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Everything you need to know about abdominal separation and how to fix it
The condition is the partial or complete separation of the rectus abdominis muscles during and after pregnancy
One in two women suffers from abdominal separation after pregnancy. Left untreated, the condition may persist well into the menopausal years and cause urinary incontinence, back pain, hernia and reduced quality of life.
Many women experience diastasis recti abdominis (DRA) or abdominal separation—a separation of the rectus abdominis muscles in the midline of the stomach—after pregnancy.
The condition may persist well after giving birth—it has been diagnosed in 52 per cent of urogynecological menopausal patients.
Dr Linas Venclauskas, a bariatric surgeon at Nordbariatric clinic in Kaunas, Lithuania, says that every second parous woman has DRA on average.
The most discernible signs are protruding belly, which, in most cases, does not go away even with physical exercise or diets, and a visibly wider linea alba that runs down the midline of the stomach.
“Pregnancy causes rectus abdominis muscles to separate to the sides resulting in a lost abdominal wall elasticity,” he explains.
“Abdominis rectus muscles are connected with a tendinous tissue which is visible as a whitish line from the exterior. Severe pressure on the muscles makes the tendinous tissue expand to the sides.”
If untreated, the condition may trigger severe health problems, the surgeon says.
“The incorrect position of the rectus abdominis muscle distributes the load onto other muscle groups—the spine, waist, pelvis.
“This may cause spine problems and lower back pains, hernia, urinary incontinence, constant bloating, and chronic constipation in some cases.”
Some women may be more prone to have abdominal separation, and the risk factors include: a large baby compared to a woman’s body, more than one foetus, weak abdominal muscles, less than a year passed after the last pregnancy, previous C-section, and the pregnant woman is over 35 years old, adds Venclauskas.
However, there are no 100 per cent preventive measures, as both active and inactive women can develop it.
Surgery or conservative treatment?
Full symptomatic relief can be achieved through abdominal wall reconstruction surgery, which restores the integrity of the abdominal wall and allows it to protect the internal organs and provide support to the spine.
The procedure can also be combined with other highly-requested postpartum surgeries like a tummy tuck or a mommy makeover.
Dr Venclauskas recommends SCOLA—subcutaneous onlay laparoscopic approach as it avoids midline incision, which preserves the aesthetic appearance and prevents scars.
The procedure also produces less post-surgical pain, faster recovery, and minimal complications.
Although surgery does not affect further pregnancies, it is advised to do it after the last childbirth because the rectus abdominis muscles may separate with each pregnancy.
However, in some cases, conservative treatment might be enough, Dr Laimonas Siupsinskas, a physiotherapist at the clinic, adds.
“If the DRA is less than two fingers in size during the rectus abdominis muscle contraction, the condition might be treated conservatively with physiotherapy—only if the surgeon allows it.
“The physical therapist can evaluate the function of the rectus abdominis and other muscles with relation to the back muscles that make up for the core stabilization of the trunk.”
The physiotherapist says breastfeeding plays a crucial role in the exacerbation of the condition—the concentration of the hormone relaxin during breastfeeding makes the fascia and muscles even more relaxed and stretched. Therefore, conservative treatment should be prescribed with care.
“The worst women can do is try to self-treat the DRA and do the exercises found on the internet,” Siupsinskas adds.
“Only a specialist can prescribe certain physical exercises after an individual consultation, and the training regime should focus on muscles that are imbalanced, weak, or too tight.”
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Jill Biden visits Imperial on women’s health and AMR mission
Former US first lady Dr Jill Biden visited Imperial College Healthcare NHS Trust and Imperial College London to explore work on women’s health and antimicrobial resistance.
The visit was hosted by professor the Lord Darzi of Denham, who chairs the Fleming Initiative and directs Imperial’s Institute of Global Health Innovation.
Dr Biden, chair of the Milken Institute’s Women’s Health Network, spoke about the impact scientists, clinicians, innovators and investors can have on improving women’s healthcare.
Dr Biden stressed the importance of “collaboration, prevention and education” in improving women’s health globally.
At the museum, Dr Biden and Esther Krofah, executive vice-president of health at the Milken Institute, heard about the worldwide significance of the discovery and the contribution of women who, during wartime Britain, grew penicillin in bedpans to support early experimentation.
The discussion also explored how AMR is a key women’s health issue, with women disproportionately affected in low and middle-income countries, and in high-income settings where women are more likely than men to be prescribed antibiotics.
Dr Biden was shown an architectural model of the Fleming Centre in Paddington, which will bring together research, policy and public engagement to address AMR worldwide.
The second part of the visit brought together Imperial clinicians, researchers and innovators for a roundtable on women’s health priorities, including improving diagnosis, equity in maternity care and support during the menopause transition.
Participants highlighted wide variation in the quality of care for conditions affecting women and called for fairer access to services, with the postcode lottery named as a priority to address.
Professor Tom Bourne, consultant gynaecologist and chair in gynaecology at Imperial’s Department of Metabolism, Digestion and Reproduction, described how AI could improve diagnostic accuracy for conditions such as endometriosis.
Equity emerged as a central theme.
Professor Alison Holmes, professor of infectious diseases at Imperial College London and director of the Fleming Initiative, highlighted persistent gaps in women’s representation in clinical trials, including antibiotic studies, which limits the ability to optimise care and treatments.
Dr Christine Ekechi, consultant obstetrician and gynaecologist at Imperial College Healthcare NHS Trust, drew on national maternity investigations to underline the importance of valid data, meaningful engagement with affected communities and rebuilding trust.
Menopause and midlife health were also identified as priorities for clinical research.
Professor Waljit Dhillo, consultant endocrinologist and professor of endocrinology and metabolism in Imperial’s Department of Metabolism, Digestion and Reproduction, described a new treatment for hot flushes, including for women unable to take hormone replacement therapy, such as those with a history of breast cancer.
The discussion then turned to bringing innovation into health systems. Innovators shared how data and technology are being used to close gaps in women’s health, while noting challenges in accessing funding to grow and scale.
Dr Helen O’Neill and Dr Deidre O’Neill, co-founders of Hertility Health, described predictive algorithms using self-reported data to help diagnose gynaecological conditions at scale.
Embedded into clinical workflows, the technology could reduce waiting times, identify conditions earlier and improve outcomes. They noted how “we have cures for the rarest genetic conditions but don’t even have the answers to common women’s health issues.”
Dr Lydia Mapstone, Dr Tara O’Driscoll and Dr Sioned Jones, co-founders of BoobyBiome, outlined work creating products that harness beneficial bacteria found in breast milk to support infant health.
By isolating and characterising key microbial strains, BoobyBiome has created synbiotics, combinations of beneficial bacteria and the food that nourishes them, to make these benefits accessible to all babies.
Speakers throughout the visit stressed the need to reduce variation in care quality and outcomes for women, strengthen prevention and education, and address power and equity in women’s health.
Professor the Lord Ara Darzi said: “It was a privilege to welcome Dr Biden and the Milken Institute to Imperial to meet some of the outstanding researchers, clinicians and innovators advancing women’s health.
“Imperial’s unique combination of clinical excellence and world-leading research positions us at the forefront of tackling the biggest health challenges facing society and the UK’s ambition for innovation demands nothing less.
“For too long, the health needs of women and girls across their life course have not received the attention they deserve.
“By working together across borders and disciplines, we can transform equitable access to care, accelerate the detection and treatment of disease, and ultimately improve health outcomes for millions of women in the UK and around the world.”
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