There is a huge lack of awareness–as well as high volumes of misinformation–around these important issues, which is unfortunate since they affect every birthing body! We obviously can’t avoid having our cores affected by pregnancy and birth, so having access to understandable, helpful information can truly make a difference in our quality of life as pregnant and postpartum people. We want to do our part to share valuable, empowering information so you can feel confident about your core health during pregnancy and beyond.
What is Intra-abdominal Pressure?
Let’s start by shedding some light on intra-abdominal pressure (IAP), as it is the key to understanding everything core-health related. There is pressure in our abdomen all the time, and certain movements and activities can increase that pressure. We can think of our abdomen as a canister in a hydraulic system whose job is to move pressure from one place to another.
Our diaphragm sits at the top of our core canister. At the bottom is our pelvic floor. The sides of the canister are our obliques. The front is our abdominal muscles, and the back is, well, our back muscles. One of the most important functions of this core canister is to properly manage IAP.
IAP management usually happens like a well-oiled machine. As kids, we could jump on trampolines with wild abandon, never stopping to consider whether our abdominal walls will hold our intestines in place. As pre-pregnancy adults, sneezes didn’t mean changing underwear!
But, when the core isn’t working optimally, perhaps due to weakening from pregnancy, the pressure isn’t sufficiently distributed and can result in undue stress on part of the canister. This can lead to issues such as incontinence, prolapse, hernias, and pelvic pain.
For instance, an umbilical hernia (when the intestines protrude through the belly button) can occur if unmanaged pressure stresses the abdominal wall to the point that the connective tissue there can no longer hold the contents of the abdomen. The organs that are supposed to stay inside then bulge out.
Similarly, when the pelvic floor isn’t functioning well, it can’t hold up when pressure is transferred there, nor can it easily transfer that pressure elsewhere. We can leak pee or poop (incontinence) and are at risk of pelvic organs falling down into our vagina or rectum (prolapse).
All of that from poorly managed intra-abdominal pressure! Helping our core function properly and control pressure really matters. This is serious quality of life stuff. And as you may have experienced, pregnancy puts A LOT of stress on our core, and those of us who are currently pregnant or who have had children can greatly benefit from learning about and focusing on proper core function–how to keep the muscles strong so they can adequately manage IAP.
What is Belly Coning?
Coning is when the belly makes a tent or dome shape through the middle. It happens when—you guessed it—your IAP isn’t well managed and the pressure bulges through the connective tissue that runs down the center of the belly from the sternum to the pubic bone.
You might notice coning starting in mid-late pregnancy when you sit up in bed, perform core work, or even when you lean back or take your arms above your head. It can happen at other times, too. You’ll likely notice coning in these same positions and movements in early postpartum, or until your core heals and full function returns. It may need help to do so.
It’s worth noting that most people cannot feel coning happening. It doesn’t hurt or produce a sensation. Those well trained in managing their IAP can often detect when the core isn’t firing as it should. They might feel vulnerable or disconnected through their abdomen, but it’s not the coning per se that produces the feeling.
The best way to identify coning is by looking at your belly if your movement/posture allows for that, or by moving in front of a mirror, recording yourself, or asking a partner to check while you’re performing the movement in question. You may also be able to detect it with your hand by gliding your fingers horizontally across your belly to feel for a ridge on your midline.
Even though we encourage you to avoid it when you can, please don’t fear that coning is dangerous. If you notice it happening, there’s no need to panic. Frequent coning may make it harder for your connective tissue to repair itself postpartum, but you’re at little to no risk for injury.
Recognizing when coning is happening is important because it tells us that your core canister isn’t working as efficiently or productively as it could be. If you can successfully manage coning, you are one step closer to successfully managing pressure throughout your core.
As noted above, optimal pressure management reduces the likelihood of pelvic pain, prolapse, hernia, incontinence, and more. So it’s not the coning, but rather the *cause* of coning (unmanaged IAP) that we really want to address. Coning is just one obvious, common signal we can watch for.
How Does Diastasis Recti Relate To All This?
Out of all three of the topics mentioned here, you’ve probably heard the most about Diastasis Recti (DR). Unfortunately, much of what you’ve heard is likely exaggerated or untrue.
You may know that DR is a thinned or weakened linea alba (band of connective tissue that runs down the midline of your belly), but you might not know that it is a healthy, physiological adaptation to pregnancy that allows your belly to expand as baby grows. It is not a death sentence for your core. It does not mean you can’t exercise. It is not abnormal. Virtually all pregnant bellies will have a diastasis by the ninth month.
DR is caused by the stretching of your abdominal connective tissue to make space for baby. Just as a balloon grows thinner as you blow more air/increase pressure inside the balloon, your abdominal connective tissue stretches and thins as the pressure in your belly increases. The connective tissue usually grows thinnest around the naval, which makes sense as that’s typically where our bellies measure the largest around.
Again, this happens in all bodies and is normal and necessary to accommodate baby’s growth. DR only becomes a concern when it doesn’t heal after baby is born. It will not heal immediately, but we want to see progress within a few months.
The status of your DR is not measured by how wide the gap is between your abdominals, as is commonly believed. The more accurate way to measure how well your DR is healing is to test the strength of the tissue in the gap. It can be wide yet strong or narrow yet weak. A healthy and healed linea alba should hold tension and not feel squishy.
A diastasis that isn’t healing after a few months, like coning, is a symptom of a larger IAP management problem. Those with DR will experience coning frequently, as IAP puts too much stress on a linea alba too weakened to hold it back. If you cone, it does not necessarily mean that you have DR, but having DR does mean that you are more likely to cone unless you strategize for it.
Similar to coning, DR isn’t the problem in and of itself. While having DR can increase your chances of developing an abdominal hernia and might make it harder for the abdominals to do their prescribed job within the canister, the critical reason we seek to heal a diastasis is because we want the core managing its IAP properly for optimal health and wellbeing. If a DR isn’t healing, we know we still aren’t managing our IAP optimally.
So, How Do We Eliminate Coning Or Heal a Stubborn Diastasis?
The treatment for diastasis recti varies widely depending on your body and needs, and we always suggest working with a physical therapist who specializes in DR—typically a Pelvic Health PT. Remember, our pelvic floor is at the bottom of our canister and plays a huge role in managing IAP.
A pelvic health physical therapist can give you an individualized treatment plan if you’re concerned about your DR, unable to manage coning, or experiencing pelvic pain, which, again, is likely a sign that the core isn’t functioning properly. There are, however, some general recommendations for the treatment of DR and coning (read: managing IAP) that are worth considering for all pregnant and postpartum people.
Coordinating exertions with exhale breaths is a good way to lessen the load on the weakened linea alba. As we described above, the top of our core canister is our diaphragm, which is a muscle used for breathing.
As we exhale, the diaphragm draws up and moves out of the abdominal cavity, reducing pressure within the canister. The other muscles that make up the canister, such as the pelvic floor and abdominal wall, also coordinate with our breath, contracting and drawing in as the air moves out.
As we inhale, the opposite happens. The diaphragm moves downward into the abdominal cavity, and the other muscles in the canister release and expand to make way for the incoming breath.
If we’re going to do an activity which we know will increase our IAP, it makes sense to coordinate that movement to an exhale when the pressure is already lower and other core muscles are predisposed to contraction/stabilization. The core naturally better manages our IAP during exhales.
Another strategy for managing IAP is posture. Our muscles naturally work better in a neutral range. For our core, that means stacking our ribs over our pelvis and keeping our pelvis from tipping forward or backward.
This does not mean you ought to stand like a robot 24/7. You can and should move through a large range of motion throughout your day! This just means that for activities that are likely to cause coning, you might consider moving to a more neutral position during that activity to help manage the pressure.
Going to lift the car seat? Move to neutral and do it on an exhale. Wanting to work planks back into your fitness routine? Keep your core neutral and, instead of trying to hold your plank for ten seconds, try flowing from down dog on your inhale and into plank on your exhale.
Another option to consider is load and repetitions. If weight lifting is part of your wellness routine, we encourage you to keep doing it! Consider, though, that using less weight or fewer reps might help your core better manage the pressure while it’s healing. We might be able to handle 20 lbs for the first few reps, but then our core muscles grow tired and find it harder to manage the pressure.
If you’re into power yoga, you could lessen the load by using your knees in chaturanga and sitting out from vinyasas as you grow tired. You might consider using props you don’t normally reach for, such as blocks or bolsters that help support your body weight and lighten the load on the core.
This is important to consider for daily life, as well. If you, like every parent, are picking up and carrying your baby throughout the day, then you are doing loaded, repetitive exercise whether or not you think of it that way. We can’t NOT pick up our babies, but we can brainstorm ways to lessen the load on our core. For instance, a properly fitted baby carrier can help distribute the load of baby’s weight and make it less taxing.
Remember, this isn’t forever. Eventually your core will be strong and functional enough to perform demanding activities without neutral posture or strict breath coordination. We want to help you get there!
These strategies are for those who might be experiencing coning during movement, whose DR isn’t healing, or whose pelvic symptoms flare during certain activities (also likely due to mismanagement of IAP). Once your core is functioning better, you can and should slowly increase load, reps, and generally move with less nitpicking. But while your DR is healing, these are strategies worth considering.
As you work on these strategies, notice how your core muscles are working throughout the day. Are you someone who tends to hold the belly in? So many of us do this! While we might want our bellies to look smaller, this has the unfortunate consequence of keeping our muscles from experiencing the range of motion they need for full health. Allow your belly in all it’s glory to be soft and round!
Are you a butt-clencher? A jaw clencher? Are you someone who tends to breathe into their chest? This is all incredibly common, and again restricts the healthy movement our core needs to function at its highest capacity.
Imagine if you kept your arms in a bicep curl most of your day. Do you think your arms would function well? Of course not. The biceps would stay clenched and become unable to stretch as needed for the elbow to unbend. The triceps on the back of the arms would grow too weak to load.
The same thing happens to our core muscles when we don’t allow them to move through their full range. They become restricted, weak, and less functional. Release unnecessary tension through the belly and bottom as you move through your day. Practice breathing downward into the belly. Not with force, but with ease.
We also strongly encourage you to do core exercises designed for the needs of pregnant and postpartum people to support and enhance your healing. While managing pressure is one (important!) element, it’s also critical to build strength and stamina back into our core musculature. Healthy core muscles help us properly manage and withstand pressure.
On our instagram page, you can find a whole series of simple, at-home postpartum core exercises that can nurture your body’s natural healing process. In our prenatal and postnatal yoga classes, you can benefit from the curriculum we designed around the needs of your core health. Core-care exercises, along with changes to your day to day movement and breathing patterns, can go a long way in helping your core grow stronger and function properly.
We hope we’ve shed light on these common yet not well understood core health concepts. It’s important to us that you feel more educated and confident about your prenatal and postnatal core health.You CAN feel strong again and live with less pain. It’s not hopeless! Please let us know if you have any questions — we’re here to help! And if we’re not sure, we can recommend the proper professional who can.