Diastasis recti
Short answer
Diastasis recti is a widening of the gap between the two vertical stomach muscles, stretched by pregnancy. It is very common and often closes by itself in the first two months after birth. If it does not, targeted exercise with a physical therapist is the first treatment; surgery is reserved for large gaps that still cause problems.
- Most people have some separation by the end of pregnancy.
- The gap often narrows by itself by about 8 weeks postpartum.
- Tension across the gap matters more than its exact width.
- Exercise is first-line; surgery is for persistent, symptomatic cases.
What is diastasis recti?
The rectus abdominis, the "six-pack" muscle, has two halves that run down the front of the belly. They are joined in the middle by a band of connective tissue called the linea alba. During pregnancy the growing uterus stretches this band, and the two halves move apart.
By the third trimester, most pregnant people have some separation. That is a normal adaptation, not damage. The question after birth is whether the gap narrows and whether the tissue in between regains tension.
How do you check for a gap at home?
- Lie on your back with knees bent and feet flat.
- Place your fingertips across your midline, just above the belly button, palm facing you.
- Lift your head and shoulders slightly off the floor, as for a small crunch.
- Feel how many fingers fit into the gap between the muscle edges. Repeat below the belly button.
- Notice how firm or soft the tissue in the gap feels.
A gap of about two finger widths or less is generally considered normal. A gap that is wider, or where your fingers sink in deeply with no tension, is worth having checked by a physical therapist. Also note any doming or coning along the midline when you sit up.
What symptoms can it cause?
- A bulge or "pooch" in the middle of the belly, especially when straining.
- A feeling that the core is weak or disconnected.
- Lower back or pelvic pain.
- Difficulty lifting or carrying.
- Sometimes, pelvic floor symptoms such as stress incontinence, because the core and pelvic floor work as one system.
What helps it heal?
| Approach | What it does | Notes |
|---|---|---|
| Deep abdominal (transversus) activation | Builds tension across the linea alba | Gently draw the lower belly toward the spine on an out-breath |
| Pelvic floor exercises | Supports the whole core system | Combine with the deep abdominal squeeze |
| Progressive strength training | Rebuilds load tolerance | Increase difficulty as long as there is no doming |
| Better daily movement | Reduces strain on the midline | Roll onto your side to get out of bed, exhale when lifting |
| Support garment | Comfort in the early weeks | Does not replace exercise |
Start with breathing and deep core work in the first weeks, then progress. The pelvic floor timer can be used to pace combined pelvic floor and core holds. A pelvic health physical therapist can watch how your midline behaves under load and tell you what to add next. See finding a pelvic floor therapist if you are not sure where to go.
What does a simple starting routine look like?
A physical therapist will tailor this to you, but many early programs start with:
- Breathing. Lying on your back with knees bent, breathe into your lower ribs. On the out-breath, gently draw the lower belly in and lift the pelvic floor.
- Heel slides. Holding that gentle tension, slide one heel away along the floor and back, keeping the midline flat. Alternate legs.
- Bent knee fall-outs. Let one knee drop slowly out to the side and bring it back without the pelvis rocking.
- Side-lying or kneeling work. Progress to positions where you support your own body weight.
Five to ten slow repetitions, once or twice a day, is plenty to start. Check your midline with your fingers during the movement: it should stay flat or firm, not bulge.
Which exercises should you avoid at first?
Avoid anything that makes the midline dome or bulge, and anything you can only do by holding your breath. That often means pausing full sit-ups, crunches, heavy front planks and heavy lifting at first. These are not banned forever. Once you can control the midline, they can usually be reintroduced step by step. The broader plan for returning to exercise is in postpartum recovery.
When is surgery considered?
Surgery (abdominoplasty with muscle repair, or a hernia repair if there is a hernia too) is considered when:
- the gap is large and has not improved after at least six months to a year of exercise,
- it causes ongoing pain or functional problems,
- there is an umbilical or other hernia.
It is usually advised to wait until you are finished having children, because another pregnancy can stretch the repair. Surgery is a decision to make with a surgeon after trying exercise.
How is it linked to the pelvic floor?
The deep abdominal muscles, diaphragm, back muscles and pelvic floor form a pressure system. If one part is weak, the others take more load. That is why people with diastasis recti often benefit from pelvic floor work during pregnancy and after birth, and why a vaginal bulge or heaviness should be assessed alongside the abdominal gap.
Quick questions
Are crunches and sit-ups off limits forever?
Not forever. Early on they can make the midline bulge or dome, so most physical therapists start with deeper core work first. Once you can control the midline without doming, curl-ups are often added back gradually.
Can diastasis recti happen without pregnancy?
Yes. It is also seen in newborns, in people with significant weight gain around the belly, and in some men who lift heavy weights with poor technique. Pregnancy is by far the most common cause in women.
Will a belly binder or support garment fix it?
A support garment can make the early weeks feel more comfortable and may help some people move more easily, but it does not train the muscles. Exercise remains the main treatment.