mom pooch

Get Your Body Back

Sure, celebrities return to the red carpet with flat bellies only weeks after giving birth, but for many of us “real” women, a postpartum pooch can burden us for months.   

Months after giving birth, many women find that they’re still plagued by a “mom pooch,” a protruding belly that can make them still appear be pregnant.  This post-pregnancy belly is caused by a condition called diastasis recti, a separation of the two-rectus abdominis muscles (or six-pack muscles) where they join in the midline.  When the abdomen is stretched during pregnancy, the membrane that joins these muscles together can split open.  About two-thirds of new moms will be affected by this condition to varying degrees.  Some will be able to reduce the diastasis through exercise and weight loss, while others may require surgery to restore their belly to its pre-pregnancy state.

Do you have a diastasis?

Dr. Lawrence Tong, a cosmetic plastic surgeon based in Toronto, says although a diastasis recti can happen to any woman, it’s most likely in those who have gained significant weight during pregnancy or had twins or a very large baby.  Women who have shorter torsos and were “all belly” while pregnant are also more likely to get a diastasis than those with long torsos and broad pelvises.

Over 50 per cent of women will have a diastasis immediately following giving birth, but those who still have a diastasis after seven or eight weeks postpartum, will likely still have it a year later if left untreated. 

The test to determine if a woman has a diastasis recti can be performed at home, even by the woman herself.  Lying on her back with her knees bent and the soles of her feet on the floor, a woman would place her hand on her abdomen with her fingertips at the level of her belly button, push her fingers into the belly and do a mini sit-up, lifting the head and shoulders.  If the muscles separate and the fingers go deeper into the belly after pushing the finers into the belly, then that’s the diastasis. 

Tong says a small diastasis of one or two fingertips is normal and can most likely be improved with exercise and weight loss alone, but a larger diastasis of three fingertips or more may require surgery to improve or fix the diastasis.  “It’s the connective tissue between the muscles that’s affected,” says Dr. Tong.  “Exercise really doesn’t improve or strengthen that tissue that’s in between.”  Strengthening the rectus muscles (or abs, as we know them) bulks up that area and makes the diastasis less noticeable, but with a large diastasis, it’s likely a bulge will still be there, even after weight loss or exercise.

Short- and long-term effects

A diastasis can cause emotional and self-esteem issues postpartum.  After all, what woman wants to be asked if she is a few months pregnant while pushing her eight-month-old baby in a stroller?  Aside from ill-fitting clothes and the emotional scars from maintaining a pregnant appearance, a diastasis can be the cause of some serious medical issues as well, the most common being back pain.  The rectus abdominis muscles support the back.  If they’re weak, it can lead to back strain.  “For your core muscles to function properly, they have to be connected to each other down the midline,” says Dr. Tong.  When these muscles aren’t connected to each other, chronic back pain can result. 

Fixing a Diastasis Through Exercise

Exercise and weight loss are the first courses of action that a woman can take to fix a diastasis, but while some women may think doing millions of crunches will restore their formerly flat bellies, these exercises can actually worsen the diastasis. 

Elizabeth de Jong Westman, a  physiotherapist at Pivot Sport Medicine and Orthopaedics in Toronto, says the key to fixing a diastasis is to restore the deep abdominal muscles to help the abdominal wall reconnect.  She leads patients with a diastasis through a series of exercises
 that draw in the lower abdominals to reactivate deep muscles that have been stretched during pregnancy. 

To help close the gap between the abdominal muscles, de Jong Westman says a towel can be wrapped around the tummy and both sides pulled when doing a tiny curl, lifting the head and shoulders up.  Although light exercise can help to improve the diastasis, de Jong Westman recommends avoiding sit-ups, planks and heavy weightlifting. “When you’re doing anything that makes you hold your breath a little bit and push the tummy out, it increases the abdominal pressure, which is unsafe in a diastasis,” she says.

The Surgical Route

If a woman has lost her pregnancy weight and been exercising regularly for three to six months and still has a diastasis, Dr. Tong says surgery may be an option.  An abdominoplasty (or tummy tuck) can correct the diastasis, helping to create that desired flat belly.  But, because it’s considered cosmetic in nature, the surgery isn’t covered by OHIP and costs around $9,000 to $11,000.

In the tummy tuck procedure, a horizontal incision is made from hipbone to hipbone below the bikini line and below a C-section scar, which would be removed as part of the tummy tuck.  As part of the procedure, the two rectus muscles are brought back together, sometimes making them even tighter than they were before pregnancy.

But surgery isn’t for every woman with a diastasis.  Dr. Tong says women who aren’t finished having children should not consider a surgical intervention to correct their diastasis since the diastasis could reoccur with subsequent pregnancies. 

Although Dr. Tong says many women will note functional improvements in the diastasis after surgery, including a reduction in back pain and improved core strength, it’s the emotional impact that is the greatest improvement.  “I’ll see patients come in wearing clothing that’s tighter fitting and they’ll be generally much happier and more confident,” says Dr. Tong.  Maybe even make you feel red carpet worthy?