Healing Abdominal Wall, Urinary Leakage or Prolapse

Has Dr. Google left you confused as to how to heal your diastasis recti (abdominal wall separation) or prolapse?

In my last post about breathing I talked about how optimal breathing is key to creating core strength.  The muscles of the core: the glottis (voicebox), the diaphragm, the abdominals and the pelvic floor all need to move in coordination for effective generation of force.  These muscles need to respond reflexively for whatever task is at hand, whether that be loading the dishwasher, working out at the gym, or chasing after your kids.
Healing from diastasis recti, pelvic organ prolapse and urinary leakage is not going to happen with 100s of kegels and abdominal bracing contractions.   Healing happens when we look at the whole system working together as a team.

Integrate the team for a Healthy Core

• Skeletal System

The bones are in a position for appropriate loading to stimulate bone growth, and to position the muscles for optimal resting length tesnion.  From a sideview, the Standing plumbline markers for alignment are the earlobe, midpoint of joints: shoulder, hip, knee and ankle.  The ribcage is stacked over the pelvis, and the pelvis is stacked over the ankles.  

• Muscle System

The muscles are able to shorten and lengthen through full range of motion.   Optimal positioning of the skeletal system allows the muscles to be in a better position to move and generate force.

• ​Pressure System

Ability to generate appropriate intra-abdominal pressure.  Normalize pressures: Increased resting muscle tension can create abnormal pressures.  Pushing type strategies (bearing down) for strength and movement increase downward pressures into the abdominal wall and pelvis.

• Nervous System

Regulation of the peripheral and autonomic nervous systems.  Dysregulated autonomic nervous systems increase resting muscle tension (among other things).

Let's look at a common muscle strategy that I see in women who present with DR, prolapse and urinary leakage: Overactive Upper Abdominals

At rest you can slightly see the crease above the belly button. From the side view the crease is more evident.

Can you see the crease just above the belly button? During the "Draw the belly button to the spine" cue, the "hour-glass" is created by over recruitment of the upper abdominals.

Due to the resting tension in the upper abdominals there is more pressure into the lower abdominals and pelvis.  When the muscles are activated in a shortened contraction, even more pressure is created into the lower abdomen.  This constant downward pressure can have an impact on the health of the pelvic organs, abdominal wall and pelvic floor.  
Changing the pressure and muscle activation pattern is essential to recovery.  Typically, this person has no problem breathing low into the belly, but may have a hard time filling the entire abdomino-pelvic canister evenly on the inhale (generation of appropriate intra-abdominal pressure, evenly distributed 360 degrees). Home practice will require breathing practices to connect with the movement of the lower ribcage, side and back body, and then bring this new awareness and pattern into movement and daily activities.

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.