Postpartum sagging (Diastasis Recti) can cause both aesthetic concerns and serious health problems.
The muscles on both sides of our abdomen, extending vertically from top to bottom, are called the “Rectus abdominis.” The structure that holds these muscles together bilaterally is called the “Linea alba.” During pregnancy (or with excessive weight gain), as the belly expands, this area widens, and in many cases, due to structural and genetic factors, the two parts of the rectus abdominis separate from each other. Even after pregnancy, in some women, despite the shrinking of the abdominal region, these two parts cannot naturally come together. The distance between the rectus abdominis muscles (at the level of the belly button) is considered abnormal when it exceeds 2.7 cm in some studies and 2 cm in others, and this condition is referred to as “Diastasis Recti.
Hidden sagging
If there is a herniation accompanying diastasis recti, which is observed as a depression line above and below the belly button, especially when the abdominal muscles contract, an overflow appearance can be seen from this depression during breathing. Many women feel the need to conceal their abdomen due to this appearance
Hidden sagging
The reason behind this condition is primarily the excessive stretching of the abdominal muscles and significant weight gain during pregnancy. Contributing factors to the development of diastasis recti include multiple pregnancies, excessive weight gain, genetically weak muscle structure, and lack of physical exercise before and during pregnancy.
The separation of these muscles usually begins during the second trimester of pregnancy and is almost present in all pregnant women during the third trimester. Studies indicate that the distance between the two rectus muscles starts to increase from the 14th week of pregnancy and continues to increase until childbirth. The process of returning to normal starts as early as the first day after giving birth and lasts until around the 8th week postpartum. However, significant improvement is less likely to occur after this period.
When does it occur?
Postpartum sagging is a fairly common condition. During the third trimester of pregnancy, 66-100% of pregnant women experience this condition, and after childbirth, approximately 53% continue to experience it. Postpartum sagging, also known as Diastasis recti, can lead to serious health problems. This is because the abdominal muscles play a role in supporting and stabilizing the torso and hip region, assisting in breathing, and maintaining our posture.
If our abdominal muscles cannot perform their functions properly, it can lead to severe hip and back pain, changes in posture and stance, and make our spine more susceptible to injuries.
Possible treatment but often neglected
One of the reasons why many women complain that their postpartum belly does not return to its pre-pregnancy state is due to this clinical condition. Despite various treatment alternatives being suggested, the primary treatment can only be achieved through surgery. During abdominal tightening operations or after cesarean section births, the separated muscles along the midline, which were cut during the cesarean incision, can be stitched back together to correct the condition. Additionally, various Pilates and physiotherapy exercises can help alleviate symptoms and serve as an alternative to surgery.
The main approach, however, is to reduce the likelihood of this condition occurring and take preventive measures. We should avoid risk factors such as having multiple pregnancies, giving birth at a later age, and gaining excessive weight during pregnancy. Strengthening our abdominal muscles through exercises before and during pregnancy is also crucial in preventing this condition. As a physician, I advise our expectant mothers to attend pregnancy education classes, become informed about the topic, and conscientiously follow pregnancy exercise programs.
Wishing you all a healthy and happy pregnancy and life.
