The enduring mystery of the postpartum pooch

Story highlights

  • Most women who give birth experience some degree of postpartum abdominal separation
  • Experts don't know what heals abdominal separation -- or whether it needs to be healed at all

(CNN)Culturally, the postpartum body is a source of abiding fascination. We are enthusiastic observers of women's shapes after childbirth and celebrate those who shed all evidence of pregnancy a few months after having a baby. These are the women who, as tabloids put it, "bounce back," even though few believe that the effort involved was akin to bouncing or any such rapid and organic movement.

Medically, the postpartum body is basically invisible. In the United States, women generally have just one appointment in this period, six weeks after childbirth, and it tends to be brief. (The American College of Obstetricians and Gynecologists recently recommended changing this.) We are largely -- and a little hopelessly -- on our own when navigating the various aches and dysfunction that pregnancy and childbirth leave in their wake.
    Not only did I not bounce back after my pregnancies, but the notion of bouncing, in any direction, sounded awful. Like many women, I had postpartum abdominal separation, known clinically as diastasis recti abdominis and colloquially as mummy tummy: The connective tissue between my rectus abdominis, a.k.a. the six-pack muscles, had stretched out about 2 inches. I also was feeling quite unstable, and I assumed that these two things were related.
    Ob-gyns don't routinely screen for or discuss abdominal separation, despite the fact that up to 60% of women experience it to some degree during the first year postpartum and an estimated 33% are dealing with it beyond that. Many of us discover that we have it after experiencing pain, impaired mobility or, yes, the not-always-beloved lower belly pooch that tends to happen as a result.
    I was experiencing all of the above when I signed up for a postpartum rehabilitation class led by my yoga teacher. A dutiful student, I followed each and every instruction. I avoided crunches, which allegedly would widen the gap. And I worked hard on strengthening my transverse abdominis, the muscles that run up and down the sides of our midsections, which allegedly would bring it all together.
    Months passed, and I felt stronger, slimmer. But the gap remained. Did I fail at the regimen? Or, more likely considering my deep commitment, did the regimen fail me? Also, when, if ever, could I consider myself healed?
    Now, research shows that I was right to be suspicious. Doctors and physical therapists still don't know what heals abdominal separation -- or whether it needs to be healed at all.
    "It may not be fun to hear, but at the moment, we don't know how to fix it with the tools we have," said Dr. Elwin Mommers, who studies hernias at Maastricht University Medical Center in the Netherlands.

    Very little is known about diastasis recti

    Mommers is the lead author of a review of studies on abdominal separation published in December in the journal Surgical Endoscopy. He and his team sorted through all the available research on the topic and found that it offered very little in the way of clarity. There was a shortage of quality studies to draw conclusions from, and the few quality studies out there didn't yield any substantial findings.
    They couldn't find any evidence that physiotherapy brings together the gap or that one particular exercise plan is more effective than another. Yes, women who take up an exercise plan might leave it with a smaller gap -- but it's likely that the gap would have closed on its own, without the exercises. Mommers said women should see this as a reason to ignore any overly prescriptive exercise plans that prohibit things like back bends and crunches, and do what feels right for their bodies.