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Mommy Belly: A Physical Therapist’s View

This is a guest post written by Dr. Kailee Venzin, Women’s Health Physical Therapist, specializing in pregnancy, childbirth, and postpartum services.  She is based in Pittsburgh, Pennsylvania.

Did you bounce back easily after your pregnancies? Or does your belly seem to just “bounce” instead? Many new and not-so-new moms find themselves tucking the soft mound that used to be their baby into their high-waisted yoga pants and still get asked at the grocery store if they’re pregnant. Many feel like their bellies are “unstable” or like “jello” and try countless ab exercises to try to feel more “pulled in” or get back their pre-pregnancy bodies, egged on by the various Instagram models and trainers. Many of these women, too, try exercise programs that claim to “heal your core” or “only do one exercise, 10 minutes a day”.  Most of these women eventually find their way to me.

After 9 months of stretching to accommodate a growing baby, your abdominals have to quickly adapt to new tasks and skills of picking up your baby, breastfeeding, and stabilizing as you walk and move. If you are not taught how to use your muscles again properly, your body may devise a new way of moving that isn’t optimal. These non-optimal strategies can cause problems like Diastasis Recti, urinary incontinence (leaking urine), pain, or organ prolapse to persist months and years into postpartum.

How do you know if you have Diastasis Recti?

Your stomach is made up of 4 muscles that all connect into a band of connective tissue that runs from your breast bone to pubic bone (called the linea alba). When Diastasis Recti occurs, the linea alba becomes stretched out and you may feel a gap in the middle of your abs.

Your 4 ab muscles:

  1. Rectus abdominis—the “six pack muscle”—it runs from your breast bone and ribs to your pubic bone
  2. External and internal obliques—these muscles are the side abs and connect into your back
  3. The Transverse abdominis—the “corset” muscle. This muscle lies underneath all the above muscles, so you can’t see it from the surface. This muscle hugs your organs.

Here is How to Check Yourself:

STEP 1:
Lie on your back with your knees bent. Place your fingers deep in your belly button. Then, lift your head and shoulders off the floor or bed.

STEP 2:
What do you feel? What do you see?

If you feel your fingers sink into your belly button, you may have Diastasis Recti. If instead you feel a taught band, you may not. Compare the feeling under your fingers to the tendon right beneath your knee cap. If it feels the same, you probably don’t have Diastasis Recti. If it feels softer than the band below your knee cap, you may have Diastasis Recti.

STEP 3:

Now, try the curl up one more time and place your hands behind your head instead. Does the middle of your stomach rise more than the sides? If so, this is called doming. It’s another compensation your body may do when your deep abs (transverse abdominis) is out to lunch. If you don’t see a hill rise up in the mid belly, you may just have some abdominal loosening.

Okay, so just say you saw some doming or felt a gap. Now what? The best thing to do is to make an appointment with a Women’s Health/Pelvic Physical Therapist. Physical Therapists (PT)are the experts in muscle and movement. He or she will be able to tell you how severe of a gap or doming you have, which muscles need to be re-trained, and get you on the right path to fixing it.

In the meantime, your best bet is to avoid the following to prevent making it worse. Your PT will be able to get you back into these things down the road, but it’s a good idea to avoid them for now, as they may make your doming or gap worse:

  1. Abdominal exercises like sit ups, jack knives, crunches, double leg lifts
  2. All fours and planking exercises
  3. Breath holding with lifting or any other activity
  4. Deep back bends

So, what else can you do you prevent it from getting worse? And an even better question…how do you fix it?!

MEET YOUR DEEP CORE TEAM

Fixing this problem does a lot deeper than just doing the right exercises. There’s actually no such thing as the right or wrong exercise for diastasis or doming.  In order to fix it, you first have to learn how to activate your “deep core team” and then bring these team members into every exercise and everything you do. Teaching this team to work well will allow you to get back into the “avoid for now” activities above, bring your gap closer together, strengthen the abs and the linea alba, and even resolve leaking with coughing and sneezing.

Your deep core team is the foundation of your house. If the foundation of your house is not strong, your house will topple over. Your Transverse Abdominis, your Diaphragm, and your pelvic floor muscles are all vital members of your deep core team. These muscles should be turning on before you pick up your coffee cup, roll out of bed in the middle of the night to pee, or before you begin your plank, but in pregnancy and childbirth these muscles go through huge changes and often are still sleeping (unlike you) into the first few years of your child’s life.

So how do you know if your “deep core team” is working properly? If you have doming or Diastasis, I can almost guarantee, one of those team members is on vacation. But even if you do not have doming or diastasis, you deep core team could still be slacking. And if it’s slacking, you won’t be able to safely tone your pelvic floor or abdomen. Try these with me:

Stand tall with your shoulder back and try the following:

  1. Deep breathing—here’s where my clients will say, “I’ve been breathing wrong all my life!” Take a deep breath in. If your shoulders move first, your diaphragm is in Punta Cana. If your diaphragm is working properly, your ribs will expand like an umbrella and then your belly will expand slightly as you breathe in. If your belly or shoulders are the only parts that move, your diaphragm could use some re-training.
  2. Pelvic Floor contraction or Kegel—Did you know that most women don’t do a Kegel correctly? I’ll give you one of my best tips—imagine you have a ruby inside your vagina. Squeeze your muscles around the ruby. Do you feel a tightening around where you would insert a tampon? If you cannot feel much, or notice your bum or stomach tightening, you’re probably not doing it properly and need some guidance. Most women will know how to tighten the pelvic floor around the bum, but most have trouble tightening the front part of it. If you had trouble with this, your pelvic floor muscles probably need to be trained properly.

When should you seek help?

If you had trouble with the exercises above—breathing properly or tightening the front of the pelvic floor, or noticed doming or gapping with the self-check, you should make an appointment with a Pelvic PT. It may be as simple as a one or two visit tune up to get the team back on board or it may involve some more training. Letting these problems go untreated can lead to even bigger problems. Problems like urine leaking with coughing and sneezing (incontinence), back pain, or organ prolapse can arise or get worse if your muscles aren’t working and coordinating properly. Problems like incontinence, back pain, and heaviness in the vagina (prolapse) are very common, but never “normal”. Just because you had a baby, doesn’t mean you have to just live with these problems forever.

This post was written especially for Yoga Matrika students and blog readers by Dr. Kailee Venzin.  This post is not meant to replace medical diagnosis and treatment and you should seek guidance from your doctor if you suspect that you have a medical problem.  You can book an appointment online and find more information about Dr. Venzin online.