Divarication of Rectus Abdominis Muscles (DRAM)
I have been diagnosed with Divarication of Rectus Abdominis. What does this mean?
Divarication of the rectus abdominis is a condition where the abdominal (tummy) muscles become separated in the middle. The separation can vary in size, from a small vertical gap 2cm-3cm wide, to a large gap of 12cm-20cm wide, extending the whole length of the abdominal muscles. This can happen in pregnancy or if there has been excessive weight gain. As the abdomen expands, the abdominal muscles become stretched and elongated until they are unable to stretch any further and may have to separate, causing the divarication.
Why has this happened?
Factors that contribute to divarication of the rectus abdominis are – large baby 8lb plus, small framed women, multiple births, well defined abdominal muscles, skin tone and position of baby.
How do I know if this has happened?
You may notice a bulge or doming of your tummy muscles when you sit up from lying down or when getting out of the bath.
What can I do to help myself?
As with virtually all other muscle issues, physical activity is the best way to treat this, particularly exercising your deep stabilising muscles in the tummy.
Avoid activities that place a strain on your abdominals, for example when getting out of bed, try to roll onto your side, drop your legs off together and push up into a sitting position with your arms. Do the reverse to get back into bed. Avoid full sit ups/abdominal crunches, holding a baby on one hip, lifting and carrying heavy objects and intense coughing while your muscles are unsupported, until the deep tummy muscles have become stronger.
What exercises should I do to work the deep tummy muscles?
There are two types of exercises that can help:
- Pelvic floor exercises: these muscles are a bit like a hammock and work with a deep tummy muscle called transversus abdominis (together with your diaphragm, they make up a drum-like shape, with the transversus abdominis coming around your body making up the sides, the diaphragm is at the top and the pelvic floor at the base). Try gently squeezing and lifting the pelvic floor, drawing up at the front and back passages, as though you are trying to control wind and the flow of urine. Hold for a few seconds and try to keep breathing normally. Try to do a few repetitions several times a day. Start whilst lying down and when you feel that you can do this easily, progress to trying it in different positions, such as sitting or standing. You can start to try and hold the exercise for 10 seconds and increase the repetitions to 10. You can also try tensing the muscles when coughing or lifting.
You can get more information about the pelvic floor and suitable exercises here: The Pelvic Floor
- Transversus abdominis exercises: this exercise is for the deep tummy muscle. Take a breath in, then as you breath out, gently draw in your lower tummy muscles (below your tummy button), like you are taking in a notch on your belt. Hold for a few seconds, while breathing normally. Repeat 5-10 times, resting for a few minutes between each repetition. Try to do this several times a day, again start whilst lying down and progress to trying it when sitting, then standing.
Will I get better?
Often a small divarication will resolve within 4-8 weeks after delivery of a baby and many women may not ever realise that they have had this - they can settle spontaneously. In some cases, the symptoms may go on for longer and may need several months of deep tummy exercises to improve. Weak abdominal muscles can be linked to back and pelvic aches and pains. Occasionally some people can also have some altered bowel function. Think of your muscles being like the foundations of your house; if they are strong, everything else works a bit better. Having strong muscles can help your limbs move better and can help with balance. In some cases, the gap does not fully close, but you can still have strong muscles working well and it should not impact on your function/everyday life.
How do I get help if I feel that I need it?
If you would like any further advice or guidance requiring the type of exercises to try, you can self-refer to Physiotherapy here: Refer Yourself
More information about divarication of the rectus abdominis muscle related to pregnancy can be found here: NHS Website
For more information regarding exercise/physical activity guidelines during and after pregnancy, visit: NHS Live well