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DRAM - weakness in tummy muscles after birth

Your tummy muscles come under a lot of strain in pregnancy.

After you give birth, your hormones rebalance. But this can take months, especially when you are breastfeeding. 

Your uterus (womb) can take up to 6 weeks to go back to its regular size after you have a baby. You might have extra fat around your tummy, back and thighs.

Breast feeding helps to reduce this extra body fat. But it can take time to strengthen your tummy muscles. Be patient with your body.

Avoid crunches and sit-ups early on

Crunches, sit ups and similar exercises are not helpful too early after having a baby. You could do lasting damage to your body. Work on your posture first.

Read more about exercise and your posture.

Try not to hold your breath when bending, lifting and exercising. This is a bad habit some people get when their tummy muscles are weak.

Breath holding is a way of supporting your tummy to make up for your muscles being weak. But it puts a lot of downward pressure on your bladder, uterus and bum.

DRAM - weakness in tummy muscles

Pregnancy causes a weakness in the midline of your tummy muscles. This is because they stretch to let your baby grow.

This stretched area is called a diastasis rectus abdomius, or DRAM.

Watch a video explaining DRAM

DRAM happens in this rectus abdominus muscle. This muscle has 2 halves that are connected by a piece of connective tissue. This tissue stretches as your baby grows. This can cause a very weak area down the middle of your tummy. 

Check your tummy muscles for DRAM before doing any:

  • tummy exercise like crunches, sit ups, planks
  • twisting your trunk, for example, lifting older children in and out of the car

You'll find it harder to do these if there is no resistance between each side of your 6 pack muscle.

DRAM
During pregnancy your muscles can stretch causing DRAM (right) through the middle of your tummy

How to check for a weakness in your tummy muscles (DRAM)

The best time to check for a DRAM is from the week after giving birth. But if you have had a caesarean wait until 5 weeks after giving birth. This is because your scar needs time to heal.

  1. Lie on a towel or mat.
  2. Place your fingers, widthways, above your belly button.
  3. Perform a sit up - put one hand behind your head for support. Lift your head and shoulders off the floor into a crunch position. As you do this, feel for any gap in the mid line of your tummy. Now check the gap just below the belly button.

If you can feel a hollow space big enough for 2 or more fingers, then the gap is too big. This means that you have less support around your tummy.

Check weekly and track the progress you are having if you also do:

  • postnatal floor exercises
  • pelvic floor exercises
  • avoid pulling into a sit up to get out of bed

At 6 to 8 weeks your abdominal muscles will naturally tighten. You will need to hold a good posture for this to happen. A poor posture makes it difficult for the DRAM to close.

Watch a video on how to check for DRAM

What you can do to close the DRAM

To help close the gap:

  • squeeze gently on your tummy muscle - this feels like sucking your lower tummy (below the belly button) in or pulling up a zip on jeans that are too tight
  • perform a repeat sit up  - you’ll often find that the gap has narrowed a bit.

Holding a good posture helps. It helps your deep tummy muscles to support your body better. This can help reduce DRAM.

Watch a video on what you can do to close the DRAM

Abdominal exercises

Abdominal (tummy) exercises like sit ups and planks can make a DRAM worse. They can sometimes cause a hernia.

If you are doing these exercises, check for a DRAM before and afterwards. If it gets bigger, you need to choose an easier exercise to:

  • build up strength
  • feel more resistance in the space along the middle of your tummy

After 8 weeks if you feel a DRAM greater than 2 fingers, ask your GP for a physiotherapy referral.

page last reviewed: 04/06/2020
next review due: 04/06/2023