Almost every pregnancy separates the abdominal muscles to some degree. The tissue between the two halves of the rectus abdominis stretches to accommodate the growing uterus. For most people it narrows on its own over the months after birth. For some it does not, and that is where rehabilitation helps.

Medically reviewed by Dr Afiya Sadiq, MPT
Last reviewed: 2 August 2026 · Our clinical team

What diastasis recti actually is

It is a widening of the linea alba — the connective tissue running down the midline of the abdomen — not a tear and not a hernia. The two halves of the muscle separate; they are not damaged.

This distinction matters, because the popular framing of “a hole in the stomach that must be closed” produces anxiety and a focus on the wrong outcome.

How to check

Lie on your back with knees bent and feet flat. Place your fingers across the midline just above the navel. Lift your head and shoulders slightly, as if starting a curl-up, and feel for a gap between the muscle edges. Repeat above and below the navel.

Note two things — not one:

Width — how many fingers fit across the gap
Tension — whether the tissue between the edges feels springy or whether your fingers sink easily

Tension matters more than width. A wider gap with good tension usually functions better than a narrow gap with none, which is why chasing a smaller number is the wrong goal.

What rehabilitation actually involves

The aim is a trunk that manages pressure and load well, not a closed gap. That generally means:

Breathing and pressure management — learning not to hold the breath and brace during effort
Deep abdominal and pelvic floor coordination — the pelvic floor and the deep abdominal muscles work together, and abdominal rehabilitation that ignores the pelvic floor is incomplete
Graded loading — progressing through positions and loads that the midline can control
Everyday technique — rolling to the side to get out of bed, and how to lift a growing child

What to be careful with early on

Movements that make the midline dome or cone outward are usually a sign the load is currently too high — full sit-ups, crunches and front planks are the common examples. This is about timing rather than permanent prohibition; most people return to them progressively.

The pelvic floor connection

Abdominal separation frequently coexists with pelvic floor symptoms — leaking, heaviness, or pain. NICE guidance supports supervised pelvic floor muscle training for postnatal pelvic floor dysfunction. If you have both, treating only the abdomen tends to disappoint.

See a clinician rather than self-managing if you have

A visible bulge that is painful, tender, or does not reduce when you lie down
Leaking urine or stool, or a feeling of heaviness or bulging in the vagina
Persistent back or pelvic pain
Any new lump, particularly around the navel — this needs examination to exclude a hernia

What we do not claim

Rehabilitation does not guarantee the gap will close to any particular width, and no exercise programme reliably restores a pre-pregnancy abdominal appearance. What it reliably improves is function — how the trunk handles load, and the symptoms that come with poor pressure management. Where separation remains large and symptomatic despite rehabilitation, surgical opinion is a reasonable next step.

Postnatal rehabilitation at APARC

This sits within our women’s health physiotherapy service. Assessment covers the separation itself, pelvic floor function, breathing pattern and the activities you want to return to. See also our guidance on physiotherapy during pregnancy and on recovery for new mothers.

Why “close the gap” is the wrong goal

Most self-directed programmes are built around narrowing the separation, and progress is judged by counting fingers. That measure is unreliable and it rewards the wrong things.

A useful test is not how wide the gap is at rest, but what happens under load. Does the midline stay flat and controlled when you lift a child, get off the floor, or cough? Or does it dome, or does the belly push outward? Control under load is what determines symptoms and what rehabilitation can actually change.

Breathing is the part most programmes skip

The abdominal wall, diaphragm and pelvic floor together manage pressure inside the abdomen. Holding the breath and bracing hard during effort drives pressure downward and forward — into the pelvic floor and out through the midline.

Retraining this is unglamorous and makes more difference than any specific abdominal exercise:

Breathe out during the effort — as you lift, stand, or push
Avoid gripping the abdomen tightly and holding it in throughout the day
Notice and correct breath-holding during ordinary tasks, not only during exercise

A sensible progression

First — breathing coordination, gentle deep abdominal activation, pelvic floor connection, and getting up from lying by rolling to the side
Then — controlled load in supported positions: bridges, heel slides, four-point positions, side-lying work
Then — upright loading: squats, split stance, carrying, pushing and pulling
Later — impact and full abdominal loading, if that is your goal, once the midline controls the earlier stages without doming

Each stage is judged by control, not by time elapsed. Someone at six weeks who has good control may progress faster than someone at six months who does not.

Constipation and straining

Regular straining raises abdominal pressure repeatedly and works directly against what rehabilitation is trying to achieve. Managing constipation — fluid, fibre, and toilet position with the knees higher than the hips — is a genuine part of postnatal abdominal and pelvic floor rehabilitation, not an unrelated matter.

Lifting a growing child

The load that matters most postnatally is not in a gym. A child gets heavier every month, is lifted many times a day, and is frequently lifted from awkward positions — a cot, a car seat, the floor while carrying something else.

Practical points: get close before lifting, use the legs, breathe out as you lift, and avoid lifting while twisting. Where possible, lower the cot side or bring the child toward you rather than reaching across.

How long it takes

Meaningful change in control usually takes weeks to months of consistent practice, and the connective tissue continues to remodel for a long time after birth. Programmes promising resolution in a fixed short period are describing something other than tissue biology.

References

NICE NG210 — Pelvic floor dysfunction: prevention and non-surgical management. www.nice.org.uk/guidance/ng210
NICE NG194 — Postnatal care. www.nice.org.uk/guidance/ng194
NICE NG201 — Antenatal care. www.nice.org.uk/guidance/ng201

Medical disclaimer

This article is for general information and education only. It is not medical advice, diagnosis or treatment, and it is not a substitute for consultation with a qualified healthcare professional. Every person’s condition is different — any rehabilitation programme should be personalised following a proper assessment. Never disregard or delay professional medical advice because of something you have read here.

In an emergency, contact your local emergency services or go to the nearest hospital immediately.

To speak with an APARC physiotherapist, contact us or book an appointment.

Diastasis Recti: Abdominal Separation After Pregnancy and What Actually Helps