles and pelvic floor muscles).

During pregnancy: *Please note: All women should have a PARmed-X for Pregnancy completed by their doctors before continuing or beginning exercise once pregnancy is confirmed. This form can be downloaded from www.csep.com.

If you were already doing abdominal exercises prior to becoming pregnant, you can continue with these up until 4 months. After this time, you’ll need to avoid abdominal exercises that have you lying flat on your back. Not to worry, there are a variety of exercises that can be done on an incline, on all fours, standing and even sitting, If you were not doing any abdominal exercises prior to becoming pregnant, start into it slowly. It’s always a good idea to book a few sessions with a registered personal trainer who is a Pre and Postnatal Fitness Specialist. She can set you up with some safe and effective abdominal exercises.

TREATMENT

During Pregnancy or After Pregnancy: If you think you have Diastasis Recti, do not ignore the problem. Left untreated, it can cause permanent damage to your core. Make an appointment with your doctor. If you are diagnosed with Diastasis Recti, get your doctor’s permission before trying the following exercises. Once you have his or her go ahead, it’s a good idea to book a few sessions with a registered personal trainer or physiotherapist who is a Pre and Postnatal Fitness Specialist. She can assist you in doing these and other exercised safely and effectively.

1.Assisted Crunch: Laying on an incline with your knees bent, take a long towel or scarf and wrap it around your torso. Cross the ends over in front and hold the ends with your Crunch up until your upper back is off the ground. As you perform the crunch, gently pull the ends of the towel together in front of your belly button, supporting the rectus abdominis. You are essentially holding both halves together with the towel. Do 2 sets of 10-15 reps, with a 1-minute rest in between

2. Laying on an incline with your knees bent, place your hands on your abdomen with your fingertips pointing down toward your pubic bone. Inhale. As you exhale, slowly lift your upper back off the ground while pressing down and in with your fingers - this will support the rectus abdominis and help bring it back together.

Melanie Osmack: Certified Can-Fit-Pro Pre & Postnatal Fitness Specialist/Pro-trainer, BCRPA Registered Fitness Instructor & Personal Trainer, IAIM Infant Massage Instructor, Mother Wellness Certified Pre & Postnatal Yoga Instructor, Childbirth Educator and MOM.

Interesting link: Berkely Parents Network: Postpartum Tummy

Abdominal muscle separation postpartum
October 2003 (excerpts)

At my 1 month postpartum doc appointment my OB told me that my abdominal muscles had separated (about 3 fingers width) and that it was possible that they would not repair. Does anyone know how common this is so long after delivery? Does anyone have any advice about how to repair this separation by exercise or surgery? Would living with this mean living with my currently distressing pot belly? Thanks! Julie
Can all go back to normal. It's very common, actually. I certainly had that, too, but it was gone at my 8 weeks check-up.

What to do? Pull-ups, expecially right-elbow to left knee and other way round.

''After the baby's birth'' by Robin Lim has more suggestions, also exercises you can do with your baby.

Postpartum Yoga - check out Yogalayam on 1717/23 Alcatraz, Tu 10-12 and Th 2-4, phone (510) 655 3664. The teacher, Saraswati, has an enormous experience with everything around pregnancy and childbirth.

Walking - with your baby in a sling or in a stroller - is also very helpful, and very easy to realize.

All the best Julia
Dear Julie:

At one month postpartum, it is very early to be worrying that the shape of your postpartum belly is permanent. It is really true that your belly developed the big ripe shape of a term pregnancy over 9 months, and you should wait at least that long for nature to take its course and pull you back into shape before deciding that your 'pot belly' will never go away.

That having been said, the separation of your muscles is called rectus diastasis, and is often permanent. The muscles themselves shorten over time from their stretched position during pregnancy, but the connective tissue between them, called fascia, does not have the same elasticity that muscles have, so once stretched, it will never return to its pre pregnancy size. However, if your skin is in good shape, your little 'pot belly' will get better than it is now, and you have a good chance of regaining that flatter shape that you miss. But you have had a baby, and if you wore tight jeans before the pregnancy, you might not get back into them, because your body has changed.

My advice as a plastic surgeon is just wait awhile. In 9 months, if you still don't like what you see, you can be evaluated for a tummy tuck procedure which tightens up that stretched fascia and removes extra skin in your lower abdomen. Until then, enjoy your baby, do your aerobic exercise as you have time, make sure you have at least one outfit that fits you now that you feel good in so you are not always aware of your 'pot belly' and relax. Your body is likely to continue to get better on its own. elizabeth lee, m.d.
Re: Abdominal Separation, as a perinatal exercise specialist, I have to weigh in on this one.

I didn't see the original post, but I can tell you that a separation of two finger widths is normal at six weeks postpartum. And that the shape of your belly is NOT related to abdomianl separation. You've got two separate issues here.

To flatten the abs after pregnancy, you need to start with the most interior layer of the abdominal wall, the transverse abdominus. This is your internal ''girdle'' muscle. By building strength in this muscle first, when you do get to crunches and such, the abdominal wall will remain flat upon exertion. This is a very important concept of postpartum conditioning. In fitness, what you pratice is what you get. And if you do crunches without the underlying internal support you belly will definately bulge. Bulging of the abdominal wall actually increases abdominal separation. (I've also found that most women to not perform the abdominal separation test correctly.)

One respondent seemed to suggest that you do oblique crunches. I do not recommend this. Oblique work can place shear forces across the abdominal wall, worsening abdominal separation, especially if the transverse abdominus is not strong enough. Generally, many types of traditional crunches are contraindicated for those with abdominal separation.

It is also important to note that abdominal separation is only a problem in the first months after pregnancy. Yes, the rectus abdominus does not go back to it's original position, but once your connective tissues have tightned up, (anywhere from three to six months post-pregnancy) you won't have a hole there anymore, and you will not be at risk for herniation. It is a myth that you can't have flat, strong abs after abdominal separation.

I'd also suggest that you do not consider surgery until you are sure that you do not want any more children.

For exercises that strenghten the transverse abdominus, and flatten the abs postpartum, check out my book, ''Exercise After Pregnancy: How to Look and Feel Your Best''. It's available locally at many of the babystores and independent bookstores as well as on my web site: www.exerciseafterpregnancy.com Helene Byrne
Abdominal separation after pregnancy is not uncommon. I had a separation as well (which has since come together). The good news is that are are exercises that you can do to encourage the muscles to come back together. You want to first focus on strengthening the pelvic floor, through exercises like pelvic tilts and kegels. You also want to do gentle abdominal exercises like belly breathing. I demonstrate these exercises in my ''Postnatal Exercise for Mom & Baby Video'', or if you aren't a video person, I recommend Helene Byrne's book and classes. I'll put links to how to get info on both of these at the end of this post.

Equally important, there are exercises/movements that you should avoid so as to not make the separation larger. Avoid advanced abdominal exercises (such as reverse curls, crunches, cross-over external oblique exercises, etc) until the muscles have closed and the pelvic floor is strong. You will also want to use splinting techniques during exercises most abdominal exercises.

For some women the separation closes on its own natually within a few months, but you can encourage the closure and take steps to keep it from getting larger.

You can get my video information and a list of ''Do's and Don'ts for Postnatal Exercise'' at: www.freyafitness.com.

You can get info on Helene's classes and book at my prenatal/postnatal exercise class website related links section: www.marieandron.com/prenatalfitness/htm ... dLinks.htm

Best wishes! Marie
Yes, there are things you can do for postpartum abdominal separation. This condition is called diastis recti and is a problem of not only postpartum women, but also of the obese. I have also seen it on men who have had surjuries that required cutting down the center of the stomach This separation can be felt in all of us, but is normally only about a finger wide. In diastis rectis that separation becomes wider, such as the 3 fingers wide you mention and is basically from the strain of all that added weight and volume. I am sure you have been told to do lots of abdominals- which is sort of true, but can also worsen your problem if not done properly in regards to this condition. In otherwise you need to modify all ab work, so that you are engaging the transversus and are also ASSISTED. The last thing in the world you want to be doing is forcing your way up in a crunch with your belly bulging out of this separation- looks a bit like a long sausage on your belly! For example use a therabands to assist yourself up and only go as far up as you can keep your belly knit together. There are a lot of exercises you can do that should be helpful but all this said there is no guarantee that your separation will mend.

I am glad to give more info on this- I am a pilates teacher and have worked under physical therapists. i would recommend that you work on this problem with a pilates teacher who is understands this issue-(many are not very knowlegeable at all)- also I would work one on one -not in a group class. I would also recommend Sara Swathidevi's postpartum yoga classes at yogalayam-she is a very knowleageable woman. I am glad to answer any questions you might have and you are welcome to contact me or check out my website www.optimumpilates.com good luck andrea
Postpartum saggy belly
Jan 2004

I need some advice about what to do/expect with my postpartum wrinkly tummy. I gained 60 pounds with my last pregnancy, and I was totally HUGE compared to my usual very skinny self. My stomach skin got so stretched it was incredibly painful. I'm 6 months postpartum and have lost all but 4 or 5 pounds and my stomach is pretty flat, but I'm left with wrinkly, loose skin just around my navel. I think the reason this is bothering me is that I remember my mother having the same thing when I was a kid, and I always thought it looked yucky. Now I have it! Is there anything to do about this? My mom never exercised a day in her life, so I'd like to think that's why she didn't lose hers. I used to be in great shape before babies, so maybe there's hope? I'm not usually this vain, but I think I'm needing to distinguish my tummy from my mom's!
yes, i have the 90 year old lady's chin on my belly too. i actually have lost more weight than my pre-pregnant self and had to buy new clothes to accommodate the weight loss (now a size 2!). but alas, my belly is wrinkly and squishy. my baby loves to tug on it while breastfeeding, which is the only time i think it's cute!

anyhow, i showed a friend and she asked her obgyn relative/friends and they said it's all genetic. you can exercise to get it flat again, but the extra skin will not go away if it's in your family. i've seen some mommy's w/ great tummy's afterwards, but me, i have the jiggles! not the jelly beyonce was talking about
Wrinked skin after pregnancy is very common, especially if you carried big, have had several babies, or multiples. The collegen fibers in your skin (which creates elasticity) becomes overly stretched out. Unfortunately exercise does not correct the condition. Neither do any of the creams that you see advertised. There is some evidence that Retin-A compounds stimulate the skin to build more collegen. But of course, you can't use it while breatfeeding. Also, some of the cool light laser resurfacing techniques like microdermabrasion, also stimulate the production of collegen. These require multiple sessions, and cost big bucks. Another option is to wait until you are sure that you will not have anymore babies, and get the excess skin removed. Also big bucks. Lastly, you can do what most of us do: switch to a one piece bathing suit and try to age gracefully. More info on bouncing back after pregnancy can be found at my web site: www.exerciseafterpregnancy.com Helene Byrne I'm a certified Pilates instuctor and I highly recommend trying it. It is an amazing form of exercise and it can do wonders for the core- abdominal area. I've been teaching Pilates for almost ten years and I'm also a Mom of a 7month old. If your interested I have a home studio on N.Berkeley. I have all the apparatus and have flexible times. Skye (510)883-0124 Skye Also recommended by 2 people: Tummy Tuck I have a friend who has had 2 boys (now 6 and . She's TINY, is in amazing physical shape, and has a wrinkly tummy. She has been told by doctors that she has great tummy muscle tone, but that has nothing to do with stretched out skin. It can be remedied with a tummy tuck operation, but that's too extreme for her so she just lives with it. October 2003

hi everyone, as i prepare to celebrate my baby's first birthday(!) i'm boo hooing my saggy belly!

i know in previous conversations people have said wait 9 or more months and it'll snap back etc. and that time has passed. i do moderate exercizing and am below my pre-preg weight. if anything, my tummy is flatter than ever, but it has a bunch of saggy skin! i gained around 50 lbs during pregnancy...

anyhow, is there anything that can be done about this that doesn't require a scalpal (which is not an option!)? it's ok when i stand up, but when i sit down it looks like i have the belly of a ninety year old lady - or her saggy chin is more like it. i exfoliate and that helped get rid of most stretch marks, it's just the extra skin that's bugging me...

if this is just the way it is, then i can find some closure - i just need confirmation i guess~! at least my baby likes to tug and pinch it, so someone is enjoying it! miracle cures welcome
For a saggy belly, I highly recommend doing Pilates. It has helped me tremedously. I have a fabulous instructor, Skye. She has a home studio in North Berkeley with all the equipment and is so knowledgable. She is a mother of a newborn too so she has great compassion for the saggy belly. Skye's can be reached at (510)883-0124. Try it, it helped me. Anon Julie- It sounds like you have a diastasis recti, a separation of the rectus abdominus, the central abdominal muscle that the body builders call "the six pack". It is very common and happens sometimes during pregnancy. As the belly grows and expands more pressure is put on the central tendon and sometimes the muscle separates from the tendon. It can also occur during the pushing phase of labor if a woman holds her breath when pushing. The separation becomes a concern when you can fit 2 or more fingers in the separation. Because it involves the rectus abdominus muscle, I strongly recommend against doing regular sit-ups, curl- ups, rotational exercises involving the abdominal region, leg lifts, laying on your elbows with a towel under the toes and pulling your legs underneath you or "jack-knifing out of bed" as these maneuvers put more strain on the rectus, which is what you want to avoid. When the separation is less than 2 fingers you can start doing more aggressive exercises, but for woman with a diastasis recti greater than 2 finger breath separation I would recommend a gentle progressive program starting with Kegals, and working the deep abdominal muscle, the transverse abdominus. This will help with improving your stability and conditioning the abdominals. You can progress to pelvic tilts with transverse abdominus contractions and later to curl ups with approximation of the separation (by laying on a towel and grabbing the right end with your left hand, the left end of the towel with your right hand pulling the towel across your body to hold in the separation). I would also strongly recommend a couple of sessions with a professional who works with pregnant and post-partem women: a Physical Therapist, Exercise Physiologist, or trainer. That way you can get the proper feedback on isolating the appropriate muscles and not overdoing it. It is difficult after having a baby, to have a good sense of where your abdominals are and how to correctly isolate and fire the ones you want. This is a something that the average therapist/exercise physiologist/trainer may not be familiar with, so ask about their experience/training working with diastasis recti. Best of luck, and patience. Kelli Manring, PT, MSPT Physical Therapist
Mama belly: Any advice before I call the plastic surgeon?
July 2003

I have hesitated to post this because I keep thinking the problem will take care of itself, but somehow it never does! I'm in my late 30s. After giving birth to my third and last child 7 months ago, my belly sticks out so much I think I still look pregnant. I obsess that I have a tumor, but I don't. I have mama belly. I don't want mama belly. Or at least not to this extent. I have lost my pregnancy weight and could probably still lose another 10-15 lbs, but the excess weight seems disproportionately attached to my lower abdomen. I work out, I do crunches, I wear ''foundation'' garments. Nothing seems to work. I wonder if I'm doing the excercises incorrectly. I wonder if 7 months post partum is just not long enough. I wonder if anyone has any advice for me before I call a plastic surgeon. Specific exercise recommendations & personal testimonies most welcome. kangaroo mama
Yes, 7 months post-partum is too soon! Although you will probably always have a gentle bulge in the tummy, no matter how much weight you lose, it should go down a lot by about one year after birth. For most women it takes about a year to get back to pre-pregnancy condition. (The old saying is, it takes 9 months to get that way, and it takes 9 months to get back.) And it does get a little worse with every child. Think of it as a badge of honor! Based on a similar discussion a couple of months ago and my own ''mama belly'' issues, I started doing Pilates mat exercises. I still have more work to do, but am starting to feel pulled together again. As I understand it, Pilates works your deepest abdominal/trunk muscles, whereas crunches work the outermost muscles. You might want to check out the Stott videos sold on Amazon, get a personal session to get you started, or go to a class. Another mama belly I'm in my late 30's and I've only had one baby but my body just didn't go back to a normal shape until the baby was 12 months old. I ate right and exercised and still it didn't start to really look better for 12 months and then it rapidly improved. Danielle I highly recommend taking a class through Karen Casino in Berkeley. She helped me ''reclaim'' my abs after a baby. Sorry I don't have her number - I'll bet she's listed. Give her a call. Her classes are held in a studio behind her house. Can't wait to see the other suggestions posted! good luck What you are experiencing is actually very common for third child/late thirties combination. What you need to do to flatten your abs is to rebuild your abdominal wall from the inside out. That means toning up your transverse abdominus (the waist cincher muscle) first. This muscle compresses and flattens the abdominal wall. Then you need to work on strenghthening the lower half of your abs, i.e. below the belly button. Classic crunches and obliques work the upper half only. And it is possible that your abs are bulging out upon exertion, so that crunches might be actually making your situation worse. For more specifics you can check out my book, ''Exercise After Pregnancy How to Look and Feel Your Best'' at www.exerciseafterpregnancy.com Helene Byrne The bad news is that having children can make your belly permanently more protruding. The good news is that, at just seven months after giving birth, you shouldn't give up hope yet. It can take a year or longer to get back to (more or less) your pre-pregnancy shape.

One issue you may be suffering from is diastasis recti. During pregnancy, the abdominal muscles can separate in the middle. Usually they spontaneously move back together after birth, but sometimes they don't. You can check if you have this issue by doing a crunch and probing the middle of your abdomen--if you feel a trench that you can stick your fingers into, that's a diastasis. If you have this condition, you shouldn't do regular crunches--instead, cross your arms over your abdomen and use your hands to push the two sides together when doing crunches.

I have this condition and it's improved somewhat but my doctor said I will always look a little bit pregnant (even though I weigh less than I did before getting pregnant). Bulging a bit
Too much tummy skin
January 2003

Hi, I have an 11-month old, my second. I'm 39, and not bouncing back in quite the same way as I did with my first: the weight is coming off a little slower and so on. But I am bouncing back.

However, this time around I did get stretch marks; not a lot, but some. They don't bother me much (I can't see them most of the time). The thing that IS bothering me is the extra skin from my super-big pregnant tummy.

This child was (as is often the case) bigger, and my tummy was bigger. Plus, I was 5 years older. But should that really account for all these folds and folds of loose, empty skin that still lie around my waist? When I ask people about it they treat it like a weight question, answering with diet and exercise; but there isn't much fat to speak of in most of these loose areas.

Any experience/advice in getting your body to reabsorb the excess? Or am I just being impatient? anonymous
Alas, for me the extra skin has continued to hang off of my stomach like a wrinkled purse, nearly three years after my last child. I am at my pre-pregnancy weight and my stomach is more toned than ever, but the skin remains. I've heard that it has more to with how elastic your skin is (how much collegen it has). I also have lots of stretch marks too. Aside from plastic surgery I am under the impression that there's not much I can do about it, except use this as an opportunity to focus on the important things in life -- which are not my looks. (And besides my husband can't see anything without his glasses -- which he removes during more intimate moments.) anon I'm going to stick my neck out on this one: try brushing your skin! I have brushed my skin with a stiff, natural bristle brush in a certain sequence to improve circulation, soften the skin and tighten loose skin and it works for me . . . to find out about this, go to this online link: http://www.t-tapp.com/home/ and select ''Cellulite Control.'' The exercise program is also very effective. --Becky I used to feel sad that I was stuck with all that extra tummy skin too until a client of mine showed me how tight her skin was pulled after a double mastectomy for breast cancer. Maybe some day all that extra stuff will come into use somewhere else on my body for an emergency. Right now it's just in storage on the tummy. a new way of looking I'm sorry to say that there's not really any way to improve the tummy skin, other than surgery, which is obviously a big undertaking and probably not worth it since it would leave scars. Anyone who offers solutions based on diet, excercise, vitamin supplements, etc, should be ignored. But don't give up yet--11 months postpartum may seem like a long time to you, but you probably will continue to see some improvement.

Another thing to try is the modern equivalent of a girdle--essentially, bike shorts that you wear under clothes. Not only will your tummy look flatter; it might even help with the excess skin. After surgery such as liposuction, surgeons recommend wearing support garments to help the skin shrink down. It's worth a try.

Also, I bet that the excess skin is more noticeable to you than to anyone else. People around you probably think you look fine. Anonymous
Postpartum Abdominal Exercises
April 2003

Do you have advice for abdominal exercises I can do at home? I am 4 months postpartum and ready to work on getting my body back. (For the record, I'm eating healthy and happily breastfeeding my sweet baby.) I'm about 10 pounds over my pre- pregnancy weight - and my tummy is so loosy-goosy. If you have any advice for types of exercises that focus on the abdomen (crunches, no crunches, weights, etc.), I would greatly appreciate it. Thanks!
I am a physical therapist that deals with abdominal muscle tone issues in new moms quite often. I think that your best bet would be some guidance in a program that includes the transverse abdominus, pelvic floor and oblique muscle contractions. I had a baby 22 months ago and found that it took me about 6 months before i felt that i could really contract those important muscle groups effectively. You should also consider the low back muscles working together with your abs especially during all of the baby care activities ( car seat, crib etc..) I would be happy to discuss these issues with you in more detail if you are interested. We can also set up some one to one sessions to get you started. There is also a post partum exercise class that Helene teaches in Montclair, she also goes over some of these principles in a class setting. Dawn Loretz i HIHGLY recommend starting pilates--the emphasis in pilates is on abdominal or ''core'' msucel control, and it gave me back the tummy i had before pregnancy much more quicky than ab crunches (with or without aerobics) did! if you need to work out at home, try the moira stott pilates collection (available at amazon, i'm pretty sure)--she's a very good video instructor-- but it's also good to take a series of classes or do some drop- in sessions to get instyructor feedback. Good luck and have fun! Jessica I teach pilates and would be glad to give you lots of abdominal exercises to help you regain your pre pregnancy belly. As well as abdominals you will want to do some pelvic floor exercises to strengthen the whole area. I would be glad to talk to you. You can reach me at 510-508-1408. I have been teaching for several years in Oakland and have worked under several physical therapists. andrea (evadne at lmi.net) Check out my book, ''Exercise After Pregnancy: How to Look and Feel Your Best''. It features a three-step reconditioning program for new moms that can be done at home, without specialized equipment. It will tell you everything you need to know about how to safely and effectively bounce back from pregnancy and childbirth. The first couple of chapters can be read on my web site, www.exerciseafterpregnancy.com. The book is available at local independent bookstores, baby stores, and selected Barnes and Nobles and Borders, and of course Amazon. Helene Byrne Two ideas for you. 1) There are several postnatal exercise classes in the area that you can bring your baby along with you. I personally teach one in Hercules(see: www.marieandron.com/prenatalfitness), but if Hercules isn't good for you, check out the following link on my website to find other instructors in the area (Berkeley, Oakland, Haward, San Franisco, etc): www.marieandron.com/prenatalfitness/htm ... dLinks.htm 2) If you prefer to workout at home, then check out my ''Postnatal Exercise for Mom & Baby'' video. The video includes a full body workout, including both cardio and strength training/toning. The baby is included throughout, so you can get back into shape and provide a fun activity for your baby at the same time. The abdominal exercises shown in the exercise video are specifically designed for postnatal women -- starting with pelvic floor and gentle abdominal exercises that are needed to start the recovery process for those overly stretched muscles. The video then shows some more challenging abdominal exercises, with modifications to use if you happen to have abdominal separation (how to test for this is also shown in the video). The video comes in both VHS and DVD formats. You can get more information on that at: www.freyafitness.com Best wishes! Marie
Stomach Exercise after C-section
September 2003

HELP! How long does it take for the stomach muscles to recover after a c-section? I delivered a nearly 11 pound baby in April, and my doctor told me it takes about 6 months for the muscles to knit back together so they can flatten out again. What are other people's experiences with this? Is that accurate? After my first baby, regular delivery, I was into most of my clothes before two months passed, but now I have this paunch in my lower abdomen that is preventing me from getting into anything. I started exercising to try to flatten them out, but can still really feel those muscles at 5 months post. I have no experience w/surgery, so my expectations may be off, but it is frustrating to see all my friends who had regular deliveries shrinking right back into their clothes. Anyone else have this problem and not have to shop for a whole new wardrobe???
I had a vaginal delivery 3 years ago and am still trying to get rid of the paunch. I hate to say it, but I don't think it's ever going to go away. I even saw a plastic surgeon about a tummy tuck since nothing else seems to work. I run 5 miles a day almost every day, but have given up on sit ups because it just isn't working. Hopefully somebody has some advice because I need help, too! Anon After your stitches have healed with a ''C'' your abdominal muscles can be reconditioned in the same way as if you had a vaginal delivery.

Since your abs are still pooching out, I would suspect that you are either doing the wrong types of exercises (crunches flex the upper spine, do not flatten the abs, and are not effective when reconditioning after pregnancy), and/or that your abs are ballooning out upon exertion, a common post pregnancy reconditioning problem.

After pregnancy, women need to rebuild the abdominal wall from the inside out, starting with the deepest layer, the transverse abdominus: your internal girdling muscle. This is the muscle the flattens the abdominal wall. Weakness in the transversus causes the belly to hang out when lax, and will lead to ballooning out upon exertion, i.e. during crunch type exercises. In fitness, what you practice is what you get. And the last thing a post-pregnancy body needs is abdominal expansion. Weakness in the transversus is also highly associated with many common spine and lower back problems.

I've worked with hundreds of postpartum women, and I can tell you that it is a very slim minority that are back into their old jeans before before their babies are crawling. I recommend buying some inexpensive transitional clothes, with elasticized waists, so that you have something that fits your new ''mommy body''. To find out more about reconditioning after pregnancy, you can read the first two chapters of my book, ''Exercise After Pregnancy: How to Look and Feel Your Best'' on my web site, www.exerciseafterpregnancy.com
Helene Byrne, perinatal exercise specialist and author
I had a c-section, and your experience sounds about right to me. A c-section is major surgery, so it takes the stomach muscles a very long time to recover. I had significant pain for many months, as well as that annoying numbness. My girl is now 13 months, and the area immediately around my incision is still faintly numb, though it doesn't hurt anymore. As for my clothes, I bought one pair of post-partum pants and wore them constantly (as well as sweats). Yes, it was irritating, but it was impossible to rush the weight loss so I didn't fight it. Then gradually (VERY gradually) I was able to wear my biggest pants, then smaller ones, etc. Breastfeeding helped take off the pounds, and now I'm wearing all my pre-baby clothes again. As far as exercise, I did NOTHING abdominal for a very long time. It just hurt too much. If you want to exercise you should go easy on yourself. As far as flab goes, I do have a little bit left. I've found that swimming helps a lot, or maybe it just burns calories (in any case, it feels great). hope this has helped you. brie Oh do I know what you are talking about. I had a baby in April (but 2002!.) She was 10.2 pounds. After my first was born (weighing 7.3 lbs), i easily went back into old clothes and never thought about exercise. I really hate to say this, but even these 17 months later, i still can't fit into my old clothes and it is very hard. I am trying to exercise more now because i have back problems due to weak stomache muscles. Don't give up, and when you can, try and excerise. I hope this is somewhat helpful and not too depressing. Andrea Don't go shopping for a whole new wardrobe just yet. From a physical therapy perspective it takes a good 6-8 weeks before strength changes occur. During your pregnancy your muscles were overstretched there return to prior state may be dependant on a number of things, time since your first child was born, what exercises you are doing, and yes age. Sometimes when a muscle is cut it can loose its sense of how to work. That's when specific training is needed. If you are not doing any specific training for the deep abdominal muscle, the transverse abdominus, that's the first step. Most people have a hard time isolating this muscle. They work hard at the top layer of muscles, the rectus abdominus, as thats the one most of us can see & feel. Pilates breath work, pelvic tilts--done properly, and hands & knees positions work best to isolate this muscle. Working on the abdominal obliques will help to trim the waistline as well. The physioball/birth ball is fun and also is great training for the abdominals. Patience and persistance, daily but not to over do it (ie. crunches until you cramp...that's way beyond). Look in to a post partem exercise class the instuctor should be able to point you in the right direction. Hope this has been helpful, feel free to contact me if you have any further questions. Kelli Murphy, PT, MSPT kellimurph at earthlink.net I found the book ''from baby to bikini'' very useful. Also, it took ages for me to figure out which muscles weren't working after my c-section so that I could try to use them again, just in standing and sitting. Side stretches helped, surprisingly, and also lying down (well after the c-section) and pulling the part above my belly button down to the floor. I had been doing situps etc for ages which helped but this last exercise turned out to be crucial, I'd forgotten that muscle was there and hadn't been using it since pregnancy. anonymous Pilates is a great way to try to get you abs back after a C-section. At our pilates studio we have worked with many women who have gone through a cesareans and it is possible to get your tummy back (though it can be a longer process if you are among those who have decreased sensation or numbness in the area). Generally, making sure that you are working the deep abs, the transversus abdominum, and not the top layer of stomach exercise is the key to getting your tummy flat. Pilates breath work and pelvic tilts are very helpful as well as visualizations, especially if you are one of those with decreased sensation. What you want to avoid is lots of crunches in which you only work the top muscle area. I would be glad to discuss it with you and if you are welcome to get more info about my studio from my website www.optimumpilates.com andrea

The diagram nicely illustrates the "parenthesis sign."

Once diastasis recti has been corrected, you will improve your posture, decrease your disposition to low-back pain, and enhance your aptitude to perform more difficult exercises correctly.

Avoid: Any strenuous activity or exercise until the diastasis recti is corrected to only two fingers width.

Having seen plenty of women who have dedicated many months and years in the gym getting back in shape after pregnancy, I must say that I disagree that distasis recti can be corrected by toning the muscles alone. I see many toned abs with the "parenthesis sign"

Muscles are stretchy and are NOT where the problem lies...it is the fascia, or the tough "gristle" that binds the muscles together in the center that is the problem. And during MR we actually do not sew the muscles but instead sew this fascia to bring the msucles together into the V-sign.

I am all for excercise and toning...it makes a major difference in helping recovery, and WILL tighten the muscles, but not move them back to the midline.

The photos shawnn posted earlier show a good MR

http://www.makemeheal.com/pictures/view ... picid=1104

Thank you for posting that! It was making me feel a little ill to read so much about how you could just about excersize it all away...I didn't feel that was true.

Thanks also for pointing out her pictures...I had not seen them, and they are fantastic!

Thanks for the articles now it all makes more sense.