My Abdomen Is Falling Apart

Hello. Hello. Welcome. You’re listening to Dr. Martha Reid Naturopathic Doctor Vancouver at Doctors Choice Integrative Medicine in downtown Vancouver, a space where I bring passion, inspiration and nourishment to the conversation of your health.

Today, I would like to talk to you about something called the DRA. Not at all to be confused with DRE. So, a DRA is a diastasis rectus abdominis, versus the DRE, which is a digital rectal exam. Completely different things. So a DRA – diastasis rectus abdominis – this is something that occurs for human beings that go through a pregnancy.

So if you are a human who has ever been pregnant or a human being that is wanting to become pregnant, at some point a DRA is something you need to know about. And so in a nutshell, what it is, is that at the front of your abdomen you have two muscles that lie side by side, head to toe. OK, so in that vertical direction, these are called your rectus abdominal muscles. And you probably know about these. You might go, oh, yeah, that’s my “six pack” or my “eight pack” or “my want to be two pack” or whatever it is you’ve got going on there. But underneath the surface tissues (your skin and then your adipose tissue) you’ve got fascia and then your rectus abdominal muscles and they’re these two – I call them the salmon fillets that lie side by side and they sort of attach at the sternum, which is part of the chest bone so you’ve got your rib cage and then where your rib cage comes in in the middle and there’s that sternum, and then there’s the xiphoid process at the bottom of it to kind of attach there at the top. And then down at the bottom where your pubic bone is. And then they lie side by side. These are the most superficial abdominals muscles in the middle of them. So they’re side by side and then the very middle going down from your breastbone down to your pubic bone, of course, on the surface of your skin, you see your belly button, right? That’s kind of sitting in the middle of your rectus, abdominals muscles but what holds these two muscles together? What adheres them or attaches them together is something called fascia. And fascia is one of my most favourite tissues in the body. When I was in medical school, we didn’t know at that time (and I’m not an old, old, old dinosaur, I promise you, I’m not that old, anyway) we didn’t know a whole lot about fascia. It was an area that really in the medical world we were learning more about at the time and where I was really, truly introduced to it was in our human dissection lab. Which if you don’t know what that means, it means where as medical students (whether that be conventional medical students or in my case, a naturopathic medical student) we do human dissection as a way to learn about the body. And so there are just such gracious, incredible people out there that when they choose to leave their bodies behind and go off into the spirit realm at the end of their life’s journey, they’ve donated their bodies to be used for dissection. And I am so incredibly grateful for that because I learned an incredible amount.

We had a gentleman teach us Dr. Gill Headley, and he is what is known as an integral anatomist, meaning he looks at the human body in its entirety, head to toe, always looking for the connections in the body. So, when we did our dissection lab the bodies weren’t cloaked and we were just, for example, looking into the abdomen or looking at the heart. It was the body was unclothed at all times and we worked through the layers of the body one by one. So removing the skin and then the superficial layers underneath and then the adipose layers and then the fascia, which is over top of muscles and underneath muscles and fascia is this incredible tissue. It’s a connective tissue in the body, and it connects things, it holds things together. Your muscles are wrapped in fascia – the fibres between your muscles have fascia, and it looks like this spider web cotton candy material that is glistening and almost dewy. It’s really neat. And when you touch it with a scalpel it just kind of melts away. It’s wild and it holds so much information energetically, apparently.

So a lot of where we get a sixth sense, you know, and you feel that the hairs go up on the back of your neck – that has to do with your nervous system. It also has to do potentially with your fascia. Like it’s just this wild, wild area when we get a frozen shoulder and we feel like we can’t move that joint. That is a floating joint that moves isn’t necessarily bones that are an issue. It may be the fascia that’s an issue. It may have gotten bunged up and locked down and now you can’t move it when your muscles are tight. It’s not actually tight muscles. It’s tight fascia, which is like the saran wrap around the muscles or the casing around a sausage. So fascia is just this incredibly cool substance in the body.

And so if we go back to the DRA and pregnancy and, you know, the salmon fillet muscles of your abdominal area, what holds those rectus abdominis together is this fascia and it is a saran wrap that goes on top of your rectus abdominal muscles and then underneath them and then between those two salmon fillets, this is fascia. It holds them together.

When the human body goes through a pregnancy of 40 weeks, it grows this child inside. I mean, I’m not telling you anything you don’t know, right? I mean, ha, ha. “Wow. Way to go, Dr. Reid. That’s amazing!” “It grows a body!” Yeah. Yeah, it does. And it takes up space and the body expands and has to accommodate for this growing baby.

Well, it grows outward. And the rectus abdominal muscles that have this baby growing in the uterus, which is deep down beneath them, is pushing outwards on those abdominal muscles, and it’s pulling them sideways. So the fascia is getting stretched and your rectus abdominal muscles aren’t totally aligned side by side anymore, like these little salmon fillets. And depending how you hold your pregnancy, may determine the amount of pressure that goes against those rectus abdominis muscles from underneath and pulling them sideways well, what happens is after we birth our babies and there’s no longer that internal presence pushing outwards against the musculature and against the fascia, the body, of course.

OK, well, it comes back to your normal size eventually or what was potentially pre pregnancy normal for you. And if it’s not, come see me and I can support you in that. But anyway, after you’ve had that baby, there is not that strain on the fascia, but it may not come back together properly. So your rectus abdominal muscles might not realign properly. And if that’s the case, you end up with this gapping along the midline of your abdomen and that has potentially some pretty impactful consequences for the body because we’ve been talking so far about that superficial fascia around the rectus abdominis that holds them together. On the backside of the rectus abdominis is the posterior fascial layer and that fascia is what a muscle called the trans versus comes into.

I know I’m giving you lots of names and lots of anatomy and it’s probably just garbledey-gook to you but, picture the rectus abdominis. Two salmon fillets underneath the skin makes her six pack to pack, 12 pack a pack, whatever pack you’ve got going on underneath that deep two. That is what’s called your trans versus muscle. And this is a girdling muscle, so to speak. Think of it as like sticking your hands on your waist right now where your thumbs are towards the back of your spine and your fingers are pointing around the front to the front of your body. You have your hands on your trans versus abdominis. It is a girdling muscle that cinches inwards and provides you that waist that you have.

OK, where are those fingers coming in together and pinching along the front of your abdomen? If you’re doing what I’ve just suggested you do where they’re pinching. And if you were underneath those salmon fillet mussels, they come into the fascia on the back side of those salmon fillets. When you’re pregnant, it stretches all of that out that trans versus the fatter the rectus abdominis after birthing.

If that doesn’t realign properly, that trans versus muscle may not be engaging properly underneath the salmon fillets. Why this matters is the trans versus muscle has a huge connection to your pelvic floor. If you happen to listen to a previous episode on “why is my bladder so small”, the pelvic floor is this bowl so to speak, at the bottom of a body and in this case a human body where there is a urethra, a vagina and an anus so however it is that you identify yourself, if you have those structures, you have a pelvic floor.

That pelvic floor is muscular in nature and it is like a sling, a hammock, so to speak, that holds that bottom bowl of your body up. And it is literally I mean, if you didn’t have a pelvic floor, what would happen to all of your abdominal organs? There would be like no bottom layer to keep them in place. So, that pelvic floor is a really important structure. It controls how comfortably we can release our bladders. It controls how comfortably and easily we can release our bowels. It controls the comfort we may experience with vaginal intercourse. It has an impact on whether the vaginal tissues are what we would call hypertonic, which can impact comfort with intercourse.

So the pelvic floor is a really, really critical area of health for people. And the trans versus muscle that girdling muscle, again, that’s coming in and clamps underneath into the fascia behind your rectus abdominal muscles if it is stretched out and can’t clamp shut because the fascia has been stretched due to, for example, a pregnancy and it’s damaged and it won’t come back together when that trans versus doesn’t close properly, the pelvic floor flops down. So, then that can have big impacts in terms of vaginal health, bladder health and rectal health. So when women, postpartum, (or people who identify as women or people who have simply had a baby and have a pelvic floor postpartum), if you are experiencing collapsing through the vaginal tissues, you may have a rectal prolapse. And that’s where, literally coming out the vaginal entrance, is tissue and you can feel it and you can see it and there’s this weight in the body. There’s the sensation that your body is falling out and how do you hold the organs in? It can be a really unsettling feeling. And so what’s happening there when things are prolapsed, it may be a bladder prolapse, things coming through the anterior wall of the vagina or a rectal prolapse where it’s bowel tissue that’s pushing in onto the vaginal tissue from behind and then pushing down and coming out the vaginal entrance… that prolapse can create a lot of discomfort for somebody and it has impacts healthwise for people.

So, how we can help to prevent this occurring is addressing the health of the pelvic floor before we ever get pregnant. So bringing it back full circle to the start of the conversation. If you are a human that is wanting to have children at some point and go through a pregnancy and if you have an intention to birth vaginally, it might be a good idea to get the health of your pelvic floor assessed before you embark on that journey. Because if you happen to be a human being who has, for example, experienced either sexual trauma in your life or mental emotional trauma in your life, and you hold a lot of those experiences in your lower abdomen that can create stress on the pelvic floor, and then that can create more difficulty postpartum for that pelvic floor to function.

If you are somebody who has had low grade chronic inflammation in the body, which may affect the connective tissue, i.e. that fascia, that will control how well the trans versus muscle closes that inflammation damaging that fascia can make it harder postpartum to have a properly functioning trans versus abdominis and pelvic floor. So it would be wise to consider looking at sources of inflammation ahead of embarking on a pregnancy if you have that opportunity. So where might there be food sensitivities? Where might there be, you know, an inability to detoxify effectively through either the liver or the bowels so that toxins are inflammatory mediators?

If you happen to be someone who is struggling with either your pelvic floor or you’ve got this a diastasis rectus abdominis, and how you’ll see that, by the way, is after you birth it will look like a gapping on your tummy or it will look like a pool of loose tissue that never seems to go away. Or you might have this sort of this little pot, so to speak, underneath your umbilicus, your belly button that just sort of sits there and never seems to go away. It looks like you’re always pregnant when you’re not when you are lying on your back and you go to set up and you notice that there’s almost this ridge that forms like a ditch straight down the front of your belly. That could be an indication of a diastasis rectus abdominis. So if you see any of that on your body and you’re not sure, please, by all means, come and see myself or see another health care provider who has experience in diseases, rectus, abdominals, pelvic floor. Physiotherapists are amazing in this arena, by the way, but get that checked out for yourself.

If you’re someone who has postpartum, if you are struggling with back pain, bladder concerns, prolapse, seeing any of these things that can indicate that you have a diastasis rectus abdominis and potentially a dysfunctional pelvic floor, all of these things are signs that your body needs some support. Please, please don’t put them in the camp of “this is just my new normal” because it may not be and it may be something that you can correct and then really improve the quality of life that you’re experiencing if you’re having a rough go with it at the moment.

So, diastasis rectus abdominis is a thing and we don’t actually know to what degree of pregnancies result in it. Some research indicates that upwards of 75% of pregnancies will have some level of diastasis rectus abdominis, whether it is a functional diastasis, is what we need to really evaluate. So whether or not functional meaning whether or not you’re actively contracting that trans versus abdominis muscle to properly lift and offload the pelvic floor or whether the fascia has become damage to the point that it can’t close that trans versus abdominis muscle, that girdling muscle to clamp shut it at the front to then lift the pelvic floor when the trans versus closes the pelvic floor lifts. If the trans versus doesn’t close because the fascia is damaged, the pelvic floor flops down. Hope that helps.

So if you have any questions or concerns at all about whether you are currently experiencing this, have experienced this, you would like to know how to potentially prevent this. Please give me a call. I would love to talk to you about what I know in this arena because I think, had I known before embarking on the journey to have babies, I think I could have prevented a lot in my own health journey and I would love to be able to share the tips I have so that you can prevent certain things too. Take care.

Thank you so much for spending this time with me and joining this conversation. If any of the things that you’ve heard today have landed with you, moved you, resonated with you, and you’d like to pipe in, I would sure love to hear from you. Some of the best conversations happen right in the medicine house with me and the easiest way to do that.

Pop over to the website www.doctorschoiceintegrative.com. Book a discovery conversation with me. It’s called a discovery call, and it’s a complimentary 15 minute slot where we can explore health together. I’d love to do that with you. Hope to see you there.