Abdominal Coning After Birth? Understanding Diastasis Recti

By Dr. Christine Martirez PT, DPT on 10/11/2024

Abdominal coning is a phenomenon many women experience after giving birth, and it’s often a sign of a condition known as diastasis recti. During pregnancy, the abdominal muscles undergo significant changes to accommodate the growing baby. For many women, this can lead to separation in the muscles, particularly in the rectus abdominis. After childbirth, it’s common for this separation to remain, causing a visible bulging or "coning" of the abdomen when performing certain movements or exercises. In this blog post, we’ll explore the anatomy behind diastasis recti, why it occurs during pregnancy, what abdominal coning is, and how pelvic floor physical therapy can help in healing diastasis recti.

The Anatomy of Diastasis Recti

Diastasis recti is the separation of the rectus abdominis muscles, the pair of long muscles that run vertically down the abdomen, often referred to as the “six-pack” muscles. These muscles are connected by a band of connective tissue called the linea alba. During pregnancy, as the uterus expands to accommodate the growing baby, the abdominal muscles and the linea alba are stretched, sometimes to the point of separation. When the linea alba stretches too much, it loses its ability to hold the rectus abdominis muscles together, causing a gap between them. This is what is known as diastasis recti. Other abdominal muscles that play a role in supporting the core, and can be affected by diastasis recti, include:

• Internal and external obliques

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  • These muscles run along the sides of your abdomen and help with twisting and bending movements.

• Transverse abdominis (TVA)

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  • The deepest layer of the abdominal muscles, the TVA acts like a corset, stabilizing the spine and pelvis and helping with core stability.

How Diastasis Recti Occurs During Pregnancy

During pregnancy, the body undergoes incredible changes to accommodate the growing fetus. Hormonal changes, such as increased levels of relaxin and estrogen, soften connective tissues, allowing the abdominal muscles to stretch more easily. As the baby grows, the uterus pushes against the abdominal wall, causing the rectus abdominis muscles to lengthen and separate. This is a normal and natural process, but in some cases, the separation is more significant, leading to diastasis recti. Other factors that may increase the risk of developing diastasis recti during pregnancy include:

• Multiple pregnancies

  Women who have been pregnant more than once are more likely to develop diastasis recti.

• Carrying multiples

  Pregnancies with twins or more put additional strain on the abdominal muscles.

• Excessive weight gain

  Rapid weight gain can cause further stretching and pressure on the abdominal muscles.

• Lack of core strength before pregnancy

  Weak abdominal muscles before pregnancy may struggle to maintain stability as they stretch.

What is Abdominal Coning?

Abdominal coning occurs when the pressure inside the abdomen causes a noticeable bulging or protrusion along the midline of the abdomen. This bulging is most visible when performing activities like getting out of bed, lifting, or even doing certain exercises, and it often indicates that there is a gap in the abdominal muscles (diastasis recti) that hasn't yet healed. Coning happens when there is increased intra-abdominal pressure that the weakened abdominal muscles cannot control, leading to the bulging of tissue through the gap. It’s important to note that coning can delay healing of diastasis recti because it continues to strain the linea alba and prevent it from regaining its tensile strength.

How Pelvic Floor Physical Therapy Can Help Heal Diastasis Recti

Pelvic floor physical therapy is an effective, non-invasive approach to healing diastasis recti and addressing abdominal coning. A skilled pelvic floor physical therapist can assess the degree of separation and create a personalized rehabilitation plan that focuses on core strength, alignment, and proper pressure management. Here’s how pelvic floor therapy can help:

• Core Strengthening and TVA Activation

One of the main goals in treating diastasis recti is strengthening the transverse abdominis (TVA). This deep core muscle acts like a corset, wrapping around the abdomen to provide stability and reduce pressure on the linea alba. Pelvic floor therapists use targeted exercises to activate the TVA and teach proper engagement of the core during daily activities, preventing coning and further strain on the abdominal muscles.

• Breathwork and Pressure Management

Pelvic floor therapists often incorporate breathing techniques to help manage intra-abdominal pressure. Proper breathing mechanics (using the diaphragm and coordinating with the pelvic floor) can prevent excess pressure from building up in the abdomen, reducing the risk of coning and allowing the abdominal muscles to heal.

• Postural Corrections

Postural imbalances, especially after pregnancy, can exacerbate diastasis recti by placing extra pressure on the abdominal muscles. Pelvic floor physical therapy focuses on correcting posture to support optimal alignment, which reduces strain on the core and pelvic floor muscles.

• Safe Movement and Exercise Guidance

Certain movements and exercises can increase the separation between the abdominal muscles, making diastasis recti worse. Pelvic floor therapists guide new mothers in avoiding activities that cause coning and teach safer ways to move and exercise, promoting healing rather than further damage.

• Pelvic Floor Strengthening

Because the pelvic floor works in tandem with the abdominal muscles to support the core, pelvic floor physical therapy also includes exercises to strengthen the pelvic floor muscles. Strengthening the pelvic floor can help support the abdomen and spine, contributing to the healing process for diastasis recti.

Diastasis recti and abdominal coning are common postpartum concerns, but they don’t have to be permanent. With the guidance of a pelvic floor physical therapist, you can strengthen your core, improve your posture, and manage pressure to promote healing. Pelvic floor physical therapy offers a comprehensive, tailored approach to healing diastasis recti, helping you feel stronger and more confident in your postpartum recovery. Looking to be on the road to recovery following birth? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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