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Closing the Gap – The Connection Between DRAM and Pelvic Floor

You have just experienced the miracle of childbirth, and now you are wondering…when will my tummy return to “normal”? Whilst it feels like you’ve just run a marathon, your body will continue to undergo incredible changes required for healing and growth. It can take between 6 – 8 weeks for the uterus to returns to its normal size. We see countless images on social media of new mums flaunting their post baby tummy just weeks after giving birth, but remember this is not the norm. Yes, some are lucky to “bounce back” quickly, however for the overwhelming majority there is a natural healing process that your amazing body needs to undergo to restore your tummy muscles, pelvic floor and pelvic organs, which can take up to a year once the baby is born.
Throughout the later stages of pregnancy, women may notice a “peak” or “doming” around the belly button when getting out of bed, or doing a task that uses the abdominals. This is often the sign of a DRAM (diastasis of the rectus abdominis muscle), a separation of the anterior abdominal muscles. By 35 weeks gestation, approximately two thirds of women will have a separation.

How does having a DRAM affect you?

It is important in both males and females that the abdominal wall works efficiently as it is required for:

• Abdominal & pelvic organ support
• Trunk support
• Breathing
• Elimination of waste products

How does this affect your pelvic floor? The pelvic floor is a sling-like group of muscles which extends from the pubic bone at the front, running underneath and all the way to the coccyx bone at the base of the spine. Its role is to support the bladder, uterus and bowel and plays an essential role in continence. These muscles, in addition to other connective tissue layers and ligaments which comprise the pelvic floor, can be strained through pregnancy and childbirth.

It is reported that up to 66% of women with a DRAM will experience some kind of pelvic floor dysfunction. In the ideal situation, regulation of pressure within the abdomen happens automatically with the muscles of the “core” working together – the pelvic floor muscles lift, the abdominal and back muscles draw in to support the spine, and breathing feels easy.  If any muscles of the core, including the abdominals and pelvic floor are weak or damaged, this coordinated mechanism for movement is disrupted and both the DRAM and pelvic floor will continue to work ineffectively, making it difficult for the DRAM to repair.

The pelvic floor and a DRAM can be strained through:

• Heavy lifting (strollers in and out of the car, carriers, loads of groceries)
• Chronic coughing & sneezing
• Constipation & digestive disorders
• A higher than healthy body weight
• Sitting bolt upright out of bed, or doing sit-ups

Over time, this repetitive strain can push down on the pelvic organs – resulting in pelvic floor dysfunction.  If a problem already exists, then the pelvic floor symptoms could potentially worsen. 

What can I do about it?

Firstly, maintaining a strong pelvic floor during and after pregnancy is crucial. You should be building up to 3 sets of 10 second holds (or for as long as you can manage). For a more detailed explanation of correct pelvic floor exercise technique see the Continence Foundation of Australia website.

Compression garments can be also be used to promote DRAM recovery and support the pelvic floor postnatally. We recommend the SRC Recovery Shorts, they are a medical grade compression, backed by research and endorsed by many obstetricians and women’s health Physios. They can be fitted and measured at approximately 36 weeks’ gestation, and can be worn immediately postpartum or as soon as you feel comfortable.

A tailored and graduated exercise program will also help in DRAM recovery. An assessment with a women’s health Physiotherapist is recommended who can prescribe your individual needs and ensure safe and effective DRAM recovery.

Remember mums, be kind to yourself. Take things slow, look after yourself, seek the right advice and support services, and most of all enjoy your new addition!

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Samara Nanayakkara
Women’s Health and Pelvic Floor Physiotherapist